A "whole" lot of questions about "macrobiotics" and diet research

When I first started blogging in 2014, I had found inquiry in the practice of macrobiotics. It's something I was introduced to by my mother, but never really explored first hand. I decided to do so and take my best stab at introducing the concepts in a fun way with a series of questions related to it. Since, I've not maintained a strictly macrobiotic diet, but because I believe the concept of macrobiotics is really about its backbone principles, I can say I still follow them at my core.

The series is titled: "How can you put STYLE in your LIFE?: Revealing the macrobiotic in your own lifestyle."

Dear Readers,

With the spring equinox just behind us, I have decided this is a perfect time to offer something of renewal and/or change to my readers. Along those lines, it’s probably about time that I address a question that I have been getting from many of those around me since the New Year. That is, “What is this macrobiotics all about and how is it a part of the lifestyle changes you’ve taken on in your own life?”*

With that, I will be starting a series to fulfill a, “Macrobiotic 101” from the perspective of yours truly (emphasis on the fact that this will, indeed, be my perspective leaving much room for the works of others as well as your personal interpretation). However, you should know me by now, and with that, there is always a little twist. I will attempt to answer the question I framed above*, but while throwing back some questions to you, the readers (insert here your space for interpretation). After all, as I have alluded to before, I believe the best response to a question is one that raises more questions than answers.

Continuing with the inquisitive theme, I have found that writing this series raised more questions for me than I could even begin to list, never mind answer. For example, the principles of macrobiotics as were established by George Ohsawa cannot be addressed in a simple series of blog posts by a rookie/newbie (again, yours truly) to this information. With that, I will consider revisiting this topic annually (i.e. again next spring) to see where we “are at” (we being me: both my knowledge base & interest you: the blog community). Perhaps at that time we can go a bit “deeper” into principles, philosophy and practice. For now, let us live in the moment with a view of macrobiotics tangible to all comers. I hope this series of posts will call your inquisitive nature to the following statement (which lends to my choice for the title of the series):

How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle (A seven part series)

Ok, so how will this “series” work? I have written seven parts. Part 1 will serve as an introduction piece, Parts 2-5 will address, “four things to avoid in order to reveal the macrobiotic in your lifestyle”. These are four principle concepts I have attempted to create as a means of boiling down my perspective of macrobiotics in a tangible, shareable way. Part 6 will recap the four concepts as they relate to the consideration of a plant-based diet, specifically. Finally, Part 7 will be a reflection back to some ideas brought up in Part 1 as well as a summary. At this point, I will call you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step.

Disclaimers: I will make my best effort to balance my subjective take on the macrobiotic lifestyle and principles with some mild discussion of objective scientific support. (The word mild is inserted here with the aim of emphasizing that the scientific support is at a minimum, not always with optimal methodology, and from varying resources, but is an attempt to peak your interest enough to seek out further validation if you so choose — in fact, I can only hope you retain a healthy dose of skepticism here as in all scientific inquiry — and further, that you be so willing as to share any findings here knowing they are beyond welcome, always). You, of course, are welcome to skip over either aspect if one approach suits you best. I have also done my best to simplify and format the material to allow just that type of navigation, if you wish, as some of the posts are a bit lengthy due to the diffuse range of the content for each topic. This should make sense since I am suggesting we dissect a system of approach to every aspect of life(style) and life as a whole! (No easy feat to be reduced to a seven part series of blog posts). Taking all of this into account, I also apologize in advance for any omissions.

I will post a new part every other day, giving you a chance to read (and potentially pursue further inquiries that may arise along the way). This will result in a 2-week journey with me! I hope you enjoy. Let’s get started…

So, I pose to you (and will again at the end of this series)… How can you put STYLE in your LIFE?

Sincerely,

Your Inquisitive Nature

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PART 1:

This begins a seven part series, “How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle”. Part 1 (here) will serve as an introduction piece, Parts 2-5 will each cover one of four suggested avoidances, Part 6 will recap the four as they relate to the consideration of a plant-based diet, specifically. Finally, Part 7 will be a summary and reflection inviting you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step. I’ll post a new part every other day, giving you a chance to read along. I hope you enjoy this 2-week journey with me!

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PART 1

What is macrobiotics? The meaning stems from its roots, macro— large scale (or great) and –biotic referring to life. A published macrobiotic counselor calls macrobiotics “The Great Life Diet”1. The Kushi Institute, the leading educational center for macrobiotics founded by Michio Kushi, defines it as, “not simply a ‘diet’, macrobiotics recognizes the profound effects of food, environment, activities, and attitude all have on our body-mind-emotions.”2 Lawrence Kushi, the son of Michio and a well established researcher in nutritional epidemiology, has said, “(The sense of) interrelationships among lifestyle, diet, disease patterns, health of the planet (not just your own body), social relationships and ecologic impact… that macrobiotics has can be applied in almost any arena, but whether you call it macrobiotics or it comes from some other course, it’s in a sense not so important.”3 Though macrobiotics goes beyond diet, if you are a consumer of “conscious” food products, macrobiotics likely has already made a bigger impact on your lifestyle than you may think. Lawrence Kushi goes on to state how many founders of today’s nutrition related companies and advocates for stocking our grocery store shelves with things like tempeh and sea vegetables, started by those who were, at least in part, originally influenced by macrobiotic principles.

When I recently took interest in learning about macrobiotics (thanks to macro-mom), I was coming from an already plant-based lifestyle of over a decade (thanks to multiple sources including mom’s lifestyle, dad throwing some awesome integrative doctor biographies at my in college and a couple of philosophy classes by one of my favorite college profs, an environmental –worth emphasizing- philosopher). Though it is true that macrobiotics is plant-based, not only does macrobiotics allow for some (very moderate) animal product (mainly fish), but its principles apply beyond food choices*. Therefore, for me, it was important to harness these principles by reducing certain practices in my current lifestyle, rather than making gross changes or additions to my diet.

Before I bring in my perspective it’s worth knowing that the macrobiotic diet is a lifestyle that had been long established before I came on to it. A wonderful blogger (I suggest you check out (http://gourmandelle.com/macrobiotic-diet-101-everything-you-need-to-know-about-macrobiotics/ ) offers, “A little bit of history” on the macrobiotic diet in a very tangible way:

“The macrobiotic diet first appeared around the end of the last century, when a Japanese army doctor (Sagen Ishizuka) established a theory of nutrition and medicine based on the traditional Oriental diet. He suffered from multiple illnesses and studied both Western and Eastern medicine. He then complied the information and his conclusions in two books Chemical Theory of Longevity and Diet For Health. Ishizuka criticized the adoption of the Western modern medicine and nutrition principles, and strongly recommended the Japanese traditional diet – whole, unrefined foods, with almost no animal foods.

Suffering multiple “incurable” diseases from a young age, George Ohsawa learned about the macrobiotic diet from two of Mr. Ishizuka’s disciples and managed to completely restore his health. He then wrote more than 300 books and articles about the macrobiotic diet.”4

Now, let’s get to the elephant in the room (as a “macro” would welcome the elephant’s presence). You may have heard about the bad reputation given to macrobiotics, and how it is a harmful diet. From what I could gather, these claims have been attributed to a history of some who consumed grains with little else and became extremely malnourished. Though these cases, to my understanding, represent nothing of what macrobiotics is today, I hear your concerns. As a future physician, I caution any lifestyle changes without the guidance of a professional, ideally a clinician. As a writer with the interest of promoting any principle that supports healthy lifestyle modification, I avoid the use of any labels. As a researcher, I want to note that there is a clinical trial registered by Lawrence Kushi to study the relationship between dietary practices (of macrobiotic-type) and certain hormonal cancers. It seems some results have emerged and can be found in his recent publications (searchable on PubMed by his name). As a person of questions, science …and even some skepticism, I can state that the articles show mixed results, but, from what I can tell, are due to methodological challenges. The field of medicine still doesn’t have clean direction (“evidence-based practice”) regarding approaches to systems of lifestyle modification (macrobiotics or others with similar principles) because they are heterogeneous and, therefore, difficult to reduce to clean studies containing appropriately matched controls and lacking confounding variables.

With that, I will attempt to sort through some investigations. To do this, I have to narrow it down as when I have searched PubMed with the term “macrobiotics”, I came up with 118 articles. When reduced to “clinical trials” 6 remain. Two references were not related to the lifestyle and so won’t be discussed here.

