Do you know what it takes to live a healthy life? There is much published on the Blue Zones… Know what they are? Know where they are? Will you live a long time?
Craig Primack MD: Secrets To a long and healthy life.
Craig Primack MD: What are the healthiest things we can do for ourselves?
Craig Primack MD: Sleep. Definitely one of ’em. What else?
Craig Primack MD: Activity, exercise. What else?
Craig Primack MD: Absolutely laugh, yeah.
Craig Primack MD: Water, yes. What else? What’s number one? I haven’t heard it yet.
Audience: It’s Laugh.
Craig Primack MD: Laugh is up there.
Craig Primack MD: Nutrition is up there.
Speaker 11: Community.
Audience: Social Connections.
Craig Primack MD: Social connections are up there.
Audience: Toxic relationships gone.
Craig Primack MD: Get rid of toxic relationships for sure. Absolutely, and actually, it isn’t specifically said but it is said in this talk. Quit Smoking. Oh. Quit Smoking. Even if there’s weight gain involved with it, which is interesting. So a lot of people continue smoking, and they’re like “I don’t want to gain the weight.” So even if you quit smoking and gain weight because of it, it is healthier. Number two we talked about. Exercise, daily, of something. Movement, it doesn’t have to truly be exercise. It needs to be not sitting sedentary. We’ve now started to say that sitting is the new [inaudible 00:01:13]. Our bodies were not meant to sit at a desk and do this on the computer all day. What are the next five on the list? What is it, number one? Maintain healthy weight. Number two, maintain healthy weight. Number three, healthy weight. Four, healthy weight. Five, healthy weight, maintain healthy weight.
Craig Primack MD: So, there are others and obviously we’re going to go into them but, really maintaining a healthy weight is important. If two people weigh the same, no matter if they weigh normal or high, exercise is the determining factor. You can be thin and sedentary and be unhealthy. Remember that, movement is better than weight.
Craig Primack MD: Blue zones. Anybody heard of what a blue zone is?
Audience: I actually saw that program at Nat Geo.
Craig Primack MD: Very cool. So Blue Zone is a very interesting thing. I think that where the same come from, people were figuring at there’s a couple areas of the world where people live longer than 100 years on average. And they circle it with a blue marker I think the first time and they called it a Blue Zone. That may be the answer, may not. But it’s where people are three times more likely to live to a hundred or more, than the average American. Which, I don’t know if that’s saying a lot or not yet. They live longer, they live healthier, they live happier. We talked about happiness. They have fewer diseases. There’s a case report, again it’s only a case report of a gentleman who moved from one of these zones to the United States. He was diagnosed with lung cancer, and he said I am going to go back to my home, I’m going to live out with my friends out the last six or twelve months that I had. And thirty years goes by, he never went back to doctor, his cancer was gone, and they said did you ever go back to the doctor? He says, “I tried to call them but they’d all passed away”.
Craig Primack MD: So it’s only, I don’t have it documented but that is in one of the things I read, I read a couple things about Blue Zones. And then more energy, because of the way they live. So where are these places? Okinawa, Japan is number one on the list. The risk of cardiovascular disease is 20% that of what we see here in the United States. One out of every five, compared to us. Breast and prostate cancer, only one out of every four as much. Here in the United States its one out of every eight woman. Highest life expectancy in the world. Dementia only one out of or one-third as likely, as what we have in the US here. Number two, Costa Rica. This is a peninsula, off the mainland. Loma Linda, California, and if anybody know anything about Loma Linda? Seventh-day Adventists community there. Seven to ten years longer than the average American, they live in this community. So they are living more of an American lifestyle but in their own community. Sardinia, Italy, and Ikaria, Greece, which is another island.
Craig Primack MD: So one common thing we find about these are isolated communities…Away from kind of the hustle and bustle of what we see in Scottsdale, honestly. So why do we live as long as we live? Is it genetics? Is it lifestyle? [Both. So what has been estimated, is 25% of it is our genes. What our parents gave to us, and if you’ve heard of the term “telomeres”, how long our telomeres are we live longer. With shorter telomeres we live shorter. It’s how many times our DNA turns over. 75% of it though, why we’re all here, is lifestyle change. Becoming a healthier person. So we can control a big percentage of this.
Craig Primack MD: It’s interesting I listened to some podcasts, and there’s a guy who’s a Lipidologist, who’s probably the biggest guru in the country. Talking about he’s in his seventies now, so he was a physician back in the 1970s. He said “heart attacks would walk into the hospital every single day. We didn’t have much to do about them”. And if you talk to somebody who works in the ER right now, they see heart attacks, but it isn’t everyday you have people with these massive heart attacks. All of the things that we’re doing as a society with cholesterol meds and blood pressure meds and all that, its making people in such, it’s making people healthier than we ever were. Even, thirty, fifty, forty years ago.
Craig Primack MD: So how? What are they doing differently than the rest of us? There’s seven to nine things that have been identified, depending on which kind of list you’re looking at. But number one, inconvenience yourself. What does that mean?
