The Longevity Plan: Seven Life-Transforming Lessons from Ancient China

DEDICATION

TO OUR

FAMILIES

———

CONTENTS

COVER

TITLE PAGE

DEDICATION

PROLOGUE: LONGEVITY SOUP

INTRODUCTION

1.  EAT GOOD FOOD

2.  MASTER YOUR MIND-SET

3.  BUILD YOUR PLACE IN A POSITIVE COMMUNITY

4.  BE IN MOTION

5.  FIND YOUR RHYTHM

6.  MAKE THE MOST OF YOUR ENVIRONMENT

7.  PROCEED WITH PURPOSE

8.  LONG LIVE THE VILLAGE

EPILOGUE: THE RULE OF SIMPLICITY

ACKNOWLEDGMENTS

BIBLIOGRAPHY

NOTES

INDEX

PHOTOS SECTION

ABOUT THE AUTHOR

COPYRIGHT

ABOUT THE PUBLISHER

Prologue

LONGEVITY

SOUP

COME NOW, SHE SAID. I WILL TEACH YOU TO MAKE LONGEVITY soup.

I’d been waiting for this moment for a very long time; finally I would learn the secret. Finally I’d know.

Feng Chun crushed a handful of hemp seeds, and then another. She strained them with hot water. She boiled the mixture in a wok, added some pumpkin greens, and stirred.

There you are, she said, pouring the gray liquid into a bowl.

Wait, I said. That’s it?

That’s it.

But . . . but that’s so simple!

Of course it is, she said. What did you expect?

Introduction

BY MID-MORNING THE DOUGHNUTS WOULD BE GONE.

That fact was an essential part of my planning each day as I prepared my breakfast in the doctor’s lounge at the hospital where I work. I’d always grab a doughnut, a bagel, and a Diet Coke. Then I’d grab a second doughnut, wrap it in a napkin, and stash it in a cabinet just outside of the operating room.

My colleagues laughed and rolled their eyes. I just shrugged. It all seemed perfectly rational to me.

My days as a cardiologist were filled with pacemaker implantations, procedures to three-dimensionally map and zap potentially fatal heart arrhythmias, and defibrillator surgeries. In between I’d snack.

Lunch on most days was a slice of pizza, or two, and another Diet Coke. On long days, I dined in the hospital cafeteria on a cheeseburger, fries, and a chocolate chip cookie.

I knew these weren’t good food choices. But I told myself, given my hectic schedule, I didn’t have time for anything else. Besides, I justified, many other doctors also partook of the free junk food at the hospital, and all of them seemed reasonably healthy. And my hospital was just like all the others I’d ever worked in or visited. At Johns Hopkins University where I graduated from medical school. At Stanford University where I did my residency in internal medicine and fellowships in cardiology and cardiac electrophysiology. As an assistant professor of medicine at the University of Utah. At nearly every hospital I’d visited as a guest lecturer. If this is the kind of food offered to doctors all over the country, I reasoned, it couldn’t be that bad.

I always figured I was making up for it with exercise. I was a religious runner—a marathoner, no less—and had been for twenty years. It’s one thing to eat healthy and be able to run 26.2 miles. I was eating trash and was still able to do it. Surely, I told myself, that wasn’t just an indication I was healthy, it was an indication I was more than healthy.

Except I wasn’t. Not even close.

It wasn’t just what I ate; it was how I lived. I worked too many hours. I took too few vacation days. I didn’t spend nearly enough time with my family. I spent a lot of time considering my productivity, and not much time contemplating my purpose. Life was a bit of a blur.

I was overweight, overworked, hypertensive, and had a cholesterol level much higher than it should have been. I was tired and stressed all the time.

I was also in constant pain. There was pain in my chest from acid reflux. There was pain in my back and neck from an autoimmune disease called ankylosing spondylitis. Food often became lodged in my esophagus from a condition called eosinophilic esophagitis, which made it difficult for me to swallow.

Many of these conditions ran in my family. And so I blamed my genes. I figured there wasn’t much sense in trying to fight it. This was just part of getting old. This was my lot in life.

I took five medications daily. And that helped . . . a bit . . . for a while.

At forty-four years old, I found myself daydreaming about retirement. Someday I’d settle down and life would be good again. Or maybe it would just be less bad. That was the same thing, wasn’t it?

In the meantime: One more busy week. One more missed vacation. One more doughnut.