1) The study (5): This was an epidemiological study, which showed no difference in bacterial infection or microflora with antibiotic resistance between vegetarians and non-vegetarians.

Impression: Of note, this study was in an attempt to prove that meat eaters nor those who work in the meat industry had increased rates of antibiotic resistance because animals in the meat industry are injected with tons of antibiotics and there has been concern that those exposed to animal products would have antibiotic resistant bacteria because of it. The antibiotic resistance was not found to be higher in meat eaters or those who work in this industry, but interestingly, there were differences in overall bacteria type between vegetarians and non-vegetarians. To me, this indicates a need for investigations into these differences. Of particular interest is how differences in microbiomes (one’s microbiome is the community of bacteria living in/on the body) impact health and disease in those following different lifestyles.

2) The study (6): This study aimed to demonstrated a marker for vitamin B12 (specifically, a metabolite of it, cobalamin) had high sensitivity. It also found that infants of macrobiotic mothers had significantly higher deficiencies in the cobalamin than omnivorous controls.

Impression: A well-done study, which indeed proved its primary outcome. It, unfortunately, points to a very important issue in the vegetarian meets medical world: vitamin B12 deficiency. Before I address this important point, I want to emphasize that this study did not measure health outcomes as they relate to the diet or the B12 deficiency related to it. B12 deficiency is prevalent in strict plant-based eaters who do not supplement their diet appropriately. Macrobiotics, given the level of purity, should be made aware of this common deficiency. However, this is not a challenge unique to macrobiotics, but of any plant-based diet.

On a tangent since I’ve possibly peaked your interest (otherwise continue to the next study below): B12 is needed for proper function of our red blood cells and our central nervous system. It may be important in cardiovascular health as well. Studies that have demonstrated no difference in morbidity in cardiovascular disease between vegetarians and non-vegetarians, hypothesize the difference is due to the presence of a byproduct of the B12 biochemical pathway. It is known that cardiovascular disease, including myocardial infarction (commonly referred to as “heart attacks”), in those who consume excess animal products is usually due to coronary artery disease from cholesterol accumulation (commonly known as “clogged arteries”). However, new evidence suggests that inflammation by way of homocysteine (a byproduct of B12 deficiency) may also lead to cardiovascular disease. I suggest that the solution to avoiding adverse events in either group, is to follow a plant-based diet that is sufficient in vitamin B12. How to do this? Follow under the care of a clinician, get B12 levels checked regularly and supplement where appropriately advised. Importantly, B12 can be stored in the liver for very long periods of time, but does not negate the need to have peripheral levels checked at least annually. Disclaimer: I am not offering medical advice, simply suggesting you seek it from your own physician. Further, future research is needed to understand the implications of B12 deficiency.

3) This is a publication (7) outlining the methodology of the study described below:

4) The study (8): An Italian funded randomized controlled trial (RCT) published in 2012 found that a diet that combined Mediterranean and macrobiotic dietary principles reduced weight gain in women undergoing chemotherapy for invasive breast cancer.

Impression: Is this a surprise? This type of dietary intervention should be expected to reduce weight. The methodology is poor in that the control group only received baseline diet recommendation where the experimental group received twice weekly kitchen activities. This leaves us with more questions; could any moderately healthy diet with twice-weekly instruction lead to decreased weight? I’d hypothesize yes. The authors make the claim that this finding is important because weight gain has been associated with breast cancer recurrence. Of note, assessing prevention of recurrence by this diet is the primary aim of the study as designed and published in item 3 above. I think this is a strong argument and certainly an important one. However, this article specifically follows the women only 1 year and, therefore, does not report on any recurrence. Also, the control group also lost weight, though only 0.1kg compared to the average 2.9kg of the dietary intervention group, this detracts some strength from the claim that weight gain is a crucial issue for women with invasive breast cancer (at least in their study population). Though a skeptic, I appreciate the authors’ ability to gain funding support and resources to conduct such a trial (including the ability to host twice weekly kitchen activities for a year!) and I feel these types of studies are the first step in better trials to come. I look forward to future publications from this trial and will, hopefully, answer the question; does this weight loss relate to decreased cancer recurrence?

5) The studies of Lawrence Kushi: He has published 183 articles apparent in PubMed. Many are not specific to macrobiotics and in fact only one review popped up when searching macrobiotic within his name related listings. This review discusses the need for rigorous trails assessing the relationship of macrobiotics to diet. He has published studies showing evidence of improved health in adolescents consuming meat once a week or less, meat consumption was associated with increase non-Hodgkin lymphoma in women and consuming vegetables and fiber decreased the risk of colon cancer, to names a few. Though each have respective methodological challenges (as with all diet related studies – as I have written about earlier), they show some intriguing data.

6) Lastly, when going through the other articles of the 118 articles

(http://www.ncbi.nlm.nih.gov/pubmed/?term=macrobiotic ) that came up under the term “macrobiotic” but were not clinical trials, the following was noted:

1. One recent article was a meta-analyses of short term intervention reports suggest a macrobiotic diet can improve type 2 diabetes, but most others were either theoretical reviews either supporting or negating evidence for macrobiotics or further evidence of the B12 and other vitamin deficiency problem in strict diets, especially in children.

2. The number of articles related to deficiency is important to note. These give clout to those who might shy away from plant-based lifestyles due to fear of deficiency. However, I would argue that the emphasis placed on establishing these deficiencies through research should be placed in establishing the efficacy of the diet itself. Diet, just like medication, should not be attempted without guidance as it can be used improperly. However, if a diet can potentially (though not necessarily without modest risk) impact the course of chronic disease (like diabetes and potentially cancer) then should it not be disregarded due to a potential and treatable “adverse effect” such as vitamin deficiency? Not to discredit that this issue needs to be taken seriously, but, just a thought.

Importantly, there has been MUCH research in nutrition (and a plant-based diet) that is not directly of, “macrobiotics”, though the researched diets may share some general characteristics in with it. However, in the interest of focus, I’ll refrain from addressing those studies too much in this series and will give an overview in Part 7 that will set up for future posts on the topic at large.

Of the research that I have presented here, specifically related to “macrobiotics”, you might have noticed something about the twist it led this post to take. I began writing about how macrobiotics is about much more than food, yet all research shared thus far emphasizes diet. Well, I held out on one case series study that I found rather interesting. This article discussed six men with AIDS who opted to follow a macrobiotic diet9. Interestingly, their CD4 counts increased over 3-years, contrary to the expected statistics. However, what’s most striking is that the authors choose to focus on the unique mood profile of these subjects, notably their decreased depression and increased vigor. None of these findings were attributed to diet, but rather to the potential hypothesized psychological profile of those who would opt for an “alternative treatment” such as the macrobiotic diet (9). I’m not disagreeing with the authors, point that their, “data support our hypotheses that psychological factors may influence the progression of AIDS in men with KS (a cancer unique to this population) pursuing a macrobiotic regimen,”(9) but even they point out, “This does not exclude the additional influence of social support, behavioral changes, and the diet itself”. I think this a perfect transition to discuss the potential greater implications of a lifestyle change similar to that of macrobiotics.

Though I cannot offer any concrete research indicating efficacy of the macrobiotic diet or lifestyle, I still want to at least compile a list of principles that stand to reason whether the questions behind the label of “macrobiotics” can be answered or not. In doing so, I’ll attempt to weave in some modest scientific evidence. Disclaimer: emphasis is on the “modest” as not every principle has been appropriately refined to meet the standards of research in the way I’ll be reducing them here. This list will begin with Part 2 of this series of posts. Keep a look out and in the meantime…

So, I pose to you… what things can we all learn from macrobiotics, regardless of our opinion of the label?

* The purpose of this article is to serve as an introduction to the principles of macrobiotics whereas the discussion of animal use, can be a lengthy one encompassing a each of the principles touched upon here and more and so, for simplicity, will not be discussed here. This also explains why I have chosen to mostly use the term “plant-based”. A discussion of the topic of animal use will be attempted in Part 6.

REFERENCES:

1. Waxman, D. The great life diet: a practical guide to health, happiness, and personal fulfillment. (Pegasus Books, 2007).

2. About: The Kushi Institute. The Kushi Instituteat

3. mindbodynourish » lawrence kushi. at

4. Ruxandra. Macrobiotic Diet 101 | Everything you need to know about macrobiotics! Gourmandelle | Vegetarian Blog, Free Meal Plans, Recipes at

5. Elder, H. A., Roy, I., Lehman, S., Phillips, R. L. & Kass, E. H. Human studies to measure the effect of antibiotic residues. Vet Hum Toxicol 35 Suppl 1, 31–36 (1993).