Craig Primack MD: Walk. Be active. And so they are active, they move. This isn’t dedicated exercise. Their life is just more movement than the rest of us. Regular, low intensity, physical activity often is part of their daily work routine. In the Sardinia Blue Zone, they’re actually shepherds. And so they’re out in the pastures all the time.
Craig Primack MD: Okinawans garden for hours a day. And a lot of it is for making food, for themselves because they eat out of their own gardens. Adventists take nature walks out in California. That’s number one.
Craig Primack MD: Hara Hachi Bu. I don’t know if I’m saying it correct, what does that mean? Its Japanese. Anybody?
Audience: I remember it from the book, but I can’t remember what it means. Something about
Craig Primack MD: Don’t google it. Here it is. Eat until you’re 80% full. In the United States when do we stop eating?
Audience: When our plate is full.
Craig Primack MD: When our plate is full or we are truly, full. And how long does it really take to tell our brain that we’re full?
Audience: Twenty minutes.
Craig Primack MD: Twenty minutes. I always say when you’re at the restaurant and you’re walking out to your car and you’re like “Oh I can’t believe I ate so much”, from the time you stop eating till then, that’s about twenty minutes. So it takes some time. We don’t pay attention as a general rule to how hungry and how full we are. They say this as a mantra, day after day after day.
Craig Primack MD: Right this one down, or right it down in the words you’re going to remember. I don’t want to be full. I want to be comfortable. What we use here is we use a hunger scale. I haven’t talked about it with everybody but there’s a few people that I talked about it with. I like to use, some people use a fullness scale, I like the hunger scale. How hungry are you, ten? The most, I would say I’m so hungry I’m already eating my arm I need something to chew on. Zero is the opposite. My favorite food even right here, no, I am not full at all. Here we want to start eating I’d really say when you’re about an eight. I want to be hungry enough that I can eat. I don’t want to be starving. Then I want to eat down to not less than a two. I usually say its about a three. You want to be comfortable enough that you say I can stop eating now, but three hours from now, three and a half hours from now, that next meal because I’m now eating five. I’m going to have to eat that. I couldn’t go seven, couldn’t go six. But I want to start doing that.
Craig Primack MD: I find for myself if I go past my eight, if I go to ten, my normal meal doesn’t take me down anymore. My normal meal that I would eat then takes me to a five and I have to keep eating to get down further. As I practice this, and it doesn’t come naturally, trust me, to any of us. So the recommendation is to judge your hunger at three different times. The first is at the beginning of the meal. When I sit down, how hungry am I at this particular meal? Somewhere about halfway through the meal. Then the third part is at the end of the meal, trying to stop at that two or 80% full.
Craig Primack MD: In cultures that eat in much more called courses than we do, we used to talk about the French paradox a lot. The French paradox they eat fattier foods, they eat richer food, and as a general rule they’re thinner than Americans. Part of it is by eating courses. They have a first course, a second course, a third course. So what does it do? It gives you time for your body to get full. They don’t eat between meals. They don’t eat seconds, they don’t eat in their cars, they don’t eat at their desks. All the things we do here. They walk, they used to sit at the café for just a cup of coffee for an hour now Starbucks has taken over and [inaudible 00:09:33].
Craig Primack MD: So that was number two. Plant Slant. So this is a bit different than the philosophies we typically teach here, but most of them are vegetarian or close to it. The average amount of meat they ate was four ounces five times a month. It was pork in one group. They eat a lot of beans: fava, black, soy, and lentils. Whole grains, garden vegetables, nuts. I’m going to talk a little more about nuts on the next thing. But about 1.5 ounces per nuts per day, and a glass or two of red wine with friends and food. This is slow, over hours, sitting and enjoying. This isn’t “give me my thing and I need another one and the kids have gone to bed and work is done and its Friday for happy hour”. This is more of the enjoyment of people than it is the wine although wine comes with.
Craig Primack MD: Nuts, I did a little analysis. We talked about nuts and I always say some nuts are okay, the problem is when we add salt to our nuts when do we stop? How much is an ounce and half? I looked it up. Almonds, its 35 nuts, its about 250 calories 240 calories for all of these. Cashews, its only 27. Pistachios are 73, that to me is a fair amount. Peanuts are 42, that’s a small handful. Nobody stops at a handful. The bowl is out and I took a handful, there’s a party and the Super bowl is coming up in a couple of weeks and I took another handful, oh my gosh and then I took another handful and its not one and a half ounces anymore. You have to watch how much you’re taking in.
Craig Primack MD: Downshift, slow down. Who’s in a hurry all the time? We all are, absolutely. Nicoyans take a break daily to rest and socialize with their friends. We don’t do that. Seventh-day Adventists take Saturday as a Sabbath day, not much of anything. Okinawan ladies gather every day at 3:30 to gossip. Its their time to spend with their friends and talk about what’s going on in their lives to help their stress. Your friends help that.
Craig Primack MD: What can we do? We can turn off smartphone notifications. That was actually one of my goals for 2019. I no longer get Facebook or any type of those notifications throughout the day. You want to go to those things you can go to them anytime you want but it isn’t throwing it at you. Laugh with friends until the sun goes down. Sit with friends have a meal. Have people over at the house don’t run to the restaurants. Cook, cook. Designate a time to take it easy. Have that time where you just unplug. Again, 10:00 at night I’m at my computer checking my email getting that last piece of work in.