I DON’T PARTICULARLY enjoy talking about the way I was back then, but my hope is that, in coming clean about my challenges, you’ll come to see that the health struggles you’ve faced in your life can be resolved with a few minor course corrections. Forgive me if I shed a bit of modesty here to drive this point home, but I’m a good doctor. I’ve recently completed my term as president of the Heart Rhythm Society, an international organization of thousands of cardiologists in more than seventy countries. Over my twenty-plus-year career I’ve performed more than 6,000 catheter ablations and more than 3,000 pacemaker or defibrillator implantations. I’ve treated tens of thousands of patients.

I had access to more information about healthy living than most people could ever dream of, and all the resources I needed to make changes. In spite of all of that, I was still confused about what I should be doing to get myself back on track to a happier and healthier life. So whether this is the first time you’ve ever considered making changes to your life to improve your health or you’ve been trying for years, you’re in good company.

And the truth is that even though I’ve turned my life around in a way that feels to me and my family like a miracle, I’m not here to peddle miracles, least of all by telling you that you should do everything I did, because it doesn’t work that way. Everyone’s a bit different, and some of us are a lot different. So what I’d like to do is help you figure out what works for you. Regardless of our individual circumstances, there do exist basic principles of well-being that can lead us all to a better life, but you get to choose how to adapt these principles in your own journey.

And on that journey, I’d be pleased to be your guide.

Not by myself, though. In these pages, I’m going to introduce you to some of the world’s most qualified people on the subject of living longer, healthier, and happier lives. Their names are Boxin, Magan, Maxue, Mawen, Masongmou, Makun, and Makang. In 2012, they were the seven centenarians of Bapan, a village in southwest China, not far from the Vietnamese border, that rests in the middle of a region with one of the highest known concentrations of people over the age of one hundred anywhere in the world. These six women and one man, along with countless others, have lived by these basic principles of well-being without ever thinking about it. It’s simply part of their lives.

I’m not only going to tell you how they live today, because no one wants to live like a centenarian, no matter how healthy they might be. I’m also going to tell you how they lived throughout their lives. I’ll also introduce you to some of the other people, from every generation, who live, laugh, love, and work in this remarkable place. Together, these people have helped me shape my ideas on well-being, and those ideas, in turn, have helped me help lots of my patients be well.

In 2014, I began a series of four-month support groups comprising patients who worked together to apply the lessons of Longevity Village to their lives. Even having come to believe strongly in the power of the Longevity Village lifestyle, I was astonished by the results; 92 percent of the participants were able to adhere to their plans and stay on pace to reach their health goals. These are people who had abused their bodies for years, had decades upon decades of bad health habits, and often had no real support at home. Despite these challenges, most have been able to reverse at least some of their chronic medical conditions, including diabetes, hypertension, obesity, atrial fibrillation, insomnia, fatigue, acid reflux, heart failure, and high cholesterol.

I’ve seen similar outcomes among hundreds of other individual patients who have embraced these lessons. After launching a website dedicated to helping people live happier and healthier lives, people from around the world have shared with me their stories of radical personal transformation. And, of course, my own life stands in testament to the effectiveness of this model; it has been completely transformed.

Why does it work? Janine, a forty-one-year-old programmer from San Francisco, was battling obesity and some associated heart irregularities when she first came to see me. In nine months, her weight was down more than 45 pounds and her heart troubles were sub-diagnostic, as though they’d never occurred at all. For me, she wrote six months into her Longevity Village journey, this way of living just feels right. It’s hard to explain, but it’s almost like this is the way we would all be living if our ancestors had just recognized that, as we modernized, we couldn’t simply leave everything that was good about the old ways behind.

With those words, Janine eloquently shared something I’d had a bit of trouble expressing when I was first explaining this health model to my patients. The Longevity Village lifestyle isn’t about living like people in a remote part of China did in the past; it’s about living in the modern world with a bit of ancient wisdom to guide our way toward happier, healthier futures.

I CAME TO learn about Bapan almost by accident. When I was nineteen years old, as part of my faith, I’d spent two years working with the Chinese immigrant population in New York City. Until that point, I didn’t know the first thing about China. I didn’t know anything about its rich history or cultural traditions. I didn’t know a word of Mandarin. I didn’t even like Chinese food.

But during that amazing time in my life, I came to adore the language, the culture, and the people I lived with and worked among. Long after I returned home to Utah from New York, I remained fascinated by China, and continued working to develop my language skills, such that today I am one of few Caucasian doctors who regularly gives medical lectures in Chinese. I’m told my accent isn’t half bad. "You’re like a proper B letter ij letter ng rén," a friend from China’s capital city told me recently, using the words that describe a resident of Beijing. I beamed with pride.