6. Schneede, J. et al. Methylmalonic acid and homocysteine in plasma as indicators of functional cobalamin deficiency in infants on macrobiotic diets. Pediatr. Res. 36, 194–201 (1994).

7. Villarini, A. et al. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori 98, 1–18 (2012).

8. Villarini, A. et al. Preventing weight gain during adjuvant chemotherapy for breast cancer: a dietary intervention study. Breast Cancer Res. Treat. 135, 581–589 (2012).

9. Levy, E. M., Cottrell, M. C. & Black, P. H. Psychological and immunological associations in men with AIDS pursuing a macrobiotic regimen as an alternative therapy: a pilot study. Brain Behav. Immun. 3, 175–182 (1989).

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PART 2:

Recap: This is a continuation of the seven part series, “How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle”. Part 1 served as an introduction piece, in Part 2 (here) I begin to uncover each of the four suggested avoidances and will continue on Friday with Parts 3-5. Part 6 will recap the four as they relate to the consideration of a plant-based diet, specifically, and finally, Part 7 will be a summary and reflection inviting you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step. I’ll post a new part every other day, giving you a chance to read along. I hope you continue to enjoy this 2-week journey with me!

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Without further ado, these are the things I learned to avoid like the plague when first studying the principles of macrobiotics.

1) DISORDER

The principle: Macrobiotics is a lifestyle of order and balance. A macrobiotic counselor and speaker I have worked with, explains it as an, “orderly approach to diet and lifestyle”10, elaborating to say that orderly cycles exist in nature, therefore suggesting that the macrobiotic lifestyle is an approach to establishing synchronicity with nature. He also speaks of how, “regularity is an anchor”11 whereby we feel stabilized (when we have it – it being regularity), whether in childhood growing up in a (hopefully) stable family, or in eating at regular meal times or participating in regular activities that we are passionate about. To take it a step further, macrobiotics recommends eating in synchronicity with the environment, that is, locally and seasonally. The elimination of disorder in the form of a chaotic lifestyle or imbalanced food choices brings our body, mind and, therefore, physiology into balance (known as homeostasis).

The suggested evidence: There are many examples of how order and regularity improve health. Allostatic load, is a fancy term used to suggest that stress to our system leads to pertubations in our normal balanced, or homeostatic, physiological systems (12). Allostatic load has been associated with stress from the experience of childhood adversity or the diagnosis of a terminal illness to everyday chronic work stress.

Specifically in reference to diet, chronic eating at unusual meal times has been linked with insulin and hormone imbalances (13). Further, a diet heavy in protein or fat has been linked to dysregulated cortisol levels (our primary endogenous stress hormone)14. Finally, not only is eating seasonally and locally environmentally sustainable and economically ideal, it also makes sense biologically. Humans became accustomed to eating by geography as we adapted to our environments. Those in hot climates, eat foods that release heat (such as those heavy in spices), whereas those in cold climates eat foods that will help them retain heat (such as those heavy in fats).

Today, all foods are available to most of us in any place or at any time (if we should be so blessed), but it might be worth considering if it is always the right place and time for the body. This in and of itself is a macrobiotic approach. I bet you’ll find that just being aware of how your time and place relates to your diet and lifestyle brings about half the change (#counsciousnessiskey). What is the allostatic load in your life? What can you do to return to homeostasis?

So I pose to you… why avoid disorder in your life?

References

10. Kramer, W. Macrobiotics of New England. at

11. B, L. Mythbusting Macrobiotics YouTube Playlist. at

12. Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I. & McEwen, B. S. Price of adaptation–allostatic load and its health consequences. MacArthur studies of successful aging. Arch. Intern. Med. 157, 2259–2268 (1997).

13. Gonnissen, H. K. J. et al. Effect of a phase advance and phase delay of the 24-h cycle on energy metabolism, appetite, and related hormones. Am. J. Clin. Nutr. 96, 689–697 (2012).

14. Stimson, R. H. et al. The postprandial rise in plasma cortisol in men is mediated by macronutrient-specific stimulation of adrenal and extra-adrenal cortisol production. J. Clin. Endocrinol. Metab. 99, 160–168 (2014).

The post PART 2, Question #16: Disorder, the FIRST of four things to avoid in order to reveal the macrobiotic in your lifestyle: Why avoid DISORDER? appeared first on It's healthy to question.

PART 3:

Recap: This begins a seven part series, “How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle”. Part 1 served as an introduction piece. In Part 2, I introduced the concept of disorder. In Part 3, I will uncover the next of the four suggested avoidances and will continue tomorrow with Parts 4 and 5. Part 6 will recap the four as they relate to the consideration of a plant-based diet, specifically, and finally, Part 7 will be a summary and reflection inviting you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step. I’ll post a new part every other day, giving you a chance to read along. I hope you continue to enjoy this 2-week journey with me!

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1) IMPURITY

1. The principle: It is best to eat food as close to its original form as possible. This is a true whole foods diet. Another word you may commonly hear, regardless of the lifestyle or diet, is, “processed”. This word simply refers to anything that may interrupt the proximity of the relationship between the food and its source. The “source” being the earth, or even more literally, the soil. Therefore, in macrobiotics, one attempts to avoid anything that may bring about a level of processing including: preservatives, fillers, chemical exposure (pesticides), refined sugar, over-cooking, cooking with non-stick, plastic or aluminum products, and microwaving, to name a few. Also avoided are foods that are farther from their original or natural form including frozen, genetically modified and non-organic produce. For most, this includes reducing the intake of animal products*. Some may also consider wearing only cotton clothing free of dye next to the skin to avoid exposure to chemicals potentially present in synthetic clothing. 

1. The suggested evidence:

i. Over-cooking (especially char-grilling, smoking, barbecuing and frying) and processing foods (especially with high heat as can be the case even in packaged foods you might not think about like dry cereals) can lead to the formation of chemicals including advanced glycation end products (AGEs) (15,16). When I looked up this term in PubMed to offer some references here, I came up with 7334 articles! I didn’t get through the first page of hits alone without coming across their implication in vascular pathologies (including the etiology of diabetic neuropathy and cardiovascular disease), wound healing and kidney disease. They are also associated with cancer, as AGEs can directly damage DNA! They lead to inflammation, insulin resistance, and by way of all of these processes (and others), overall shortened life expectancy (17).

ii. Cooking aside, chemicals used as pesticides, cleaning products and in everyday products (like plastics) can also lead to adverse health effects. Though DNA damage is usually the most commonly cited effect of chemical exposure (as this process often categorizes chemicals as carcinogens, or chemicals linked with increased risk of cancer), some chemicals can lead to other health effects including hormonal imbalances. According to the Environmental Working Group, these include BPA, dioxin, atrazine, phthalates, perchlorate, fire retardants, lead, arsenic (yes, arsenic can be found in food and water), mercury, perfluorinated chemicals, organophosphates and glycol ethers18. Perfluoroctonoic acid, the chemical used to make non-stick kitchenware, has been linked to decreased bone density in women, various childhood diseases (possibly through exposure via the mother in utero or through breast milk) and, potentially, cancer.

iii. Cocamide diethanolamine is a perfect example of chemicals that go beyond dietary exposure. This is a chemical that has been found in nearly 100 types of shampoo. So, yes, macrobiotic living means considering every substance that makes contact with your person from shampoo with DEA to deodorant with aluminum. There are numerous impurities in our everyday experience from our house to the air that we breathe.

iv. Sugar is an impurity. Sure, in and of itself sugarcane sounds and seems “all natural”, but let me ask your inquisitive nature this: would you take cocaine over sugar? You might want to consider that sugar works on the same brain networks as cocaine19! So when sugar makes its way into your food (and I’m not talking about adding a little sugar to your tea, I’m talking about the sugars most people don’t know are in their everyday food products in the seemingly “health food” isle of the grocery store) you become ad addict. Try elimination for a few days and see how you feel… and better yet, see how your taste buds react to moderate sugar (a piece of fruit, for example) afterward. In the meantime, read Dr. Hyman’s books (available on Amazon).

The impurities around us are overwhelming, huh? Well, a macrobiotic approach aims to reduce as many impurities as one can, without allowing added everyday stress over those you cannot avoid (don’t forget, disorder—and therefore, stress– is just as undesirable as impurity). I bet you’ll find that just being aware brings about half the change (#counsciousnessiskey).

