Macrobiotic Diet

Ishizuka and food-based therapy in Japan

A Smithsonian Institution archive guide describes macrobiotics as beginning in Japan in the late 19th century as a reaction to the arrival of Western foods. It credits Sagen Ishizuka with restating traditional Japanese ideas in scientific terms in two books published in 1897 and 1898, and says he held that health depends on a balance between potassium and sodium, best maintained through a cereal-based diet.

According to the same guide, Ishizuka and his followers founded a society in 1908 to promote diet-based therapy, and members including the physician Manabu Nishihata continued the work after Ishizuka died in 1910. This is an archivist's summary written to describe a collection, not a critical biography.

George Ohsawa and the yin-yang framework

The archive guide states that George Ohsawa, born Yukikazu Sakurazawa, joined the society in 1919 and worked for it full time from 1923. It identifies his main contribution as bringing yin and yang concepts into macrobiotics. He traveled in Europe in the 1930s, left the society in 1939 to start his own group, and established teaching centers in Yokohama and Tokyo after World War II.

Cancer Research UK dates the diet to the 1920s and attributes its development to Ohsawa, who is described as believing that a simple diet could bring people into harmony with nature. The charity adds that he also claimed the diet could treat cancer and other serious illnesses. The difference in dating reflects whether Ishizuka's earlier work or Ohsawa's formulation is counted as the start.

Spread to the United States

Michio Kushi studied under Ohsawa for a year and moved to New York in 1949, where, the archive guide says, he began teaching a macrobiotic way of life. A medical review reports that Ohsawa introduced the diet to the United States in a strict form of ten progressively restrictive stages, and that Kushi later reformulated it as a high-complex-carbohydrate, low-fat diet adjusted to the individual.

The archive guide describes a setback in 1965, when a pregnant woman died after following an austere form of the diet and medical authorities spoke out against macrobiotics. Kushi then relocated to Boston, founded the East West Foundation, began East West Journal in 1970, and opened the Kushi Institute in 1977 in Becket, Massachusetts.

A diet and a wider way of life

Macrobiotics refers both to a way of eating and to a wider philosophy. Kushi is quoted in a medical review as defining it as a way of life, a philosophy and a cultural movement, not only a diet. A nutrition review describes the diet as low in fat, high in fiber and complex carbohydrate, and mainly vegetarian, tied to a lifestyle system and a spiritual philosophy, and notes that its composition is not fixed.

Strict stages and later forms

Ohsawa's version consisted of ten stages that became progressively more restrictive and ended with a diet of brown rice and water. This strict form is sometimes called the Zen macrobiotic diet; none of the sources opened for this page defines that label. The American Institute for Cancer Research notes that early versions limited foods as the stages advanced, and that the Americanized version today is closer to a flexitarian, mainly vegetarian plan.

Relation to other dietary approaches

Cancer Research UK reports that most followers eat a vegan diet, although some include small amounts of fish or meat. Machipedia's Dietary Approaches page places the macrobiotic diet alongside related pages such as Plant-Based Diet, Vegetarian Diet and Ayurvedic Diet. What distinguishes macrobiotics from those pages is its yin-yang food philosophy and its history of staged restriction, rather than the exclusion of animal foods alone.

Foods emphasized

Cancer Research UK describes a strict diet with rules about which foods are eaten and how they are prepared, built mainly on whole grains with vegetables, fruit and vegetable soups. A medical review adds that sea vegetables are eaten regularly, that meat, poultry, eggs, dairy, refined sugar and additives are avoided, and that foods are preferably organic and minimally processed. The American Institute for Cancer Research also lists beans and miso soup among the foods used.

Yin-yang food classification

Practitioners classify foods by yin and yang qualities and describe choosing foods to balance the two, a framework the archive guide credits to Ohsawa. The sources reviewed for this page do not set out the classification in detail. It is a doctrine of the macrobiotic movement and not a measured physiological property of foods, and no study opened here tests the classification itself.

Eating habits and counseling

Cancer Research UK lists further rules reported by followers, including eating only when hungry, chewing thoroughly, avoiding supplements and processed foods, avoiding microwave cooking and purifying drinking water. Practitioners may also offer exercise advice, home remedies, cooking classes, counseling and meditation. The charity notes that costs can be high, with counseling sessions reaching about 180 pounds each.