Mandarin isn’t an easy language to master, though, and thirty years after first learning how to say n letter h letter o with appropriate intonation, I’m still working on it. So each week, over a video conference call, I meet with my Mandarin language coach, Zheng Lv, who lives in Xi’an, the starting point of the northern route of the famed Silk Road and the home of Emperor Qin Shi Huang’s incredible Terracotta Army. As we chat, Zheng helps correct my tones and pronunciation, and sometimes introduces me to new words and Chinese concepts. Our sessions together are generally conversations, prompted by something we’ve heard about in the Chinese or American news media, and sometimes I tell her about an article of particular interest I’ve read in a Chinese or American medical journal.

That’s what happened in 2012, when I mentioned to Zheng an article I’d read about the Bama County Centenarian Study, which had been published in a Chinese medical journal. At the time I was exploring the literature on how certain groups of people, living in certain ways, seem to be defying the conventional laws of aging. When I mentioned the article, Zheng told me she’d just seen a TV program about this region of China, where people reportedly live remarkably long lives free of the conditions that typically come with aging. The village of Bapan, Zheng said, was getting quite a bit of attention in China. They say the land has magical properties, she told me. In China they now call this place Longevity Village.

Longevity Village, I learned, was a small, poor, and remote town of just a few hundred people in the Guangxi Zhuang Autonomous Region. I’d never been to that part of China before, but I knew that rural villages in China’s more remote areas often suffered from a lack of quality medical services. I also knew that, in general across the world, poor people don’t tend to live as long and often have poorer health than people who live in more developed areas. Yet if what I was learning was true, none of that seemed to matter. Through happiness and hardship, into their eighties, nineties, and one hundreds, with few modern conveniences and even less medical intervention, the people of Bapan survive and thrive.

Over time, Zheng and I would return to the subject of Bapan again and again. I’d tell her what I’d been learning in my studies of the medical literature, and she would tell me what she was hearing about this area in China’s popular media. I felt like I simply couldn’t get enough information.

"Q letter ng du letter gàosù w letter y letter di letter n, I’d say to her. Please, tell me more."

Zheng probably wondered why I was so obsessed. What she didn’t know was that I’d finally hit a health crisis and the solutions I’d tried simply weren’t working. My conditions had worsened. My pain had, too. I couldn’t run like I used to, so I was putting on even more weight. At the end of each day at the hospital I felt exhausted, but at night I was restless. I was tired all the time, so I was irritable.

I’d lost hope.

Bit by bit, though, I was finding glimpses of it in what I was learning about Longevity Village, and every time I’d find a new bit of research, or found another doctor who had done work in Bama County, I’d feel as though I was further unlocking some sort of magical treasure chest. For most of my life I’ve been an early-to-bed sort of guy, but I spent long hours, late into the night, hovered over my computer, poring over the Chinese medical literature in search of more information about Bapan.

It was my wife, who quickly came to share my excitement, who finally convinced me we needed to go.

So that’s what I did.

And it changed my life.

MY FIRST TRIP to Bapan came in the summer of 2012. With me, as she has been on all our excursions to Bama County, was my wife Jane. Joining us was our eldest son, Joshua, who was then nine years old.

We’d intended to arrive in the village the evening before, rest up, and head straight to the home of one of the village centenarians at first daylight. Getting to Longevity Village had proved to be a challenge, though. We’d faced torrential rains on narrow mountain roads as we moved deep into northwest Bama County only to find, as night fell and the thunder and lightning pounded the skies, that we’d been dropped off at the wrong village. We stayed in a guesthouse and, when we awoke the next morning, learned we were not far from Bapan. We made our way there in a rickety three-wheeled moto-taxi, which dropped us off on the main road.

I probably should have been tired after such a long trip. It had been a three-day journey from our home in the United States and, troubled by the notion that we’d already been steered off course, I hadn’t slept well the night before. But as we stepped into the village and saw a welcome sign festooned with the photos of the village’s seven centenarians, I felt a surge of energy and excitement unlike anything I’d ever experienced. And as I looked around at my traveling companions it was clear they felt the same.

Underneath each photograph was a brief biography of each of the elders in Chinese characters. I translated the words for my wife and son.

Some of these people were here a hundred years before I was even born! Joshua marveled.