So I pose to you… why avoid impurity in your life?

References

15. Goldberg, T. et al. Advanced glycoxidation end products in commonly consumed foods. J Am Diet Assoc 104, 1287–1291 (2004).

16. URIBARRI, J. et al. Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet. J Am Diet Assoc 110, 911–16.e12 (2010).

17. Goldin, A., Beckman, J. A., Schmidt, A. M. & Creager, M. A. Advanced Glycation End Products Sparking the Development of Diabetic Vascular Injury. Circulation 114, 597–605 (2006).

18. Dirty Dozen List of Endocrine Disruptors. Environmental Working Group at

19. Lennerz, B. S. et al. Effects of dietary glycemic index on brain regions related to reward and craving in men. Am J Clin Nutr ajcn.064113 (2013). doi:10.3945/ajcn.113.064113

*The purpose of this article is to serve as an introduction to the principles of macrobiotics whereas the discussion of animal use, can be a lengthy one encompassing a each of the principles touched upon here and more and so, for simplicity, will not be discussed here. This also explains why I have chosen to mostly use the term “plant-based”. A discussion of the topic of animal use will be attempted in Part 6.

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PART 4:

Recap: This begins a seven part series, “How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle”. Part 1 served as an introduction piece. In Part 2, I introduced the concept of disorder and in Part 3, the concept of impurity. In Part 4, I will uncover the next of the four suggested avoidances and will finish tomorrow with Parts 5. Part 6 will recap the four as they relate to the consideration of a plant-based diet, specifically, and finally, Part 7 will be a summary and reflection inviting you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step. I’ll post a new part every other day, giving you a chance to read along. I hope you continue to enjoy this 2-week journey with me!

EXTREMES

Let’s start this one with an example. I have a friend who was telling me recently about someone they know and care about who potentially has come to exhibit traits of alcoholism. This person has a high-pressured job and has fallen into the pattern of a workaholic. However, because he’s chronically stressed, nearly 24/7, on his one night off (when he gets it) he goes out and binge drinks (excessive drinking) all night, nearly to the point of black out. You may be thinking this situation in itself is extreme, and not healthy on either end (in fact, qualifying for an official DMS-V diagnosis of alcohol abuse); isn’t it obvious? Well, let’s dissect the concept of “extremes” a little more and come back to this example later…

1. The principle: Macrobiotics is a lifestyle of moderation. It encompasses some aspects of eastern philosophy in that energy is at the core of everything. This philosophy brings in the concepts of “the five transformations” and of “yin and yang” and is beyond the scope of this article. When I say everything has an energy I mean from different foods to different people and different states of health. For simplicity, I simply offer the example that certain foods are considered more yin (or expanding and softening) and others are more yang (or contracting and hardening). Examples of foods that are said to be more yin are greens (which expand upward when they grow) or alcohol (which dilates your capillaries and “shoots up” to the brain). An example of yang foods may be salt (causing your cells to spill out water and contract) or baked goods (that harden as they cook).

The above image is from the website of Denny Waxman: a leading educator and outstanding teacher of the macrobiotic lifestyle; http://www.dennywaxman.com/ (20)

The diet also considers what effect the food might have on the pH of the GI tract and blood when absorbed (especially if in excess or extreme)21. Extreme acidity is linked with disease. The diet aims to balance all of these forces. To make it all the more complicated, yin and yang circle into each other (just picture the symbol above#). Therefore, in theory, going a bit too yin can actually have a yang effect. Again with simplicity, I offer this metaphor to consider: if you eat only salt (theoretically yang), eventually the salt and water in the body (and each cell) will equilibrate eventually causes expansion (yin) of the cells. Therefore, not only does food have “energy”, but so does the body. This “energy” of the body can be referred to as one’s “condition”. From this crude example, you may also being to see how the “energy” of the food can transition to the “energy” of the body, or, how the food can affect one’s condition. In approaching lifestyle and food this way, one can see how extremes, or excess of any one extreme, may be unhealthy. Macrobiotics is about eating to one’s condition with the goal of aligning any “extremes” so to speak, back in balance, or maintaining balance with moderation.

Disclaimer: “energy” is used here with a very broad application and again, being that the scope of this article is to offer an introduction to some principles of macrobiotics, the philosophy, semantics or etymology of this term will not be discussed here. Please take its use, “with a grain of salt” (pun intended) (insert wink here).

2. The suggested evidence: This should be a fairy easy principle to grasp (HA!), ok, well, energy-talk aside. There are many, many foods that are advised as best to avoid in extremes4. For simplicity, I’ll touch upon here those mentioned above: too much alcohol or salt, or sweets are simply not good for your health. High intake of salt leads to high blood pressure. Excess alcohol should be avoided in those with high blood pressure, and in long term can cause serious liver disease. Increased intake of white bread and sweets can lead to insulin resistance and risk for diabetes. I will mention a few recent articles, published in high impact scientific journals, worthy of discussion. (A brief shout out to my fellow research scholars for sharing these in our email thread). One recent study demonstrated that animals* of young or middle age that were fed a high protein diet had poorer outcomes when faced with the burden of cancerous tumor(22).

Note: Yes, this was an animal study. The use of animals for research is an entirely separate topic to be discussed in a later post, in part, in part 6 of this series.*

A clinical (human) study published in the Journal of the American Medical Association (JAMA) demonstrated that those who overate on a low-protein diet had significantly less weight gain and had increased metabolism23 indicating that excess protein in the diet is not optimally healthy and may, in fact, increase disease. A second recent study drew media attention to call sugar the new food enemy. This study demonstrated that increased consumption of sugar (processed as opposed to sugar from fruits) was associated with higher rates of cardiovascular disease (even in those who were not obese)24. Finally, chronically elevated sugar in the blood has also been linked with dementia (memory loss and potentially Alzheimer’s Disease)25. These findings give the phrase, “everything in moderation”, a new weight (literally) and if taken seriously can minimize the risk for disturbing balance in the body.

Back to the example; the workaholic (prior post) is very contracted/tense/tight (yang) and the alcohol is a form of release (yin). Neither are healthy, but one can see how balance is necessary, even if forced, in our lives. So shouldn’t we aim to make conscious choices to meet a healthy balance? A macrobiotic approach is to avoiding extremes and considering things in moderation. In regards to diet, macrobiotic calls us to “eat in the middle” so-to-speak. It’s not about deprivation, but moderation. I bet you’ll find that just being aware brings about half the change (#counsciousnessiskey).

So I pose to you… why avoid extremes in your life?

References

4. Ruxandra. Macrobiotic Diet 101 | Everything you need to know about macrobiotics! Gourmandelle | Vegetarian Blog, Free Meal Plans, Recipes at

20. Waxman, D. Macrobiotics; http://www.dennywaxman.com/MACROBIOTICS.pdf. Denny Waxman at

21. Womhoff, L. Macrobiotic diet basics, Page 6 of 9; The Theory of Acid and Alkaline. Macrobiotics Cooking with Linda Wemhoff at

22. Levine, M. E. et al. Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism 19, 407–417 (2014).

23. Bray, G. A. et al. Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial. JAMA 307, 47–55 (2012).

24. Yang Q et al. ADded sugar intake and cardiovascular diseases mortality among us adults. JAMA Intern Med (2014). doi:10.1001/jamainternmed.2013.13563

25. Moreira, P. I. High-sugar diets, type 2 diabetes and Alzheimer’s disease. Curr Opin Clin Nutr Metab Care 16, 440–445 (2013).

*The purpose of this article is to serve as an introduction to the principles of macrobiotics whereas the discussion of animal use, can be a lengthy one encompassing a each of the principles touched upon here and more and so, for simplicity, will not be discussed here. A discussion of the topic of animal use will be attempted in Part 6.

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PART 5: 

Recap: This continues the seven part series, “How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle”. Part 1 served as an introduction piece. In Part 2, I introduced the concept of disorder and in Part 3, the concept of impurity and in Part 4, the concept of extremes. Today, in Part 5, I will uncover the last of the four suggested avoidances. Tomorrow, Part 6 will recap the four as they relate to the consideration of a plant-based diet, specifically, and finally, Part 7 will be a summary and reflection inviting you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step. I’ll post a new part every other day, giving you a chance to read along. I hope you continue to enjoy this 2-week journey with me!

