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

Updated: Mar 21, 2018

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?


Your Inquisitive Nature

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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!



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.


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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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!


Without further ado, these are the things I learned to avoid like the plague when first studying the p