Who should we meet first? I asked.

I’m dying to meet Boxin, Jane replied, pointing to the weather-faded photograph of the man at the center of the sign. Can we find him first?

Boxin, pronounced (bwo-sheen), was the oldest man in the village, purportedly having been born in 1898. He wasn’t hard to find. Everyone in the village knew who he was and where he lived, and they were anxious to take us to see him.

We were led first to a narrow set of concrete stairs leading from the village’s main road, along the riverfront, to a second flight of homes. A few of the houses seemed to be very old, little more than sticks and mud bricks. Many more, though, were newer. Albeit still quite simple, they were of wood, cement, and cinder block construction.

As we walked, a local villager told us Boxin had attained a kind of celebrity status in the region, and even throughout China. When we arrived at his modest home, though, it was clear that celebrity didn’t come with any Western-style monetary rewards.

We climbed a small set of stairs into the second story of the basic cement home. The front room was three-sided, sort of like a dollhouse in which parts of the interior are visible to anyone from the outside. We stepped through the open space and into a small entryway. No one appeared to be home, but I heard faint sounds coming from the interior. A moment later, one of Boxin’s relatives appeared outside.

The man’s face contorted into what I read to be a mixture of surprise and puzzlement. As had been the case throughout our journey to this place, I sensed that my family and I might have been some of the first Caucasians these rural Chinese had ever encountered.

Hello, I greeted him in Mandarin. We’ve come here all the way from America and we wanted to see Boxin. Is he home?

Upon hearing my Chinese, the man lit up.

Yes, yes of course. He will be so excited to see you, the man said.

The man, who introduced himself as Boxin’s grandson, told us that like most of the village elders Boxin didn’t speak Mandarin, but offered to translate between my Mandarin and his grandfather’s village dialect, called Zhuàng huà.

We were ushered deeper inside the house, past a small partition into a kind of waiting room. The sounds from inside grew more distinct. We made our introductions to more of Boxin’s family members. His great-grandchildren crowded around us, as eager to see and speak with us as I was to meet their patriarch. We were then led into a larger living room area. In a corner, to my surprise, were a few youngsters watching television; my preconception of a village where everyone is so incredibly healthy was that it would be a place where no one sat around watching TV.

One of the great-grandchildren explained that because of the number of Chinese people who wanted to meet Boxin, they’d turned this space into a kind of reception area. Along one wall sat an ornate cushioned settee, what Joshua later described as a throne. A colorful ceramic relief with mountains, trees, flying geese, and a tremendously large red Chinese hieroglyph, which I recognized as the symbol for longevity, served as a backdrop. No one occupied the central seat, but it was clear who would.

A large plaque bearing a government proclamation honoring the home’s ancient owner hung as though this was some kind of museum. Along that same wall, and several others, were photographs. Almost all depicted a man with a narrow face and small, dark eyes, usually wearing a round cap. In one photo the little old man was at the center of a table with six elderly women, three on each side, smiling and conversing.

Those are all of the centenarians together, the grandson explained.

My mind was having trouble registering what I was seeing. The people in the photograph looked as though perhaps they were in their mid-eighties.

But this must have been very many years ago, I said.

Not at all, the grandson replied. That photograph was taken last year.

I looked again at the photo and four smaller ones below it depicting the same meal. All of the people in the pictures were sitting perfectly upright. Each was balancing a bowl in one hand with chopsticks deftly perched in the other. They were smiling and laughing. One was rising from her chair, stretching out to reach for something across the table.

Jane’s attention was drawn to another room. She motioned to me. I stepped toward the doorway and heard a younger woman engaged in an animated conversation with someone. She seemed a bit exasperated, urging whoever she was speaking with to hurry up. A moment later, I got my first glimpse of Boxin.

At a reported age of 114, he was the oldest person I’d ever seen, and the oldest person in this village, but instead of being seated in a wheelchair or residing in a bed, he was searching intently through a closet, then under his mattress, then back to the closet again. He moved with a fluidity and intensity that surprised me, bending and stooping, turning to respond to a woman who must have been one of his great-granddaughters.

He moved like our nine-year-old son! He bent at the waist, flexed his knees, and turned his head, with the freedom and energy of someone less than half his age. I didn’t hear the sort of grunting that accompanied nearly every one of my exertions.

When one of his great-granddaughters finally said, American, the spritely old man froze. He stood fully erect, turned to look at us, and his face exploded into a wide smile. He reached out to Jane and, holding her hands in his, exclaimed, Americans! We are friends! China and America are friends!

