The macrobiotic diet is essentially a specific vegetarian form of nutrition and life-style. A typical macrobiotic diet would consist mainly of whole grains, cereals and cooked vegetables. Some types of fish are allowed but only in moderation.
Popularised in the 1970s by Michio Kushi, it is now often promoted for the prevention and treatment of cancer. There are, however, no clinical trials of macrobiotics for cancer treatment, nor are there reliable epidemiological data to suggest that this diet is effective for cancer prevention. The strictest forms of this diet can lead to severe malnutrition.
Edzard Ernst, CAM Cancer Consortium. Macrobiotic diet [online document], August 25, 2020.
Assessed as up to date in August 2020 by Barbara Wider.
Assessed as up to date in January 2019 by Barbara Wider.
Assessed as up to date in February 2017 by Barbara Wider.
Assessed as up to date in April 2016 by Barbara Wider.
First published in February 2014, authored by Edzard Ernst.
Macrobiotic diet, as we know it today, was developed and promoted by Michio Kushi and is based on concepts of the Japanese philosopher George Ohsawa. Several degrees of strictness in adhering to an essentially vegetarian regimen exist. A typical macrobiotic diet would consist mainly of whole grains, cereals and cooked vegetables. Some types of fish are allowed but only in moderation. Dieters are encouraged to adhere to a life-style which includes eating vegetables while in season, avoiding processed food and overeating, as well as chewing food thoroughly before swallowing1.
The standard macrobiotic diet consists of 50 – 60% whole grains, 20 – 25% vegetables, 5 – 10% pulses and sea vegetables as well as 5% vegetable soup; nuts, seeds fruits and fish can be added occasionally1,2. Essentially, the macrobiotic diet is a high-fibre, low-fat, high complex carbohydrate, mainly vegetarian diet3.
Application and dosage
Proponents recommend adopting this diet for life, and it is possible to do this at different levels of strictness.
The term ‘macrobiotic’ goes back to Hippocrates and was extensively used by Hufeland, a famous German Physician who lived in the 18th century and published his book The Art of Prolonging Human Life (1797) using the term ‘macrobiotic’. The guiding principle of macrobiotics, namely that food and its quality affect health and well-being, can be found in most cultures. In the late 1800’s, the Japanese doctor Sagen Ishizuka allegedly helped patients recover from illness through a macrobiotic diet balanced in acid/alkaline and potassium/sodium content. George Ohsawa recommended progressively more restrictive stages of this type of diet. In the 1970’s, Michio Kushi popularised his less restrictive version of the macrobiotic diet in the US and in Europe4.
Claims of efficacy and alleged indications
Mechanism of action
Macrobiotics is based on the Taoist philosophy of balance; restoring balance between the inner opposite yet complementary forces Yin and Yang treats and prevents disease and illness. The postulated cancer-related mechanisms of action of the macrobiotic diet are not entirely clear. As the diet contains less saturated fat and protein6, it seems conceivable that it is less carcinogenic than a diet with a high fat content. There is some preliminary evidence that adherence to this diet might reduce some risk factors7,8. Being a high fibre and low fat diet, macrobiotics might normalize risk factors such as obesity9.
Prevalence of use
The popularity of macrobiotics varies from country to country and by ethnic group surveyed10,11.
Cost and expenditure
Adherence to a macrobiotic diet should not be significantly more expensive than conventional nutrition.
There are no clinical trials or reliable epidemiological data available to suggest that this diet is effective for cancer prevention5,12. Vegetarian diets seem to confer some protection against cancer but it is unclear whether this effect also extends to the macrobiotic diet13. Such a postulated effect could most likely also be achieved by diets that are more nutritionally balanced and less complex to prepare.
Nutritionally vulnerable groups such as small children, pregnant women and elderly individuals should be particularly cautious regarding the malnutrition risk.
Other problems or complications
- Kushi LH, Cunningham JE, Hebert JR et al. The macrobiotic diet in cancer. J Nutr. 2001; 131(11 Suppl): 3056S-64S. Accessed 11th of September 2020.
- Jonas WB, Ernst E. Part II. Introduction: Evaluating the safety of complementary and alternative products and practices. In: Jonas WB; Levin JS (eds) Essentials of complementary and alternative medicine. Philadelphia: Lippincott Williams Wilkins. 1999; pp. 89-107.
- Lerman RH. The macrobiotic diet in chronic disease. Nutr Clin Pract 2010; 25: 621-6. Accessed 11th of September 2020.
- Anon. Macrobiotic diet. Wikipedia 2017. Accessed 11th of September 2020.
