I know there are a couple Dr.. Greger detractors on the forum, but he's got a new video talking about the diets and lifestyles of the long-lived Okinawans and vegetarian Adventists that I think people will find interesting..
He mentions that both groups eat a mostly plant-based diet.. He cites , which found that the vegetarian Adventists who also practiced a healthy lifestyle had average lifespans of 87 (men) and 90 (women).. That's 10-14 years longer than the general population, and even longer than the traditional Okinawans (77.6 for men and 86.0 for women).
For those who don't like to watch videos, I've included the transcript at the bottom, along with all his references.
My one criticism of this video is his claim that:
The plant-based nature of the diet may trump the caloric restriction, though, since the one population that lives even longer than the Okinawa Japanese don’t just eat a 98% meat-free diet, they eat 100% meat-free. The Adventist vegetarians in California, with perhaps the highest life expectancy of any formally described population.
His claim may be true, but its a big stretch to try to argue it from a comparison between the Okinawans and the vegetarian Adventists, to say nothing of attributing the (small) difference to the 98% vs..100% meat-free diet. There are plenty of other differences between the two groups that could explain they longevity difference besides the (perhaps) tiny bit more meat eaten by the Okinawans relative to the vegetarian Adventists - things like access to healthcare.
Here is the gist of the Adventist paper he's referencing :
High physical activity [> 15min 3x / week vigorous exercise], frequent consumption of nuts [>5 times/wk], vegetarian status [eating meat less than once per month], and medium body mass index [not specified, but presumably 22.5 - 25.0] each result in an approximate 1.5- to 2.5-years gain in life expectancy compared with the corresponding high-risk values [high risk for BMI wasn't specified, but was presumably > 25.0]. The sum of these independent effects (9.7 years in men and 10.4 years in women) is similar to those predicted in subjects who have contrasting values for all variables simultaneously.
So from this we can conclude the following two interesting things:
Being vegetarian ("low risk" as defined by the authors as eating meat less than once per month, although mostly not vegan - the authors say "few Adventists in this study were vegans") vs. eating meat once a week or more ("high risk" as defined by the authors), provided a 1.5-2.5 year gain in life expectancy, and
Having a medium BMI (vs. low or high) provides a longevity advantage.
First BMI. The fact that having a medium BMI was better than a low BMI in this Adventist study, while having low BMI was better than medium BMI in this other Adventist Study  discussed a couple days ago in this post can best be explained by the fact that this study followed subjects for only 12 years, and excluded only the first 4 years of mortality data in an attempt to eliminate the confounding effects of pre-existing conditions. As we saw from , the lingering effects of pre-existing conditions (esp. respiratory problems and a prior history of smoking) have an impact on both BMI and mortality for much longer than 4 years. So I think it's safe to say that this study's conclusion that a medium BMI is better than a low BMI should be taken with a big grain of salt in light of the better evidence of the opposite on another group of Adventists in .
Regarding the extra 1.5-2.5 years gain from being vegetarian vs. eating meat more often than once per week. Consider what the following graph from  shows us.
The interesting thing about this graph is its left-to-right structure. Here is the text describing the figure:
The first bar shows life expectancy when all variables take medium-risk values. Then passing from left to right through the figures, additional variables are also set at either high- or low-risk values, those variables to the right of a particular bar being still at medium-risk values. In the final contrast, when all variables are at either low- or high-risk values, the differences in the expected ages at death are 10.8 years (men) and 9.8 years (women).
So for men who are in the "medium risk" category for all these health factors, their average lifespan was 85.1 years (first, white bar on left).
Now consider the first 3 bars in the graph above. Keeping all the other factors at their "medium risk" category, eating meat less than once per month (i.e. vegetarian) resulted in a mean lifespan of 85.3. Eating meat more than once per month but less than once per week (semi-vegetarians) resulted in a lifespan of 85.1. And eating meat once per week or more resulted in a lifespan of 83.8. Given the confidence intervals, there really wasn't any difference between almost never eating meat and eating it occasionally (but less than once per week). This is virtually exactly what the Okinawans do, since according to the video, they get about 1% of their calories from fish and < 1% from meat. Here is a cool pie chart of the traditional Okinawan diet:
The limited benefit from being a very strict vegetarian Adventist vs. an Adventist who occasionally eats meat is further supported by , which found that the subpopulation of Adventist "vegetarians" [sic] with the lowest mortality rate were the pesco-vegetarians, followed by the vegans, lacto-ovo-vegetarians and semi-vegetarians, in that order:
The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97).. The adjusted
HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians.
