Macrobiotic diet

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.

No clinical trials or reliable epidemiological data exist to suggest that the macrobiotic diet is effective for cancer prevention.

Strict forms of this diet can lead to malnutrition.


Mora D, CAM-Cancer Collaboration. Macrobiotic diet [online document]. Nov 25, 2023.

Document history

Updated and revised in November 2023 by Dana Mora. Assessed as up to date in August 2020, January 2019, February 2017 and April 2016 by Barbara Wider. First published in February 2014, authored by Edzard Ernst. Next update due: November 2026



Description and background

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 lifestyle which includes eating vegetables while in season, avoiding processed food and overeating, as well as chewing food thoroughly before swallowing (Kushi 2001).

The term ‘macrobiotic’ goes back to Hippocrates and was extensively used by Christoph WF Hufeland, a German physician (1762-1836) who published his book “The Art of Prolonging Human Life” (1797) using the term ‘macrobiotic’. Macrobiotics encompasses behaviour, thought, breathing, exercise, relationships, customs, cultures, ideas, and consciousness, as well as individual and collective lifestyles found throughout the world (Kushi 2001). 

The popularity of macrobiotics varies from country to country and by ethnic group surveyed (Sparber 2000, Supoken 2009).

Ingredients and quality requirements

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 occasionally (Kushi 2001, Jonas 1999). Essentially, the macrobiotic diet is a high-fibre, low-fat, high complex carbohydrate, mainly vegetarian diet (Lerman 2010).

While not related to cancer outcomes, an observational study was conducted in the USA to compare the nutrient composition and inflammatory potential of a macrobiotic diet with national dietary recommendations and intakes of a sample from the National Health and Nutrition Examination survey (NHANES). The study found that the diet met or exceeded recommended dietary allowances and that it had a lower inflammatory index compared to NHANES data (Harmon 2015).

Alleged indication

Proponents believe that this diet prevents illness in general (Lerman 2010, Hübner 2012). Some even claim that a macrobiotic diet effectively treats and prevents cancer of all types (e.g. Lerman 2010).

Application and dosage

Proponents recommend adopting this diet for life, and it is possible to do this at different levels of strictness.

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 protein (Porrata- Maury 2012), 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 factors (Bhumisawasdi 2006, McEvoy 2012). Being a high fibre and low-fat diet, macrobiotics might normalize risk factors such as obesity (Craig 2010).

Legal issues

There are no legal issues. 

There are no clinical trials or epidemiological data available to access the effect of the diet for cancer prevention (Hübner 2012, Weitzman 2008).

A randomized controlled trial called The Diet and Androgen-5 (DIANA-5) assessed if a dietary change based on Mediterranean and Macrobiotic diet principles could decrease the incidence of breast cancer related events. Although principles of the macrobiotic diet were included, the trial did not research its sole effect among cancer patients (Berrino 2023). The trial found that the intervention did not show a reduction in breast cancer reoccurrence, but at one year follow-up it was effective in reducing weight and metabolic syndrome parameters (Berrino 2023, Bruno 2021). Vegetarian diets seem to confer some protection against cancer but it is unclear whether this effect also extends to the macrobiotic diet (Tantamango-Bartley 2013). Such a postulated effect could most likely also be achieved by diets that are more nutritionally balanced and less complex to prepare.

There are a number of anecdotal reports of cure of established cancer through adherence to a macrobiotic diet; (Lerman 2010, McEvoy 2012) but to date these reports have not been confirmed in clinical studies (Sparber 2000, Weitzman 2008, Anon 1993).

Adverse events

Strict forms of the macrobiotic diet can lead to nutritional deficiencies, particularly in vulnerable populations such as children. (e.g. Zick 2018, van Dusseldorp 1999, Parsons 1997, van Dusseldorp 1996, Sanders 1995, Schneede 1994, Dagnelie 1994, Miller 1991, Dagnelie 1990, Sherlock 1967, Kirby 2009)


None known.


Nutritionally vulnerable groups such as small children, pregnant women and elderly individuals should be particularly cautious regarding the malnutrition risk.

Other problems or complications

None known.

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