Tips for Adapting a Longevity Plan for Better Health: Interview with Dr. John Day

A number of my Chinese colleagues began sharing with me information about a village in the Guangxi Province in southwest China near the Vietnam border, that has one of the highest percentages of centenarians in the world. The residents there are not on medications, and they’re thriving at 100+ years old. So it was based on these conversations with colleagues during a time in my life where my body was starting to break down, that I felt like I had to learn more. 

What made you decide to temporarily move there? How long did you and your family live there?

As I learned more about the people living in and around this place in China, I thought about the possibility of prolonged travel to this part of the world. However, I thought that because of my busy electrophysiology practice, I couldn’t do it. It was my wife who deserves the credit here — she told me we had to do it, so we took our family. That was the first of our many journeys together as a family to this village.  It was the summation of these many trips over five years, and the findings of our research team, that ultimately led to this book.

How old were your kids when you first visited the village?

During the first visit to this village, the ages of our children ranged from five to nine years old. It was a great opportunity to get our children out of our abundant lives in the United States and go into the rural backwoods of China, exposing them to language, culture, and hand farming — things they would otherwise have never come into contact with.

Describe how the people of Bapan lived, what they ate, how they exercised, and what their environment generally looked like. 

The environment is beautiful. It’s a lush green, very mountainous rural area with beautiful limestone mountains. The scenery is absolutely breathtaking. There is a beautiful river that runs through the village. It is nothing like the big cities that most people are familiar with, such as Beijing or Shanghai. The way the residents of Bapan live is very simple. They arise with the sun. They are poor and traditionally work in the fields doing hand farming. They eat real food. There was no sugar or processed foods until just recently. In fact, there were no roads into the village until about 10 years ago, so they were geographically cut off from the rest of China and the rest of the world. That is part of their health and longevity secret, as they weren’t influenced by modern society, modern life, or modern foods. The people there are also very tightly knit — multiple generations of families live together. Neighbors know each other and help each other. It’s a perfect recipe for health and longevity. 

Discuss the principles of the Longevity Plan to create health, happiness, and longevity.

In the book, each chapter discusses one of the 7 principles that we learned about health, happiness, and longevity. Chapter 1 focuses on eating real food. As a cardiologist, I used to justify that my busy lifestyle allowed me to eat the free junk food that was offered in the doctor’s dining lounge at the various hospitals I’ve worked at over the years. I rationalized that as long as I exercised, it was okay, but by my mid-40s, it all caught up with me. You can’t “out train” a bad diet! The diet of the residents of Bapan is focused on real food. It is primarily plant based, mainly because they are too poor to afford meat. There is no dairy in their diet because they’re lactose deficient. They do eat fish a couple of times a week. Their plates are full of vegetables with every meal, three meals a day. They also enjoy legumes, nuts, and seeds. 

In chapter 2, we talk about mindset. Mindset is critically important to health and longevity.  For example, studies show that those who embrace the aging process live 7.5 years longer. Also, optimistic people have fewer chronic diseases. The residents of Bapan are amazingly optimistic. They’ve been through 20 years of Chinese revolution, failed Chairman Mao policies, and famine, and yet these people are remarkably optimistic. Every centenarian we met told us that they were living the best years of their lives, even at 100+. 

The third chapter describes the importance of having a supportive community. The people in this village really come together to support one another. There is a beautiful story that we share in the book of one centenarian who took care of anyone in need over many decades.  However, during the cultural revolution she was branded as a rich peasant.  With the label of a “rich peasant,” the local Communist leaders tried to starve her to death. However, the people of the village risked their lives to smuggle food to her — and that’s the way it works in this village. Families and communities support each other, and encourage one another to live healthy lives. It is this way of living that supports health and longevity. Western science backs up this principle.  For example, studies show that social isolation is a bigger predictor of premature death than obesity or smoking. 

The fourth principle is physical activity. If you were to ask any of the centenarians in the village what they do for exercise, they would give you that “deer in headlights” look. The idea of putting on your special gym attire, driving to the gym, exercising, changing out of your gym clothes, getting back in your car, and driving to work is totally incomprehensible to them.  Rather, physical activity is something they do throughout the day — it’s not something they do for an hour in the morning before work. They are physically active, all day long. Until recently, there were no cars in the village, so they walked everywhere. They do regular hand farming. They use every muscle group, and as such, it has really conferred a graceful aging process. 