So as much as it pains me to say it , and contra what Dr. Greger suggests, being a strict vegetarian, as opposed to eating meat (esp. fish) occasionally like the Okinawans, doesn't appear likely to be responsible for much of the lifespan advantage enjoyed by the Adventists relative to the Okinawans, which is substantial for men (average of Adventists man with best diet/lifestyle = 87.0 years, average Okinawan man = 77.6 years).
Transcript: The Okinawa Diet: Living to 100
The dietary guidelines recommend that we try to choose meals or snacks that are high in nutrients but lower in calories to reduce the risk of chronic disease.. By this measure, the healthiest foods on the planet, the most nutrient dense, are vegetables, containing the most nutrient bang for our caloric buck.. So, what would happen if a population centered their diet around vegetables? They might end up having among the longest lives.
Of course, any time you hear about long-living populations, you have to make sure it’s validated, as it may be hard to find birth certificates from the 1890’s.. But validation studies suggest that, indeed, they really do live that long.
The traditional diet in Okinawa is based on vegetables, beans, and other plants.. I’m used to seeing the Okinawan diet represented like this, the base being vegetables, beans, and grains, but a substantial contribution from fish and other meat, but a more accurate representation would be this - if you look at their actual dietary intake.. We know what they were eating from the U.S.. National Archives, because the U.S.. military ran Okinawa until it was given back to Japan in 1972, and if you look at the traditional diets of more than 2000 Okinawans, this is how it breaks down.
Less than 1% of their diet was fish; less than 1% of their diet was meat, and same with dairy and eggs, so it was more than 96% plant-based, and more than 90% whole food plant based—very few processed foods either.. And, not just whole food plant-based, but most of their diet was vegetables, and one vegetable in particular, sweet potatoes.. The Okinawan diet was centered around sweet potatoes—how delicious is that? Could have been bitter gourd, or soursop—but no, sweet potatoes, yum.
So, 90 plus percent whole food plant-based makes it a highly anti-inflammatory diet, makes it a highly antioxidant diet.. If you measure the level of oxidized fat within their system, there is compelling evidence of less free radical damage.. Maybe they just genetically have better antioxidant enzymes or something? No, their antioxidant enzyme activity is the same; it’s all the extra antioxidants that they’re getting from their diet that may be making the difference—most of their diet is vegetables!
So, 6 to 12 times fewer heart disease deaths than the U.S.—you can see they ran out of room for the graph for our death rate, two to three times fewer colon cancer deaths, seven times fewer prostate cancer deaths, and five and a half times lower risk of dying from breast cancer.
Some of this protection may be because they were only eating about 1800 calories a day, but they were actually eating a greater mass of food, but the whole plant foods are just calorically dilute.. There’s also a cultural norm not to stuff oneself.
The plant-based nature of the diet may trump the caloric restriction, though, since the one population that lives even longer than the Okinawa Japanese don’t just eat a 98% meat-free diet, they eat 100% meat-free.. The Adventist vegetarians in California, with perhaps the highest life expectancy of any formally described population.
Adventist vegetarian men and women live to be about 83 and 86, comparable to Okinawan women, but better than Okinawan men.. The best of the best were Adventist vegetarians who had healthy lifestyles too, like being exercising nonsmokers, 87 and nearly 90, on average.. That’s like 10 to 14 years longer than the general population.. Ten to 14 extra years on this Earth from simple lifestyle choices.. And, this is happening now, in modern times, whereas Okinawan longevity is now a thing of the past.. Okinawa now hosts more than a dozen KFCs .
Their saturated fat tripled.. They went from eating essentially no cholesterol to a few Big Macs' worth, tripled their sodium, and are now just as potassium deficient as Americans, getting less than half of the recommended minimum daily intake of 4700 mg a day.. In two generations, Okinawans have gone from the leanest Japanese to the fattest.. As a consequence, there has been a resurgence of interest from public health professionals in getting Okinawans to eat the Okinawan diet, too.
D C Willcox, G Scapagnini, B J Willcox.. Healthy aging diets other than the Mediterranean: a focus on the Okinawan diet.. Mech Ageing Dev.. 2014 Mar-Apr;136-137:148-62.