Training and practitioners

The archive guide states that the Kushi Institute was founded in 1977 with a mission of training people in macrobiotics, which is the organization's mission as the archive describes it. Cancer Research UK states that no single body regulates macrobiotic practitioners in the UK and that no recognized qualification is required, and suggests asking about training, experience and insurance. The sources reviewed do not describe any professional register.

Disease claims made by proponents

Ohsawa claimed the diet could treat cancer and other serious illnesses, according to Cancer Research UK. A review in The Journal of Nutrition states that macrobiotics gained popularity partly through case reports of individuals who attributed recoveries from cancers with poor prognoses to the diet. Those accounts are self-reported and were not collected under controlled conditions.

Use among people with cancer

A 2018 review reports that as many as 48 percent of people with cancer pursue popular diets, including the macrobiotic diet, hoping to improve survival and prevent recurrence. A German analysis of the cancer diets most discussed by patients also listed the macrobiotic diet and noted that patients following such diets are thought by proponents to be able to contribute substantially to recovery.

General health and prevention

Cancer Research UK reports that long-term followers often have low fat and cholesterol levels, which may lower the risk of heart disease and fat-linked cancers, while stating that a normal healthy diet offers the same benefits. Proponents also present the diet as a way to eat locally, seasonally and with less processed food; a nutrition review notes that several popular recommendations of this kind descend from the macrobiotic lifestyle.

Cancer treatment studies

A 2002 review in The Permanente Journal found only one peer-reviewed study of the diet in cancer: a retrospective analysis that included 23 of 28 reachable people with pancreatic cancer who had followed it for at least three months. Their median survival was 13 months against 3 months in registry data, a comparison the review authors call biased because participants had to survive three months to qualify. A small prostate cancer series used matching criteria the authors describe as unclear.

The review found no prospective or randomized trials and concluded that efficacy as a cancer treatment cannot be determined. A 2001 review reached a similar conclusion, and a German systematic review found no clinical study reporting a survival benefit and instead found reports of malnutrition and side effects.

Cancer risk and chronic disease

The 2001 review states that women eating macrobiotic diets have modestly lower circulating estrogen and that the diet probably carries a reduced cancer risk, an inference based on its resemblance to prevention advice rather than on trials of the diet. A review of popular cancer diets found that macrobiotic eating meets most American Cancer Society and AICR guidelines, but also noted limited evidence of improved outcomes. The AICR states there is no scientific evidence that it reduces cancer risk more than its own plant-based recommendations.

Studies of infants, children and adolescents

Dutch researchers Dagnelie and van Staveren followed infants aged 4 to 18 months on macrobiotic diets and compared them with matched controls. They reported deficiencies in energy, protein, vitamin B12, vitamin D, calcium and riboflavin, along with retarded growth, fat and muscle wasting and slower psychomotor development. An earlier cohort report found very low B12 levels and iron deficiency in 15 percent of the macrobiotic infants and none of the controls.

A follow-up of 48 adolescents fed macrobiotic diets until about age six found 31 were cobalamin deficient, and controls scored better on most psychological tests. These were observational studies from specific communities and years, so they cannot be applied to every household that uses the label.

Infants, children and pregnancy

The Dutch studies described above link macrobiotic diets in infancy to growth delay and deficiencies, and the researchers also reported lower vitamin B12, calcium and magnesium in the breast milk of mothers on macrobiotic diets. A medical review notes malnutrition in infants, including B12 and D deficiency and rickets. The sources reviewed contain no guideline specific to pregnancy beyond the archive's account of a death in 1965.

Strict stages

A medical review reports that the final, grain-only stage of Ohsawa's version has been associated with scurvy, anemia, low blood protein, low blood calcium, emaciation, renal failure and death. Cancer Research UK likewise states that very strict early versions that allowed only whole grains caused severe malnutrition and, in some cases, death.

Cancer care and nutrition

Cancer Research UK states that it does not support macrobiotic diets for people with cancer, that people who are unwell or very young can be seriously harmed, and that it should not be followed instead of conventional treatment. A nutrition review raises concern about delay in conventional treatment and about nutrient deficiency. Another review found that nutritional counseling can often address insufficiencies in these diets.

The AICR lists possible low intakes of vitamin D, vitamin B12, iron, protein and calcium and recommends working with a registered dietitian experienced in vegetarian diets; Machipedia's Dietetics and Nutritional Therapy pages describe those fields. Anyone with a health condition should not delay or replace necessary medical care with this diet.