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STASIS

The principle: Stasis, whether of blood, lymph or energy, can harbor disease. Movement and change are crucial to survival of every being and of the planet. Macrobiotics promotes at least 30 minutes of exercise a day. There is also a practice in macrobiotics known as “the body rub” where a wash clothe (organic, of course) is dipped in warm water and used to scrub the skin, especially in places where lymph nodes are anatomically prominent26. Clothing that limits circulation or lymphatic drainage, such as bras with underwire, should be avoided.

The suggested evidence: Red blood cells turn over occurs every 120 days in order to keep our blood at maximum capability of transporting oxygen to our tissues and carbon dioxide out of the body through the lungs. This explains the timeline of the laboratory value, hemoglobin A1C. This laboratory test is one often used to diagnose or monitor disease in patients with diabetes (type 2). When blood sugar has been elevated for an extended period of time (such as 120 days) it can form molecular bonds with proteins on the surface of red blood cells (a process called glycosylation). Being that hemoglobin is one of the proteins that red blood cells carry (and, arguably the most important being that it’s the one responsible for oxygen transport) the amount of accumulation of this glycosylation is described by the hemoglobin A1C test and can tell a clinician how well (or how poorly) controlled one’s blood sugar levels have been over the past 3 months (120 days). Here’s the punch line: red blood cells are usually very malleable and limber (they have to be to get through your teeny tiny capillaries to every micron of your body), but when these cells become glycosylated they have difficulty traveling around the body (stasis). This leads to lack of oxygen (hypoxia) in certain areas like the nerves leading to neuropathy and secondary skin ulcers as occurs in diabetes, for example. Blood sugar aside, any lack of blood flow leads to hypoxia and potential tissue damage through the process of ischemia. Any tissue that cannot get oxygen, cannot survive. This is the concept, though overly simplified here, behind conditions like stroke and heart attack.

Lymph transports and filters chemicals, fats and immune cells throughout our body. When lymph cannot flow, chemicals and fat are left behind (stasis). Further, if lymph is unable to circulate, immune cell circulation is also impaired – especially the dendritic cells, which are the ones to grab that static debris and those invading pathogens and bring them to the lymph nodes to show the army (aka immune system) what to go after in the body (bad guys) and what not to (self). Being that our immune system is the army against infection and disease and the source of “clean up” of a lot of biological debris in our body, stasis of it can pose a serious problem. Not to mention, if our immune system cannot determine bad guys from self, things like allergies, autoimmune diseases and even cancer can evolve (where our body is unable to see when our self has gone awry) – notably, I’m over simplifying here. To pose some more specific examples, even distant disease (such as of the lung relative to the gut) has been linked to sites of lymphatic dysfunction farther away in the body (the gut) when that dysfunction is blockage (stasis)27. Blockage of lymphatic drainage also leads to the decreased clearance of products of the skin (possible support for the body rub)28and deposition of fatty tissue and manipulation of genetic expression in fat cells29. A more obvious example of stasis occurs in women who acquire lymphedema after mastectomy (surgical breast tissue removal) due to breast cancer. Lymphedema is a pooling of fluid (usually in the arm closest to the surgical site) due to the removal of lymph nodes and tissue, which normally would serve to filter said fluid out of the arm, and likely, into the blood stream to the kidneys and out of the body. Importantly, though the blood has the heart to propel it throughout the body, the lymph relies on the movement of skeletal muscle to help propel it through lymphatic vessels. Therefore not only is stasis in the form of inactivity a risk factor for virtually all acquired diseases (Total time sitting has been linked to all cause mortality30), but it promote cascades into a diffuse state of stasis throughout the entire body. Put down the computer (after you finish reading this) and do a little yoga or go for a 30-minute walk while you meditate on, or simply, ponder…

One who embraces the principles of macrobiotics, “keeps it moving,” bringing about a sense of synchronicity in all systems including the blood, lymph, gut, muscles, energy and entire body, therefore, aligning mind, body, spirit and nature at large. I bet you’ll find that just being aware brings about half the change (#counsciousnessiskey).

So I post to you… why avoid stasis in your life?

References

26. About: She Cooks Macro. She Cooks Macroat

27. Deitch, E. A. Role of the gut lymphatic system in multiple organ failure. Curr Opin Crit Care 7,92–98 (2001).

28. Liu, N. et al. Hyaluronan metabolism in rat tail skin following blockage of the lymphatic circulation. Lymphology 35, 15–22 (2002).

29. Aschen, S. et al. Regulation of adipogenesis by lymphatic fluid stasis: part II. Expression of adipose differentiation genes. Plast. Reconstr. Surg. 129, 838–847 (2012).

30. Patel, A. V. et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am. J. Epidemiol. 172, 419–429 (2010).

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PART 6:

Is diet all in a name… or bounded by a specific shape?

A brief overview of the “plant-based diet” vs. the “macrobiotic lifestyle” and how the ethics of animal life, consumption and use can’t be avoided.

This is an attempt at “a topic” that is, in reality, a million topics in one. The good news is: I will never be out of questions to raise on this blog even if I only ever continue along the lines of what will be addressed here. The bad news: it is nearly impossible to even briefly address all of them in one post. I do my best to highlight some of this topic as it relates to our series with an emphasis on the macrobiotic lifestyle. Disclaimer: much of this topic is controversial and my writings here are not for me to claim or stand by any one view point, but rather are an attempt to be provocative, as I aim to bring only enough information to light to let my readers raise and respond to their own questions following their own inquisitive nature.

*The topic of food pyramids, plates and nutrition plans will be the topic of a future post.

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Recap: This continues the seven part series, “How can you put STYLE in your LIFE?: revealing the macrobiotic in your own lifestyle”. Part 1 served as an introduction piece. In Part 2, I introduced the concept of disorder and in Part 3, the concept of impurity and in Part 4, the concept of extremes and, finally, in Part 5, the concept of stasis. Today, in Part 6, I will recap the four as they relate to the consideration of a plant-based diet, specifically. Finally, in Part 7, I will be a summary and reflection inviting you to see what might have been revealed to yourself regarding your own lifestyle and how you may take the next step. I’ll post a new part every other day, giving you a chance to read along. I hope you are still enjoying this 2-week journey with me!

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Hopefully by now in the series you may begin to see that macrobiotics is about a lot more than diet alone – hence the emphasis on lifestyle. So, with this in mind along with all of the information of the prior 5 parts, has it become apparent to you what differences exist between macrobiotics and a, simply, plant-based lifestyle? Let’s list some examples to apply the four described principles:

1) DISORDER: A plant-based diet does not necessarily mean that one eats at regular times of day consuming mainly seasonal and local ingredients.

2) PURITY: Persons who are plant-based may still consume processed foods (just take a look at any “meatless” section in your local grocery store’s frozen food section) or cook on non-stick pans. Or, simply, look at some of my glutenous vegan food pictures (Instagram). 

3) EXTREMES: A personal weakness of mine when simply plant-based, is to over do the salt or sugar (mmm vegan brownies – luckily macrobiotics is about moderation and eating to your condition as sometimes a yummy one of these is necessary). Some who follow a plant-based diet without proper guidance may, indeed, become vitamin deficient (as the concern raised in Part 1). Eating only yin greens will not only throw you yang, but may deplete your body of more than just impurities.

4) STASIS: Finally, just because one consumes mainly plants in a diet, does not mean they have committed to a lifestyle, which includes regular activity, mind-body balance or stress reduction, and blood and lymph friendly practices (such as “body rubs”/The body scrub).

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Now, let’s get to another elephant in the room (this time a bit more literally on the animal reference); animal use.

Chang is the Thai word for elephant – a sacred animal in the Thai culture. These are some I interacted with in 2006.

For this part of the article, I’m going to jump out of order on principles since not only do they overlap, but addressing each individually would require not only an entirely separate series of posts, but likely an entire blog or website (and plenty of those already exist for those interested in the pursuit of animal happiness –some supplied as references at the bottom of this post).

In thinking about the principle (of avoidance) of “impurity”, animals raised for the purpose of human consumption are often fed food they wouldn’t necessarily consume in nature (corn and wheat rather than grass ), therefore minimizing any nutritional hierarchy that would exist in nature (if much of any to being with). These animals are also often given hormones and antibiotics (impurity should be self explanatory here). However, I bet most readers here would already agree that these practices are not ideal (macrobiotic or not). This might suggest that if such circumstances are removed, so are the challenges to the macrobiotic principles they challenge.

