Medical Edge Newspaper Column

Macrobiotic Diet: No Panacea, But A Step In The Right Direction

May 20, 2007
Dear Mayo Clinic:
Is the macrobiotic diet a fad or is it actually a beneficial diet, especially for those diagnosed with cancer? -- Hampton Bays, N.Y.

Answer:
Because it is said to be based on the traditional (pre-Westernization) Japanese diet -- including whole grains, vegetables, beans, and modest amounts of fish -- one might argue that the macrobiotic diet is hundreds or even thousands of years old. So it does not appear to be a passing fad.

Moreover, because it is essentially a vegetarian regimen, with several additional positive features, the diet may be beneficial as long you don't take it to extremes. Such healthful eating might help to prevent numerous diseases, including cancer, but there's no evidence that it is an effective treatment for patients who already have cancer.

The core of macrobiotics is the goal of achieving balance -- in life generally but particularly in what individuals put into their bodies -- between the opposite but complementary forces of "yin" and "yang." A food that is yin, according to macrobiotic principles, induces ethereal qualities such as lightness, coolness, and mental processes; by contrast, yang foods are characterized by intensity, heat, and physicality. In the macrobiotic construct, certain fruits (particularly from the tropics) are deemed yin, with refined sugar being extremely yin. Yang foods, for the most part, come from animals, with red meat being the most yang.

Conceptually, even the very yin can be balanced by a like measure of yang, but advocates argue that such a combination would be too unstable. They say people should instead stay closer to the balance point (like the fulcrum of a seesaw) to remain steadily at equilibrium, and that this should be achieved by limiting themselves to foods that are inherently yin-yang balanced or that are only slightly off-center. Here is where whole grains, vegetables, and beans come in. Adherents consider grains -- especially brown rice -- to be the perfectly balanced food, with selected vegetables and beans not far behind.

Whether one subscribes to such characterizations or not, there is no denying that a diet rich in unadulterated grains, organic vegetables, and beans, supplemented occasionally by nuts and fish, is a step in the right direction. Moreover, the diet is free of specific items -- meats, eggs, sweets, and processed foods -- associated with poorer health. Advocates also emphasize such positives as physical activity, minimal exposure to pesticides, and stress reduction.

It is thus easy to see why the macrobiotic diet and its associated practices are attractive. Doctors should have no problem with it, provided that it is undertaken with care. Despite their positives, vegetarian diets (including macrobiotics), if not carefully managed, can result in nutritional deficiencies, including inadequate intake of protein, Vitamin D, calcium, and iron, among other essential nutrients. This is of special concern in children and adolescents, pregnant women, and individuals -- such as cancer patients -- who are vulnerable because their health has already been compromised.

Undertaking the macrobiotic diet, or any other significant dietary change, should therefore be done as a "team effort" -- the individual, a physician, and, if possible, a nutritionist should collaborate to ensure that all dietary needs are met. The team should also provide a check that in pursuing the new practice, other important activities are not discarded. A cancer patient, for example, might be tempted to drop conventional treatment in the mistaken belief that the new diet is a virtual panacea.

Even advocates agree that the macrobiotic diet should be individualized. They say the proper choice of foods varies with factors like the season, climate, activity level, gender, age, and health status. This is one reason why the diet has been difficult to study; in theory, there are as many variations of it as there are practitioners.

For your own decision making, consider the advice that Mayo Clinic offers on this and other approaches to complementary and alternative medicine: Steer a middle course between uncritical acceptance and outright rejection. Be open-minded yet skeptical at the same time.

-- Brent A. Bauer, M.D., Director, Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, Minn.