A Drewnowski, J Hill, B Wansink, R Murray, C Diekman.. Achieve Better Health With Nutrient-Rich Foods.. Nutrition Today: January/February 2012 - Volume 47 - Issue 1 - p 23–29.
D C Willcox, B J Willcox, H Todoriki, M Suzuki.. The Okinawan diet: health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load.. J Am Coll Nutr.. 2009 Aug;28.
S Davinelli, D C Willcox, G Scapagnini.. Extending healthy ageing: nutrient sensitive pathway and centenarian population.. Immun Ageing.. 2012 Apr 23;9:9.
B J Willcox, D C Willcox.. Caloric restriction, caloric restriction mimetics, and healthy aging in Okinawa: controversies and clinical implications.. Curr Opin Clin Nutr Metab Care.. 2014 Jan;17(1):51-8.
M Poulain.. Exceptional Longevity in Okinawa:: A Plea for In-depth Validation..Demographic Research;Jul-Dec2011, Vol.. 25, p245.
N S Gavrilova, L A Gavrilov.. Comments on Dietary Restriction, Okinawa Diet and Longevity.. Gerontology.. 2012 Apr; 58(3): 221–223.
B J Willcox, D C Willcox, H Todoriki, A Fujiyoshi, K Yano, Q He, J D Curb, M Suzuki..Caloric restriction, the traditional Okinawan diet, and healthy aging: the diet of the world's longest-lived people and its potential impact on morbidity and life span.. Ann N Y Acad Sci.. 2007 Oct;1114:434-55.
D C Willcox, B J Willcox, H Todoriki, J D Curb, M Suzuki.. Caloric restriction and human longevity: what can we learn from the Okinawans? Biogerontology.. 2006 Jun;7(3):173-7.
G E Fraser, D J Shavlik.. Ten years of life: Is it a matter of choice? Arch Intern Med..2001 Jul 9;161(13):1645-52.
D C Willcox, B J Willcox, Q He, N C Wang, M Suzuki.. They really are that old: a validation study of centenarian prevalence in Okinawa.. J Gerontol A Biol Sci Med Sci.. 2008 Apr;63(4):338-49.
M Suzuki, B J Wilcox, C D Wilcox.. Implications from and for food cultures for cardiovascular disease: longevity.. Asia Pac J Clin Nutr.. 2001;10(2):165-71.
M Suzuki, D C Wilcox, M W Rosenbaum, B J Willcox.. Oxidative stress and longevity in okinawa: an investigation of blood lipid peroxidation and tocopherol in okinawan centenarians.. Curr Gerontol Geriatr Res.. 2010;2010:380460.
 Arch Intern Med. 2001 Jul 9;161(13):1645-52.
Ten years of life: Is it a matter of choice?
Fraser GE(1), Shavlik DJ.
BACKGROUND: Relative risk estimates suggest that effective implementation of
behaviors commonly advocated in preventive medicine should increase life
expectancy, although there is little direct evidence.
OBJECTIVE: To test the hypothesis that choices regarding diet, exercise, and
smoking influence life expectancy.
METHODS: A total of 34 192 California Seventh-Day Adventists (75% of those
eligible) were enrolled in a cohort and followed up from 1976 to 1988. A mailed
questionnaire provided dietary and other exposure information at study baseline.
Mortality for all subjects was ascertained by matching to state death tapes and
the National Death Index.
RESULTS: California Adventists have higher life expectancies at the age of 30
years than other white Californians by 7.28 years (95% confidence interval,
6.59-7.97 years) in men and by 4.42 years (95% confidence interval, 3.96-4.88
years) in women, giving them perhaps the highest life expectancy of any formally
described population. Commonly observed combinations of diet, exercise, body mass
index, past smoking habits, and hormone replacement therapy (in women) can
account for differences of up to 10 years of life expectancy among Adventists. A
comparison of life expectancy when these factors take high-risk compared with
low-risk values shows independent effects that vary between 1.06 and 2.74 years
for different variables. The effect of each variable is assessed with all others
at either medium- or high-risk levels.
CONCLUSIONS: Choices regarding diet, exercise, cigarette smoking, body weight,
and hormone replacement therapy, in combination, appear to change life expectancy
by many years. The longevity experience of Adventists probably demonstrates the
beneficial effects of more optimal behaviors.