- Hübner J, Marienfeld S, Abbenhardt C et al. How useful are diets against cancer? [in German]. Dtsch Med Wochenschr 2012; 137: 2417-22. Accessed 11th of September 2020.
- Porrata-Maury C, Hernández-Triana M, Rodríguez-Sotero E et al. Medium- and short-term interventions with ma-pi 2 macrobiotic diet in type 2 diabetic adults of Bauta,Havana. J Nutr Metab 2012; 856342: doi: 10.1155/2012/856342. Accessed 11th of September 2020.
- Bhumisawasdi J, Vanna O, Surinpang N. The self-reliant system for alternative care of diabetes mellitus patients--experience macrobiotic management in Trad Province. J Med Assoc Thai 2006; 89: 2104-15. Accessed 11th of September 2020.
- McEvoy CT, Temple N, Woodside JV. Vegetarian diets, low-meat diets and health: a review. Public Health Nutr 2012; 15: 2287-94. Accessed 11th of September 2020.
- Craig WJ. Nutrition concerns and health effects of vegetarian diets. Nutr Clin Pract 2010; 25: 613-20. Accessed 11th of September 2020.
- Sparber A, Bauer L, Curt G et al. Use of complementary medicine by adult patients participating in cancer clinical trials. Oncol Nurs Forum 2000; 27: 623-30. Accessed 11th of September 2020.
- Supoken A, Chaisrisawatsuk T, Chumworathayi B. Proportion of gynecologic cancer patients using complementary and alternative medicine. Asian Pac J Cancer Prev 2009; 10: 779-82. Accessed 11th of September 2020.
- Weitzman S. Complementary and alternative (CAM) dietary therapies for cancer. Pediatr Blood Cancer. 2008; 50: 494-7. Accessed 11th of September 2020.
- Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev 2013; 22: 286-94. Accessed 11th of September 2020.
- Anon. Questionable methods of cancer management: 'nutritional' therapies. CA Cancer J Clin 1993; 43: 309-19. Accessed 11th of September 2020.
- van Dusseldorp M, Schneede J, Refsum H et al. Risk of persistent cobalamin deficiency in adolescents fed a macrobiotic diet in early life. Am J Clin Nutr 1999; 69: 664-71. Accessed 11th of September 2020.
- Parsons TJ, van Dusseldorp M, van der Vliet M et al. Reduced bone mass in Dutch adolescents fed a macrobiotic diet in early life. J Bone Miner Res 1997; 12: 1486-97. Accessed 11th of September 2020.
- van Dusseldorp M, Arts IC, Bergsma JS et al. Catch-up growth in children fed a macrobiotic diet in early childhood. J Nutr 1996; 126: 2977-83. Accessed 11th of September 2020.
- Machiels F, De Maeseneer M, Van Snick A et al. A rare cause of rickets in a young child. J Belge Radiol 1995; 78: 276-7. Accessed 11th of September 2020.
- Sanders TA. Vegetarian diets and children. Pediatr Clin North Am 1995; 42: 955-65. Accessed 11th of September 2020.
- Schneede J, Dagnelie PC, van Staveren WA et al. Methylmalonic acid and homocysteine in plasma as indicators of functional cobalamin deficiency in infants on macrobiotic diets. Pediatr Res 1994; 36: 194-201. Accessed 11th of September 2020.
- Dagnelie PC, van Staveren WA. Macrobiotic nutrition and child health: results of a population-based, mixed-longitudinal cohort study in The Netherlands. Am J Clin Nutr. 1994; 59(suppl): 1187S-96S. Accessed 11th of September 2020.
- Miller DR, Specker BL, Ho ML et al. Vitamin B-12 status in a macrobiotic community. Am J Clin Nutr 1991; 53: 524-9. Accessed 11th of September 2020.
- Dagnelie PC, Vergote FJ, van Staveren WA et al. High prevalence of rickets in infants on macrobiotic diets. Am J Clin Nutr 1990; 51: 202-8. Accessed 11th of September 2020.
- Salmon P, Rees JR, Flanagan M et al. Hypocalcaemia in a mother and rickets in an infant associated with a Zen macrobiotic diet. Ir J Med Sci 1981; 150: 192-3. Accessed 11th of September 2020.
- Sherlock P, Rothschild EO. Scurvy produced by a Zen macrobiotic diet. JAMA 1967; 199: 794-8. Accessed 11th of September 2020.
- Kirby M. Danner E. Nutritional deficiencies in children on restricted diets. Pediatric Clinics of North America 2009; 56: 1085-103. Accessed 11th of September 2020.