Of note, I’ve heard the argument, “What about all the animals that are killed in the process of gathering plants for human consumption (especially when considering being “in sync” with the environment)?” However, much more harvesting is needed to supply these crops to feed livestock than would be needed to feed the entire human population in plants only. Further, this is in line with utilitarianism mentioned below (the idea that harm as few as possible for the benefit of as many as possible) and the topic of intention described below. Again, there is not enough room to address all concerns here so environmental ethics will need to be the topic of, yet another, future post.

In some sense animals are still not a primary food source –from THE source (the earth/the soil), but another means of processing plants, (or another step removed, (from the earth/soil)). (Yes, I am aware of arguments that animal meat offers a ‘simple’ way to obtain essential nutrients due to the idea that the animal has done the processing‘for you’, but this is just the contrary to the principle to begin with, not to mention the digestion of animal products is not necessarily easier on the gastrointestinal system than plant sources, but I won’t go into that here). Regardless of your view on animal products, what is most important to grasp, ties in all four principles. Macrobiotics is an attempt to be in sync with what the earth gives us for food, rather than viewing it as a hierarchical chain. (No, I’m not trying to get theosophical on you, just stating a fact; the earth IS where our food comes from although I could see how this would be hard to believe if one is used to consuming colorfully designed packaged products made of nearly 100% chemical filler or animal protein squeezed out into smooth cylindrical shapes as regular ‘meals’).

Now, take a second to think about what it’s like to work in a chain of command where you are defined as “below your boss” or needing to fight harder to overcome those “below you” and “survive” in the workplace. If you’re like me, you already feel knots building in your shoulders (contracting yang energy?) from the stressful experiences this idea provokes. (Not to mention if this is your current work situation, you may need to reassess either the environment or how you approach balancing the stress provoked from it). Therefore, macrobiotics suggests that the closer one is to the earth and its sources, the less dependent on process and hierarchy, and the less hostility in one’s own body (lower allostatic load), social relationships and environmental/ecological impact.

Let’s push this concept a step further into philosophical and theoretical application. Hostility is present in an animal as it is being sacrificed and so it is yet another form of extreme, imbalance and stress (talk about extreme(s)… as the act of taking life might be considered). Of note, macrobiotics places animal products in the “extreme” “yang” category. I’m still not entirely well versed in the Eastern philosophical grounds, but maybe it has to do with the extreme energy harbored through their sacrifice? What do we care, you ask? Well, I’m going to be bold and throw out there a radical concept. There are accounts of recipients of organ transplants experiencing cravings or even recalling memories of their donors, a concept known as “cellular memory”. Only one article on PubMed broaches this topic25 that I could find. Further, many remain with an understandable and healthy skeptical view26,27 of the concept of “cellular memory” as these accounts only rely on storytelling and not science, but is it possible there’s something to it? We know that stress has the ability to bring about epigenetic modifications to cellular protein expression28,29. Yes, at present, this is a huge stretch with no evidence to be directly linked to these “extreme” ideas. However, given even just the ideas at hand, is it possible for the energy of a slaughtered animal to be “remembered” in its cells, possibly biologically, and encompassed by yours? Maybe not… just food for thought… literally. Of note, Will Tuttle, the author of “The World Peace Diet”, would argue that the answer to this question is; yes. Reference to his work, which I don’t have space to describe here, is below30.

Ok, “cellular memory” aside, what about the act of killing animals? If this is something one believes is ethically unsound it creates someone so called, the “ethical vegan”. Macrobiotics consider ethics in their diet, in addition to nutrition, with the foundation that ethical considerations, outside of human interest alone, is in sync with the environment. Questions about (and often raised to) “ethical vegans” are well addressed by a book I recently read and will share here as a reference in the interest of space (it would be impossible for me to address each individual ethical consideration of “ethical vegans” and “macrobiotics” alike in a single post). Note, many of these issues come down to intention. Therefore, here, I am emphasizing the intentional killing of animals for human consumption. More on intention as well as other ethical considerations are addressed in this book:

----Mind If I Order The Cheeseburger? And other questions people ask vegans – Sherry F. Colb; Amazon.com “Look Inside”

31Talk about inquisitive nature, this book addresses many questions often raised to those who consume a plant-based diet or raised, in general, by those considering embarking on such a diet. It is a quick read that addresses these questions using well-structured arguments (that follow the format I was taught in Philosophy/PHL101 in college myself!). With the exception of some metaphors that might be a bit stark and sometimes a bit oversimplified to make a given point, it is well written and serves as a good resource for those asking the questions and a good reference for those who tend to be asked.----

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Ok, I know you’re thinking that with all of this talk of ethics, philosophy and inquiry, I must address this one: “You’re a scientist that advocates for plant-based diets and potentially animal rights; what is your stance on animal use for scientific research?”

Well, this is a tough one. I am not entirely sure what macrobiotics would say about this and I am sure anyone could apply the principles in support of their respective viewpoints. I will say that at the current time (emphasis here, indicating that things may change given my knowledge base, views on the world, or the evolution of technology and its advances), I see a need for – at least some – animal research. Speaking of hierarchy, there is an unspoken one in medical research. Life-saving medical advances are often made by progressing from molecular to cellular laboratory bench research to animals before human subjects**. Sure, diet research can be done in human subjects only, but can uncovering cures for pediatric cancers, genetic disorders and tools for trauma surgeons (for example) be done in humans first line? Until we evolve so much as to no longer need these “cutting edge” acute care interventions, we need the research to continue to support and advance them. Not to mention, the only way to potentially evolve to a point of no longer needing them is in research to begin with. In fact, you’d be hard pressed to find even the most rigorous biomedical scientist to say their career goal is to harm animals. Rather, scientists are likely to admit their goals as eliminating x disease, finding cure y or prevention z …or overall advancing the human race.

Therefore, animal use in research is an ethical conundrum I am not equipped to address here, and will pose back to you for reflection. However, I will, personally bank on the principle of avoiding extremes here. Animal research may, at this moment, be necessary in moderation, when no valid alternative can be seen and with as much dignity preserved and lack of suffering granted (oh boy suffering animals brings in terms like sentiency –back to the philosophy 101 textbooks as those which helped shape my plant-based choices in college to begin with – that good ‘ol environmental philosopher might have been onto something). I am somewhat comforted by rules such as animal care guidelines required by most Institutional Review Boards of medical research and often by most reputable journals before considering the publication of such work. These guidelines are in place, specifically, to reduce harm to animals and see that all research is done in humanistic (animalistic?) manor. In fact, as I mentioned above, I haven’t come across a single scientist that wants to hurt animals, but I have come across many who want to help humans (utilitarianism– here you go again philosophy 101 professor – the idea that it is best, and ethical, to act in favor of the greater good – i.e. harming a few animals to rid potentially millions for suffering or cure many of a disease). I haven’t reconciled an ideal way to bridge the gap between certain forms of science (some biomedical research) and human advancement along with the complete elimination of animal suffering, at least yet.

**The truth is, every aspect of evidence-based medicine and research has its own ethical conundrum. For example, human cells used for tissue based research are indeed “animal free”, but they bring up a unique ethical challenge (informed consent) and highlight the philosophical question, “when does life end if these cells remain immortal?” These are beyond the scope of this discussion here and will serve as a future post. In the meantime, I’ll be finishing a book that addresses both of these issues and I suggest you do the same before I write my opinion of it (The Immortal Life of Henrietta Lacks, by Rebecca Skloot)32. At the end of the day, I give gratitude for every form of life or derivation from it that has contributed to evidence-based medicine, from human cell to living animal, especially if I am directly involved in said research or sharing such findings (as I do on this site).

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Getting back to the discussion comparing “plant-based” and “macrobiotic”. Though I have lead you to believe that macrobiotic was more than just a diet, this certainly does not mean to suggest that “plant-based” is merely a diet. In fact, I have attended enough animal rights events to know that many (dare I say most) vegetarians and vegans are so because of way more than food. I list some valuable organizations below doing work to fight against atrocities such as factory farming, for example.