 JAMA Intern Med.. 2013 Jul 8;173(13):1230-8.. doi: 10.1001/jamainternmed.2013.6473.
Vegetarian dietary patterns and mortality in Adventist Health Study 2.
Orlich MJ(1), Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, Knutsen S, Beeson WL,
(1)School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
JAMA Intern Med.. 2014 Jan;174(1):168-9.
JAMA Intern Med.. 2014 Jan;174(1):169.
JAMA Intern Med.. 2013 Jul 8;173(13):1238-9.
Dtsch Med Wochenschr.. 2013 Sep;138(39):1930.
IMPORTANCE: Some evidence suggests vegetarian dietary patterns may be associated
with reduced mortality, but the relationship is not well established.
OBJECTIVE: To evaluate the association between vegetarian dietary patterns and
DESIGN: Prospective cohort study; mortality analysis by Cox proportional hazards
regression, controlling for important demographic and lifestyle confounders.
SETTING: Adventist Health Study 2 (AHS-2), a large North American cohort.
PARTICIPANTS: A total of 96,469 Seventh-day Adventist men and women recruited
between 2002 and 2007, from which an analytic sample of 73,308 participants
remained after exclusions.
EXPOSURES: Diet was assessed at baseline by a quantitative food frequency
questionnaire and categorized into 5 dietary patterns: nonvegetarian,
semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, and vegan.
MAIN OUTCOME AND MEASURE: The relationship between vegetarian dietary patterns
and all-cause and cause-specific mortality; deaths through 2009 were identified
from the National Death Index.
RESULTS: There were 2570 deaths among 73,308 participants during a mean follow-up
time of 5.79 years.. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per
1000 person-years.. The adjusted hazard ratio (HR) for all-cause mortality in all
vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97).. The adjusted
HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in
lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95%
CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with
nonvegetarians.. Significant associations with vegetarian diets were detected for
cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality,
and endocrine mortality.. Associations in men were larger and more often
significant than were those in women.
CONCLUSIONS AND RELEVANCE: Vegetarian diets are associated with lower all-cause
mortality and with some reductions in cause-specific mortality.. Results appeared
to be more robust in males.. These favorable associations should be considered
carefully by those offering dietary guidance.
 Int J Obes Relat Metab Disord.. 1998 Jun;22(6):544-8.
Body mass and 26 y risk of mortality among men who never smoked: a re-analysis
among men from the Adventist Mortality Study.
Lindsted KD(1), Singh PN.
(1)Center for Health Research, Loma Linda University, CA 92350, USA.
OBJECTIVE: To re-analyse the previously reported linear relation between
Quetelet's body mass index (BMI) and mortality, among men from the Adventist
Mortality Study after accounting for effects due to age at measurement of BMI,
smoking history and race.
DESIGN: Prospective cohort study.. To specifically account for effects due to age
at measurement of BMI, smoking history and race, our methodology includes: 1,
computing hazard ratios for BMI quintiles from a proportional hazard regression,
with 'time on study' as the time variable, and age at baseline as a covariate; 2,
conducting separate analyses of middle-aged (age 30-54y) and older (age 55-74y)
men; and 3, restriction of the analyses to never-smoking, non-Hispanic white
SUBJECTS: 5062 men (age: 30-74 y, BMI: 14-44 kg/m2) from the Adventist Mortality
MEASUREMENTS: Subjects reported data on anthropometric, demographic, medical,
dietary and lifestyle characteristics at baseline and were enrolled in mortality
surveillance during a 26y study period (1960-1985).
RESULTS: During the early years of follow-up (years 1-8, 9-14), we found some
evidence of excess risk among the leanest men that was probably due to the
effects of antecedent illness.. During the later years of follow-up (years 15-26),
effects due to antecedent illness were not apparent and a significant positive,
linear relation between BMI and all-cause mortality was consistently found among
middle-aged (30-54 y) and older (55-74 y) men.. Disease-specific analyses of the
later follow-up (years 15-26) revealed that the positive linear trends with
all-cause mortality, were primarily due to excess risk of cardiovascular disease
and cancer among the heavier men.. Among older men, a significant inverse relation
between BMI and respiratory disease mortality risk was identified during later
follow-up (years 15-26), but this effect attenuated after restriction of the
analyses to men with no baseline history of respiratory disease.
CONCLUSIONS: The re-analysis confirms the findings of a positive, linear relation
between BMI and all-cause mortality, reported in the original study.