Additionally, there are no traditional Western toilets in this village — residents have squat toilets — and 97% of centenarians are able to independently use squat toilets in this part of China. That says a lot about how these residents do not experience all the falls and other frailties seen in the Western world. Therefore, every aspect of their ongoing daily physical activity has paid huge dividends for them. They are constantly moving.  

The next chapter focuses on finding your rhythm. This is something that people find very fascinating, because it’s not seen in any other health book, but coming from an electrophysiologist, perhaps it fits right in. The residents of Bapan have a rhythm to their lives. They live in harmony with circadian rhythms, and there is a time and a place for everything. They live according to the natural rhythms of life. They eat at the same time every day. They are physically active throughout the day. They get up with the sun, and go to bed when the sun sets. Research shows that circadian rhythm disruption in shift workers or people who travel a lot can put them at very high risk of premature death due to cardiovascular disease. The villagers honor this rhythm, and do not try to fight it. 

The next principle is to make the most of your environment. This small little village in China was unique in that they didn’t have all of the air pollution, noise pollution, water pollution, and other pollution seen in the rest of China. Maximizing your environment for health and longevity goes beyond what we typically think of as clean food, clean water, and clean air — it factors in other things. For example, many studies show that people who are exposed to high ambient noise levels have a much higher risk of premature death from cardiovascular disease. It also has to do with gut health — there have been many studies looking at the gut microbiome of these residents, finding some of the healthiest gut microbiomes based on what they eat and how they live. This gut environment can help with disease prevention. 

Making the most of your environment also has to do with the people environment around you. They are not surrounded by people who entice them to eat the donuts or leftover Halloween candy that was brought into the nurses’ station. Everything about their environment helps to serve them well. In my talks about this book, people tell me they wish they had the willpower of these people. However, it’s not about willpower — healthy living is the path of least resistance, and by properly structuring their environment, they don’t have to fight the daily “shoulds” and guilt when making little health choices throughout the day. It is something that is second nature for them. They optimize their environment for health without even thinking about it. That is really the secret of life. 

Maybe most importantly, the final principal was to proceed with purpose. 

Yes, you’ve got to have a purpose. You’ve got to have your “why”. There are fascinating studies showing that people who live with a purpose in life end up living much longer and healthier lives, and this provides the framework for all other health decisions. All of the centenarians in this village had their why. All of the centenarians are still working, even at 100+ years old — no one is retired. Retirement is a foreign concept there, because they are always contributing. No one is put to pasture — these centenarians work in the fields, and when they can no longer work in the fields, they help with childcare in their multi-generational homes. This has changed a little bit nowadays, because many “health seekers” are coming by the busloads to this village to learn the secret of health and longevity. The centenarians share their wisdom with these guests every day, and in turn, get a small donation; they feel a sense of purpose, and believe they’re providing for future generations of their own family. 

Approximately how long did it take after applying these habits to your life before you started noticing a positive effect on your own health? 

The extra weight that I was carrying quickly dropped off — it’s amazing how fast that happens once you rid yourself of sugar and processed foods. I also immediately saw my blood pressure drop 30 to 40 points, allowing me to get off my anti-hypertensive medication. My total cholesterol dropped nearly 100 points. My eosinophilic esophagitis went into remission. My autoimmune disease, ankylosing spondylitis, went into remission. I went off my pain medicines. One by one, everything that was affecting me disappeared, and to this day, I continue to remain medication free. I’m very physically active now. I summited a mountain this morning at 5 am, skiing down with headlamps. This is what I do every day before I go into the lab to perform ablations and device cases. Being in my 50s now, I’ve never felt more alive. However, this was more than just a diet for me. It has also helped with stress. Embracing life and taking this chance to slow down has helped me focus more on what is most important in my life, which is my family and my children. I make this a priority and realign what I do every day around the priorities that I have set.

What made you decide to write this book?

Writing this book is something that happened very serendipitously. I had a great experience in this village, and was able to improve my health and turn things around for me. I always thought that I might share my story in a pamphlet or something for my patients, especially those with atrial fibrillation (AF), who struggle with this lifestyle-related disease. Then, I was asked by my hospital to give a grand rounds presentation about this trip; afterward, many of my colleagues told me I should write a book. One of my colleagues encouraged me to get in touch with a physician colleague of his who wrote a successful book. He, in turn, connected me with other people, and soon we had a major book deal with Harper Collins. So it was something that I had never planned on doing, but it has been a life-changing experience for myself, my wife, and our family.

Do the people of Longevity Village know about this book?

My first trip there was purely for fact-finding. I wanted to find the answer to health, happiness, and longevity.