One of the organizations I am the most passionate about, the Physicians Committee for Responsible Medicine, is committed to projects that support animal rights, reduce animal use in biomedical research, advocate for healthy plant-based living and result in self-funded rigorous nutritional studies33. Therefore, I think PCRM is the perfect example of coming full circle in this particular series of issues. Because I cannot possibly begin to share in this space the amazing work they are doing and the extremely sound arguments they, and particularly their founder Dr. Neil Bernard, hold, I can only offer to share here their mission and a link to the debate “Don’t Eat Anything With a Face”34 featuring Dr. Bernard and Gene Baur, President and co-founder of Farm Sanctuary35. I will even ask you to visit their site to learn more on your own and even consider the extra step to donate to their cause: DONATE TO PCRM and/or DONATE TO FARM SANCTUARY …

…So that you can see I practice what I preach; the organizations I support:

I support PCRM, Farm Sanctuary, and Compassion Over Killing

With that I ask a question in closing; what are the divides between “plant-based”, “macrobiotic” and simply ethical?

So I pose to you… Is diet all in a name?

References

25. Pearsall, Schwartz & Russek. Changes in heart transplant recipients that parallel the personalities of their donors. Integr. Med. 2, 65–72 (2000).

26. Williams, N. Cellular Memory in Transplant Patients: Pseudoscience. Rational Skepticism at <http://www.rationalskepticism.org/pseudoscience/cellular-memory-in-transplant-patients-t38895.html>

27. Cellular memory. The Skeptic’s Dictionary at <http://skepdic.com/cellular.html>

28. Reul, J. M. H. M. Making Memories of Stressful Events: A Journey Along Epigenetic, Gene Transcription, and Signaling Pathways. Front Psychiatry 5, 5 (2014).

29. Zannas, A. S. & West, A. E. Epigenetics and the regulation of stress vulnerability and resilience. Neuroscience 264C, 157–170 (2014).

30. Tuttle, W. M. The world peace diet: eating for spiritual health and social harmony. (Lantern Books, 2005).

31. Colb, S. F. Mind if I order the cheeseburger?: and other questions that people ask vegans. (2013).

32. Skloot, R. The immortal life of Henrietta Lacks (kit): book club kit. (2010).

33. Physicians Committee for Responsible Medicine 2006 Fiscal Year Report. PCRM.org at <http://www.pcrm.org/good-medicine/2007/winter/physicians-committee-for-responsible-medicine-2006>

34. Don’t Eat Anything With A Face. at <http://qwww.intelligencesquaredus.org/debates/upcoming-debates/item/910-dont-eat-anything-with-a-face>

35. Farm Sanctuary. at <http://www.farmsanctuary.org>

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PART 7:

Just a day ago I was in a lecture on autoimmune disease.  The lecturer continued to mention how correlated autoimmune disease is with environmental conditions so I decided to ask whether any environmental influences (like diet) have been associated with remission rates in such diseases.  The speaker actually said, “I have many patients that come to me saying their conditions almost entirely resolved with a vegetarian diet…so I say, if a vegetarian diet helped, go vegetarian.”  In response to another students question about how to best advise our patients against all the seeming environmental risk factors (impurities) in the world, the speaker said, “Ya know, I say everything in moderation, avoid extremes and follow a healthy balanced diet.”  My point is, we all (NIH researchers included) may already be just a little more “macrobiotic” (in terms of principles) than we think.

Now that you have a background in macrobiotics, let’s summarize by revisiting the topics of my initial post.  1) Research 2) My, personal, decision to explore macrobiotics.

1) RESEARCH:  

WHAT type of research can be done to establish that this diet and lifestyle may impact outcomes in these diseases? OR must we rely on the research already in progress by such investigators like Neal Barnard and Dean Ornish to corroborate that the diet alone can make a significant difference in the body and in, perhaps, our DNA? Many people have criticized the Kushi’s over the years for not doing research. Others, criticize those who do nutrition research for it’s lack of precision.

Well, I have done my best to show you that there has been limited research in macrobiotics itself (Part 1) and though there’s modest research to support some of the principles I raised in Parts 2-5, but these are an attempt to dig into the literature where numerous limitations exist. Therefore, I regret to agree that there certainly exists no concrete research that indicates efficacy of the macrobiotic diet or lifestyle.  However, as far as DIET, specifically, Dr. Neal Bernard and Dr. Dean Ornish are conducting sound research assessing disease outcomes based on lifestyle intervention with many successful results (though some modest challenges as I’ve begun to suggest exist in most nutrition research methodology).  I will discuss the work, specifically of Dr. Ornish in a post in the near future (outside of the current macro series you’re reading).  I will also soon address the challenges to obtaining funding for this sort of research (which therefore only favors the lack of its existence to begin with).  Though this is exciting to me as a physician interested in nutritional health, the research of these investigators will not officially answer the question; “Does macrobiotics work?” per se.

Therefore, if we are discussing how to conduct better research of the macrobiotic diet and lifestyle, specifically, I am afraid we have ahead of us a fork in the road.  One pathway (A) in the fork leads to good, sound, biomedical research.  That pathway tells us we need to reduce confounding variables and assess one, clear intervention on one clear disease.  This would mean selecting only one diagnosis.  For example, only breast cancer patients could be included for study, or even better, stage 0 DCIS (ductal carcinoma in situ). I pose this to exemplify how the more specific, the more ideal.  Ok, next step down this particular pathway (A) needs to include a clean intervention.  This would mean a very specific lifestyle (the more details the better). For example, participants will each eat exactly 5 cups of brown rice a week, with the remainder of the calories distributed as ____% other grains, ____% leafy greens, ____ % other vegetables, ____% beans & legumes, including no refined sugar or flour, baked goods limited to ___ servings per week… and the list goes on.  As you can see, this level of specificity is extremely difficult to obtain or assure without flaws.  Aside from the methodological challenges of pathway A, this reductionist approach does not lend itself to true “macrobiotics” (i.e. true macrobiotics is personalized to season, geographic location, and condition of each person), as I hope you will better understand after this series of posts. Therefore, though pathway A is necessary to conduct sound biomedical research, it is nearly impossible to use this approach to conduct research specifically in “macrobiotics”.  However, it may help us obtain at least some answers to questions about dietary effects on certain medical conditions.

Ok, so what would pathway B hold at this fork in the road?  Pathway B would be to really study the true macrobiotic lifestyle.  This means that each individual person (subject in the research study) would be assessed for their condition (allopathic disease diagnosis, level of yin vs. yang in their condition, areas of energetic stasis, etc). The intervention would also be personalized to each condition (for example: those who are more yin are recommended some more yang foods than the subjects who are more yin, those who have more stasis are recommended 60 minutes of walking every day compared to others who are seen as overactive and recommended 15 minutes of meditation daily, etc).  In this, pathway B, the study is more heterogeneous overall (subjects and interventions are all different).  Though this pathway allows for a more ideal approach to macrobiotics it makes any findings more difficult to interpret and, therefore, any conclusion that much more difficult to draw.  In other words, if all subjects improve it could not be said if it was the food or the exercise that helped or perhaps just the amount of lifestyle change in general, or increased attention from research assistants, and not necessarily “macrobiotics”. One can see how this pathway loses its research “prestige”. Critiques would discount and significant results due to a lack of “clean” experimental design.  So, what I have done is outlined the problem (likely exactly why the Kushi’s have opted out of research for so long), but I haven’t addressed macro-mom’s request.  In other words, does the road lead to a potential pathway C?

I see hope for a pathway C.  C must stand for CONTROL.  I think the best bet that macrobiotic investigators will have for conducting better research will be to focus on their control group.  Of course, the control group in research is the group that allows for comparison to the “norm”.  In other words, we would “hope” (sorry to imply bias here as sound research should never) that a “macrobiotic intervention group” would improve across all outcomes compared to the “control group”.  Therefore, the success (or failure) of proving the (potential) benefits of the macrobiotic diet lies in defining an ideal CONTROL (yea, pathway C!).  A control group basically serves to reduce the placebo effect (or the chance that persons may improve in outcome based on chance alone and without a “real” or “active” intervention; note: the placebo effect is yet another topic I will need an entire post, outside of this series, to address).  The question remains, “what is the ideal control group for macrobiotic research?” Well, macro world, I don’t have a great answer for you… yet, but I bet it’d look something like this:

Intervention (Macrobiotic) Group

Control Group

Counseling ___ number of times

Extra time with providers (nurses, physicians, dieticians) to match the extra amount of time being given to Group macro

Assessment of condition

Since conditions will be of such a variety, controls will need to MATCH these conditions (just as many relatively yin persons as in Group macro, just as many with diabetes or cancer, etc). Note: in order to match effectively and see gross differences in such a heterogenous population, we need a HUGE sample size of subjects in both groups.