Yes! Jane responded enthusiastically in her best Mandarin. We are friends!

As we walked to the reception room, I learned something remarkable from one of Boxin’s great-grandsons. Even after Boxin had passed the hundred-year mark, he had continued to work in the fields, and was the extended family’s main provider of food and income. Long after many of his fellow centenarians had stopped this kind of work Boxin had continued to do arduous labor.

Only in the past two years has he slowed down a little bit, the great-grandson said.

I chuckled at that. Boxin’s slow mode was considerably quicker than many people’s fast.

Several minutes later, Boxin returned, sporting his traditional changshan and black trousers.

Come, he said. We will eat.

I would have been perfectly content to simply sit and talk with Boxin for hours to come, but our relationship began with an invitation to share food. And that, I believe, is a very good place for relationships to begin.

I think that was the very first thing Boxin taught me. Nourishment is, after all, the beginning of everything else we do. If we’re going to do something radical, such as resolving to live longer, happier, healthier lives, it should begin with what we eat.

That’s where this book will begin, but this is not a diet book, especially if you think of a diet as a plan that limits the amount of food you can eat. Instead, this is a story about a village where eating good food, and plenty of it, is just part of a lifestyle where no one stresses out about living long, healthy, and happy lives. They just do it.

And if they can, all of us can.

LIKE ALMOST EVERYONE else in the United States, I’d tried a lot of different diets and exercise regimens over the years, without much success or benefit. I’d consulted fellow doctors and nutritionists. Everyone seemed to have a different answer for me.

But everything began to change as I came to know the villagers of Bapan.

Here was a place where people age very slowly and don’t struggle with diets or obesity. It’s a place where people in their nineties and even one hundreds are often still out in their gardens and farm plots, growing their own organic food. It’s a place where there is virtually no heart disease or cancer. It’s a place where dementia is all but unheard of. And because of these and other factors, it’s a place where people have an optimistic outlook on growing old. In fact, the oldest people in the village were the most adamant that life just keeps getting better with age.

To be honest, all of this was a bit destabilizing for me. It stood in stark contrast to much of what I’d learned at Johns Hopkins and Stanford. In those places, I’d been taught that chronic medical problems were just part of aging and that we have medications and surgeries to treat these conditions. In this way of looking at life, a painful decline was pretty much inevitable; all we could do was make it more tolerable. This was also in line with the hundreds of medical studies, abstracts, and book chapters I have published over the years on cardiovascular disease, strokes, and dementia. All along I had just considered these conditions to be a normal part of the aging process.

As a cardiologist specializing in the treatment of atrial fibrillation, a condition most often brought on by our modern lifestyle, high blood pressure, and obesity, I was treating thousands of patients with that same logic. Lots of medication. Lots of procedures. Lifestyle changes that accommodated their ailments, rather than addressing the root problems.

Bapan was like a tonic to all of that.

At the time of my first visit, there were only about 550 people living in Bapan. Not surprisingly, the number of centenarians fluctuates from time to time as the eldest residents die, quickly and peacefully in their sleep, in most cases, and the relatively large number of people in their tenth decade cross the threshold into their 100s. Conservatively, though, there’s usually at least 1 centenarian for every 100 people living there.

To put this into context, the average ratio of centenarians in the United States is 1 in 5,780, and that’s really not bad, globally speaking. But even among the places across the globe that have come to be known as The Blue Zones, a term coined by the Belgian demographer Michel Poulain and popularized by Dan Buettner’s wonderful book about places in the world where people tend to live abnormally long lives, Bapan is off the charts. For instance, the famed island of Okinawa, Japan, quite well-known for the longevity of its residents, only has, approximately one centenarian for every 2,000 people.

There are a few caveats to this, the key one being that Bapan’s oldest residents aren’t likely to ever claim a Guinness World Record for longevity because there aren’t any formal birth certificates to substantiate their ages. There were no censuses conducted in Bama County a hundred years ago, and China didn’t begin issuing birth records until after the 1949 communist revolution. Also, with China’s economic transformation beginning in 1978, most of the younger generations have migrated to the large industrial cities of China looking for work.

However, I’ve become quite confident that these individuals’ ages are accurate, according to China’s national census and their government-issued ID cards, or at least very close, for a number of reasons.

First, there is an extensive body of medical literature in both Chinese and Western medical journals on the longest-lived residents of Bama, China. Some of