It wasn’t until after we had sold the rights of the book to Harper Collins, and I went back with a research team including photographers and videographers, etc., that I shared it with the villagers. They were excited about it, and were amazed that people in the West would be so interested in this tiny village. I have not been back since the book release, mainly because things have been so busy with the book launch. My children are begging me to go back to China, so we’re talking about possibly going back this summer for another extended stay.

What feedback have you received about the book thus far?

I am particularly excited that we were recently listed as one of the best nonfiction books of 2017 by the Huffington Post. This caught me off guard that we would be recognized like that, and I believe is a testament of the powerful, life-transforming message of this book. This was a culmination of a five-year project for me, my wife, and our family. It was the icing on the cake to know how we were able to change the lives of the readers that have read or listened to this book on audio tape. This book also has become a number one Amazon bestseller. 

Have you adapted the lessons of the Longevity Village into the treatment plan for your patients? What results have you seen?

Absolutely! Studies show that with aggressive lifestyle intervention, up to 50% of AF cases go into remission without drugs or procedures, so this has become a big part of my treatment strategy for patients with AF. When I do a new consultation for atrial fibrillation, the first part of the focus is to see if we can’t reverse the AF or put it into remission with aggressive lifestyle intervention. It’s amazing how many patients are open to that if you just give them the invitation. For those who are unable to reverse the AF with lifestyle medicine, we then try the traditional pathways, which are to start with pharmacologic agents and possibly ablation. However, it’s gratifying to see so many patients put their AF into remission through aggressive lifestyle intervention or lower their CHADS₂ score so that they no longer need anticoagulants. Not only are we fixing the atrial fibrillation, but we’re also fixing their obesity issues, diabetes issues, hypertension issues, and other medical conditions that may be plaguing them.

What are your recommendations for adapting this health model to patients?

It may seem like a challenge to many electrophysiologists to achieve because of running a busy clinic, finding enough time, or feeling like it’s hard to motivate patients to make the significant interventions, but lifestyle medicine works. I take heart from the Cochrane study that evaluated smoking cessation, for example — brief physician advice increased patients’ chances of quitting smoking by 66%. The same thing can be applied to atrial fibrillation — even minimal physician advice can change people’s lives, and it doesn’t take but a few seconds. Another easy step would be the appropriate referral to a dietitian or cardiac rehab.

Why was it important write this book? What are the key take-home messages you’d like people to know about the Longevity Plan? 

I think that all too often, we feel like we are prisoners to our DNA. Various diseases run in our family, and we think that is the way it’s going to be. We can also become numb to what’s going on around us, because everybody else is eating processed or sugar-laden food, and everybody else is physically inactive and overweight, so we think that is the new norm. However, the message of this book is one of hope. Most people can reach age 90 in excellent health if they make simple lifestyle decisions a habit each and every day. If they’re lucky and have the right genes, they may even get to 100+! So that is something that is very powerful. I think in the healthcare industry, we are used to seeing patients with a lot of wear and tear on their bodies. We think that is a normal part of the aging process, but it’s not. Aging can be a beautiful thing. We can still enjoy running, hiking, biking, and even skiing at age 90 and beyond, with the right lifestyle intervention. Personally, my goal is to ski on my 100th birthday. I’m going to get there!

How is thriving and finding balance physically, mentally, emotionally, and spiritually an especially important lesson in this day and age? 

It is so critically important to be well balanced. This book goes so much further than just eating real food and being physically active — those are just 2 of the 7 principles. There has to be a spiritual component. Various studies show that spiritual people live an average of 3 to 6 years longer. Socially connected people also experience better health and longevity. We have to take the time to stay connected, through family dinners, getting to know our neighbors, and having real connections with people. It is important to be spiritually grounded and focus on our purpose.

Because you are a busy well-known health expert and you run a successful EP practice, what are some of your techniques for finding balance in your own life?

Even though I’ve written this book, I’m the first to say that I’m not perfect, but I try to stay balanced. For me, one of the most important things is to try and make it home every night for family dinner. I have four children, from ages 1 to 15. We try to do everything together. We exercise together. After family dinner, we get together as a family to discuss the highs and lows of the day and share an inspirational or spiritual message.  This family bonding moment each day is critically important in this busy, hurried world. 

What’s next for you? Tell us about your e-book, Simplicity.

This was something that we did as a side project, right after finishing The Longevity Plan. Writing books is in my blood now, and I’ve got another idea for a book that I’m working on, so stay tuned!