Dietary intervention = macrobiotic diet (again, this would be heterogeneous, but it’d mimic some of what was suggested above at least in caloric definition and general principles would need to be identified (i.e. how much animal product, how often grains, etc))

This could vary. The control may be another form of dietary intervention (likely simply increasing vegetable consumption)

Other changes (reduction of processed chemical exposures, increase in exercise, meditation/yoga, body rubs, etc)

Each change would need to be accounted for with a control. For example: 1) change of clothing or pots and pans used, not necessarily to reduce chemical exposure, but to show any potential observed improvements in Group macro are not simply a result of change in product type alone, 2) and 3) subjects may be controlled for exercise/yoga by being recommended by a physician to increase activity or reduce stress without the specific intervention of Group macro, 4) subjects may be advised to shower daily to compare to Group macro who will also complete body rubs

Are you starting to see the basic methodological approach here? Of course, the control group will likely experience changes and perhaps even improvements in their conditions, but it will be easier to conclude what improvements are attributed to change of any kind or exposure to increased time with healthcare providers in general verses outcomes related, specifically, to macrobiotics. Now we can see how, a research outcome is only as good as its Control (or Comparison).

Of course, this level of complexity and design is only capable with adequate resources and funding (as I mentioned above, this is an entirely separate challenge to lifestyle intervention research of which I’m excited to address in the future).

Dr. Ornish’s research serves as a good starting place or example for the macrobiotic community as it incorporates much of the above (diet, yoga, mindfulness) while also accounting for comparison in the control groups.  However, challenges remain.  What Dr. Ornish does well is he understands the importance of assessing outcomes.  He doesn’t simply look at overall health improvements, but changes in biological markers or disease and health including alterations in gene expression. This is important to understanding HOW lifestyle changes impact health and disease and not just IF they do.  Again, please stay tuned for a post on the horizon where I’ll share some highlights (as best I can) of the works of Dr. Ornish.

In the meantime, as macro-mom suggested, many of the benefits of macrobiotics that are spoken of are based on case studies.  Well, sorry to say, I’m only offering one more study here (case study, sample size of 1) here. Allow me to transition from biomedical research methodology to something much easier to talk about… me (haha).

2) My, personal, decision to explore macrobiotics:

I want to share some steps I take to reduce the presence of the four avoidances and the (potential) benefits I claim to have experienced.  Again, note, this is a sample size of 1. Further, correlation never (in any scientific writing – research or other) equals causation.  In other words, correlation between the timing of my macrobiotic lifestyle changes and my subjective, self-reported changes, definitely do not mean that macrobiotics caused these benefits.  In fact, they very well might be a placebo effect at work (after all, there is no control group here).  BUT, who or what’s to say they are not “significant” in their own way (even if not by statistically p-value)?

MY ACTIONS:

1)    I wake up when my body is ready.  Unfortunately, not always at 8am when cortisol rises and would be best for me to eat, but it works with my own synchronicity.

2)    I eat at regular mealtimes, avoiding snacking in between.

3)    I avoid eating at least 2 hours before bedtime.  Unfortunately, not always before midnight as, again, would be best for my cortisol levels (and synchronous with my melatonin levels / internal clock and circadian rhythm).

4)    I balance my schedule between work time, blog time, activity (dance, yoga, meditation) time and social time – even if not in advance. Therefore, I participate in activities to reduce or balance stressors of the other aspects of my life.

5)    I eat seasonally and locally (and organic), when possible and I cook as many meals as I can.

6)    I eat a plant-based diet.  With that, I do get annual blood work to ensure my vitamin B12, vitamin D, iron and other levels are in balance.

http://www.kushiinstitute.org/what-is-macrobiotics/

7)    I cook on stainless steal and cast iron supplies using wood utensils.  I avoid microwaving and only rarely eat grilled or fried veggies.  I can be caught occasionally eating some processed vegan products like seitan or the rare vegan dessert, but I am careful to balance it with a few days of rest from such products (or a “macrobiotic remedy”, which I have not had time to share the details of here, but likely will in future posts).

8)    I avoid over-seasoning, using only occasional sea salt, tamari, miso, gomashio and sea vegetables to compliment cooking (or rare brown rice syrup and very rare maple syrup in the case of desserts or mild sweets).

9)    I drink alcohol in moderation choosing only beverages without added sugar or processed mixers, when I do take a drink.

10) I complete “the body rub” every other day, or daily when I can.

11) I dance at least three to four times a week and add yoga weekly when able.  I choose stairs instead of elevators when short distances and feasible.  I try to reduce wearing synthetic material close to my body or underwire.

BETWEEN ACTION & BENEFIT:

One will find EMPOWERMENT: I keep myself from disappointment when I “stray” from the above goals.  I simply acknowledge where I’m at, assess if I can do better, and keep the principles in mind for when I can return to them.  After all, these principles are about bringing positive change into ones life and reducing stress that comes with the four avoidances so it would be counter-productive to become consumed in any of their applications (this would be extreme and out of balance).  Remember, “the most important thing you can be doing, is the thing you are doing right now” –Deepak Chopra on advice given to him by a Thai monk.

BENEFIT:

1)    Yang to my yin: When I first worked with a macrobiotic counselor, I was informed that my condition was “tight”.  Well, I really do feel “loosened up” (relative to my condition).  I don’t work as hard, or as late.  I don’t get as tense as I used to (and I think my body reflects that as you’ll see in 2&3 below).

2)    I got out of my head: I used to suffer from regular (weekly at least) headaches (if not migraines).  I used to attest them to every thing under then sun – and sometimes the sun itself (hunger, tension, lack of sleep, odd smells, bright light).  However, I can now say in the last 4 months of macrobiotic lifestyle – I have had less headaches than I can count on one hand!  Better yet, I know each of the few headaches that I did experience, followed a period of reverting to my “yin condition” and eating too much sugar (post VegFest, for example) or more processed vegan food.  I’ll add here that some more personal hormonal symptoms have also completely resided.  My previous near daily consumption of ibuprofen has dropped to a rare use of 1 Tylenol (maybe once every 4-6 weeks).

3)    Peaceful warrior: I used to suffer allergies to raw carrot, apple, pear, almonds, strawberries (probably more).  All – gone!  I have consumed each of these items in the past month after slowly introducing apples and carrots when I noticed I had no itch in my throat, no red in my eyes.  I stopped fighting myself, literally (that is what an allergy is) and my body has come to peace.  Yet, still a warrior because with my immune cells no longer busy expelling energy on mast cell degranulation and histamine release (the mechanisms of allergic reaction) anymore, they are readily available at a moment’s notice to do real battle.  In fact, I had a mild cold back in January and it was gone before I could blink. Way to go lymphocytes! In entering spring (allergy season) I’m not sure I’ll be 100%, but I’m sure I’ll be ready for battle in ways my immune system wasn’t in years past.

4)    Unleashed the green goddess: Empowerment, not just of kale, but of self.  Again, as above, this is where the curiosity and questions all started regarding macrobiotics –looking for a sense of self-empowerment.  Ironically, I’ve not only found it, but I hope I’ve now shared some of it… with you.

Now that you have been entirely versed on my perspective of macrobiotics 101 as applicable to all lifestyles (I hope), you may have interest to go back where we (and macrobiotics in general) began; George Ohsawa.  I purposefully withheld his references until now so you would (hopefully) have a better grasp and, dare I suggest, more open mind to what he offers. Google away! I hope you find it interesting to compare to the way in which I have shared my perspectives on the principles in this series.

In conclusion…

https://www.facebook.com/ilovemacrobiotics

Many of the internationally recognized leaders of the macrobiotic community offer simple steps to ‘getting started’, which is why I chose to create a list of different sorts in this series.  Therefore, if you are interested in learning more about macrobiotics, I encourage you to visit, read and study the resources I provided through this series.  However, I hope I have shared some of the essence of macrobiotics in my own STYLE in a way that gives you motivation to embrace at least a part of it into your LIFE.  Even if this is the last article you ever read containing the label “macrobiotics”, I hope the principles shared in these posts (turned into positives here): ORDER, PURITY, BALANCE, SYNCHRONICITY, serve as encouragement to bring as much order, purity, balance and synchronous movement, not just your diet, but your life. With that, go forth and bring your personal STYLE to your own LIFE.  So I pose to you… where is the macrobiotic in your lifestyle?