Craig Primack MD: Belong. What they did, one of the people who were interviewed said “This isn’t a me place. Its an us place.” We’re a group. Family, religion, community. Almost all the people were involved with their particular religion and their community. It didn’t matter which of the five places you were but the one in that they had a community that they belonged to. A purpose.
Craig Primack MD: Don’t zone alone. If you’re going to do this on yourself or on your own its not going to work the same. That’s part of it. What makes Blue Zones work is everyone supports the same lifestyle. Your community is what helps you to do this. I always say that if you’re going out to dinner and you want to eat healthy and three people order the cheeseburger and fries and you’re the next person to order, you getting the salad? You are if you’re really, really dedicated, most people are not. If four people are getting the salad, now you’re the fifth person you’re getting the salad. Its easy to eat or live a certain way whenever everyone else around you does. That’s part of the message here as we have to start changing and getting the people around us.
Craig Primack MD: What is that? Friends influence you more than your spouse has been proven. You are an average of the five people you most associate with. Again if they’re going out and having happy hour every Friday, you’re likely going to happy hour every Friday. If they’re going for a hike every Saturday morning, my friends and our dogs, I’m most likely going for a hike every Saturday morning. So you have to pick and choose how you’re spending and who you’re spending it with.
Craig Primack MD: Extras. There they kept loved ones first. Grandparents, parents were always near by or in the home. Multiple generations helping each other supporting each other. They committed to a life partner. Some of these cultures divorce is not a thing that happens. They stuck it out through thick and thin because they had not just their spouses support but they have the community support. They invest in their children with time and love specifically and not things. The Okinawans, and I thought this was interesting, they create “Moais”. Its groups of five friends that committed to each other for life. This is a lifetime commitment that they have to their community. Inconvenience yourself, be active, eat to 80%. As you start, we talk about mantras and that little green dot. That’s not a bad mantra to start thinking of for the next two weeks. “I’m only getting to 80%, 80%, 80%”.
Craig Primack MD: More plants. Salads for sure. I don’t think meat has a problem when we’ve looked at it if you keep your portions reasonable and that’s really four ounces for most of us. Even red meat several times a week if we keep it to four ounces. That’s I think the secret when it comes to that and what we know here.
Craig Primack MD: Downshift, slow down, do things. Belong to a group of some type. Do it with other people and have a reason that you get up in the morning. Move to a Blue Zone is one way to do this because in Scottsdale its really hard to do many of the things that are listed here. I mean talk about walking places. You can go out for a walk in your neighborhood, in the park, but you don’t walk somewhere to go. You don’t go to restaurants, you don’t go to stores, they’re nowhere around. Slow down, move, have community meals with friends, have hobbies. I talk about hobbies a lot. Turn off your Netflix, turn off your things. Sleep, that’ll be my next talk, but sleep. Believe in something and have a purpose, and thanks for coming.
Craig Primack MD: I’m here for questions.
Audience: Is it better to exercise first and then eat?
Craig Primack MD: If it works for you, absolutely. I personally believe in eating first, then exercising. I have a routine that I wake up, I have my chocolate shake. Many of you have heard that, there’s 365 days of the year, 345 days I’m a chocolate shake. I take my dogs for a walk and I do roughly 25 to 30 minutes of exercise more days of the week than not. There’s other people that do it on an empty stomach. There is some data that says if you do it on an empty stomach you absorb some more protein after the meal but my belief is that it depends on your workout. Because sometimes if you’re doing a hard enough workout and you need that energy where is that energy coming from? You haven’t eaten since hopefully 7:00 or 8:00 the night before and so you’re using some of your glycogen, but you’re using micro bits of muscle to fuel that exercise also. So I’m the believer in protein for breakfast. There’s no right answer for sure.
Audience: When they say meat, are they referring to any kind of animal product (eggs, yogurt) or are they specifically talking about meat flesh?
Craig Primack MD: I think they’re talking about animal products, because animal protein is better than plant protein when you look at what the makeup of the amino acids are. Eggs are a great source of protein. I do think dairy in certain amounts are great as long as people don’t have lactose intolerance or any problem with that. I think yes, its both. Its not hotdogs, its not sausage, its not luncheon meat per se.
Audience: But when they say meat is bad, are they also saying yogurts bad, eggs are bad, any kind of animal product is bad? You know what I’m saying?
Craig Primack MD: I think when they say that they mean meat… meat is bad. Vegetarians and even some people have eggs and fish as part of their restricted diet so I think they’re saying those are still better. We think egg is a perfect protein. 1970s-80s one yolk a week, that’s gone we’re back to eggs, eggs are good for us. Cholesterol in our diet does not cause truly cholesterol in our blood stream. Carbohydrates in our diet is more likely to cause high cholesterol in our blood stream. You are not always what you eat. Well you are what you eat but not [inaudible 00:18:57]. What else?
Craig Primack MD: Thanks for coming.
Audiences: Thank you.