Macrobiotic and Raw Diets
By Cristina M. Caro, MBA,
RD, LD
As a dietetic professional, I am often asked about the safety and efficacy of
alternative diet therapies, namely macrobiotic and raw food diets. These alternative
diets are publicized as “cure alls” and guaranteed prevention for
modern day ailments. Truth be told, there are no “magic bullets”
to annihilate disease, or “guaranteed” preventative nutrition therapies;
however, diet modification can certainly help many afflictions.
Macrobiotic and raw food diets can offer health benefits in conjunction with
medical treatments for diseases. Though, I would caution patients not to delay
proven treatments in pursuit of “natural” remedies, especially those
proposed by unlicensed professionals. While showing respect for patients’
beliefs and choices regarding specialized diets, we have a duty to provide evidenced-based
advice for complementary therapies. To that extent, I have reviewed scientific
literature for unbiased information on macrobiotics and raw foods.
Unfortunately, there is limited clinical data, with several studies having methodology
flaws. The difficulty in studying macrobiotic and raw food diets lies in ideology—these
diets are actually life philosophies that encompass behavior, food, and thought.
The intangible nature of these principles makes it seemingly difficult to conduct
sound scientific research. Nonetheless, I have sifted through the media “hype”
and anecdotal reports to filter out the faulty logic and myths. In the following
segments, I will outline the basic principles and components of each diet, and
identify the dietary advantages and pitfalls. My hope is that you may use this
information to speak openly with patients about these alternative diet therapies
and provide reasonable advice.
Macrobiotic Diet: Basic Principles and Components
The Macrobiotic Diet is based on the principles of Yin and Yang, which promote
balance, health and spiritual freedom. These principles consider individual
differences with respect to one’s climate, geography, and health status.
The approach also emphasizes physical activity and stress reduction to restore
power and natural healing. Hernan Aihara, a Japanese physician, describes macrobiotics
as “finding [your] physical limitations and trying to live within them.”
The traditional macrobiotic diet is very strict, allowing only natural, in-season
foods, and specialized cooking techniques. Aluminum and non-stick cookware,
microwave ovens, and electric cooking devices are discouraged. Many foods are
forbidden including alcohol, coffee, dairy products, dietary supplements, eggs,
herbal teas, meats, processed foods, and many fruits and vegetables. Beverages
are limited to special teas. As you can imagine, diet adherence is extremely
difficult. Western culture has adapted the diet to allow for occasional consumption
of “forbidden” foods, while emphasizing natural, minimally processed
foods. The modern macrobiotic diet is composed of 40-60 percent whole cereal
grains, 20-30 percent vegetables, and 5-10 percent beans. Fruits, nuts, seeds,
and white fish are allowed 2-3 times per week. Ginger, miso, mustard, sea salt,
and tamari soy sauce are the basic seasonings. Artificial sweeteners, chemical
additives, genetically modified foods, and refined sugars are excluded. Of course,
organic foods are preferred. The following chart outlines the recommended intakes
based on the “Great Life Pyramid: Macrobiotic Dietary Guidelines For A
Temperate Climate “illustrated by Michio Kushi.
Daily: Whole Grains—barley, brown rice, buckwheat, corn, millet,
oats, rye, & wheat; and minor portions of bread, noodles, pasta, and cereal
flour products
Vegetables—sea vegetables (nori, wakame), green leafy, round & root
vegetables; prefer locally grown, major portion cooked, some raw or pickled
Beans—chick peas, lentils, soy beans (tempeh, tofu)
Weekly: Fish/seafood (primarily white)
Fruit (locally grown and in season)
Nuts and Seeds
Sweets (grain or fruit based)
Monthly: Dairy, eggs, meat, poultry, if desired
Dietary Advantages
A macrobiotic diet is mainly a vegetarian diet, focusing on whole cereal grains.
The Journal of Nutrition suggests that high intakes of whole grains may reduce
the risk of cancer and diabetes by altering the metabolism of estrogren, glucose,
and insulin, and by altering the oxidative process. Furthermore, the dietary
fiber effects of whole grains may reduce serum cholesterol levels and decrease
the risk for heart disease. Another heart healthy aspect of the macrobiotic
diet is lower intakes of dietary fat. Kushi et al found that average macrobiotic
intakes for saturated and polyunsaturated fats are 5 percent and 8 percent respectively.
Resources
For Alternative Nutrition |
The dietary components of sea vegetables and soy foods may provide protection
against hormone-dependent cancers (breast, endometrium, prostate) and stomach
cancer. The Journal of Nutrition informs us of the anti-tumor activities of
fuciodan, a sulfated polysaccharide found in brown seaweed, and the phytoestrogens,
protease inhibitors, and saponins found in soy. Sea vegetables and soy foods
also contain powerful antioxidant vitamins and minerals to protect cells from
oxidative damage.
By and large, the macrobiotic diet is low in saturated fat (and cholesterol)
and rich in antioxidants, fiber and phytonutrients, all of which shadow recommendations
for the prevention of chronic diseases.
Dietary Pitfalls
The exclusion of dairy, eggs and meat from the diet may lead to inadequate intakes
of calcium, vitamin B12 and essential amino acids. In fact, some clinical deficiencies
have been observed in infants and children consuming a traditional macrobiotic
diet. The diet restrictions pose a genuine risk for malnutrition, especially
for persons who require substantially more calories and nutrients due to age,
compromised health status, or physical activity. Normally, supplementation could
compensate for some diet inadequacies, however, the macrobiotic approach discourages
dietary supplements of any kind. To that extent, a macrobiotic diet may not
be suitable for children, adolescents, pregnant, and lactating women.
Despite the nutritional risks, macrobiotics is a popular approach to cancer
and other debilitating illnesses. Testimonials of disease remission are highly
publicized in lay literature. But is there any scientific basis for these anecdotal
reports? Honestly, there is limited research evaluating the effectiveness of
macrobiotics on specific diseases and no randomized control trials (the gold
standard) have evaluated the therapy. So, the current evidence on macrobiotics
is inconclusive. The American Cancer Society publicly notes a lack of empirical
evidence that macrobiotics prolongs cancer survival or reduces the side effects
of treatment. The primary concern is the macrobiotic philosophy may lead patients
to delay or discontinue conventional therapy. The secondary concern is the diet
changes may affect treatment outcomes. High intakes of soy phytoestrogrens may
stimulate tumor cell proliferation in breast and endometrial cancers. Dr. Weiger,
a Harvard researcher, warns that phytoestrogen intakes are 10 times higher in
macrobiotic diets and the higher lignan intakes from legumes, seeds, vegetables
and whole grains can also be damaging.
Often, cancer patients are asked to avoid particular foods and supplements while
receiving treatment. This is because diet changes may alter the metabolism of
some drugs and reduce the efficacy of chemotherapy. Subsequently, the Harvard
School of Medicine has cautioned the use of macrobiotics in conjunction with
conventional cancer therapy.
The Raw Food Diet: Basic Principles and Components
As mentioned earlier, Raw Foods is more of a lifestyle than a diet. The fundamental
principles guide behavior and thought, in addition to food choices. Many raw
food practitioners are holistic people that posses a genuine concern for the
environment. They believe raw foods promote the use alternative food preparation
methods to conserve energy (cooking is thought to waste gas and electricity
and harm the environment). Raw food followers eat organic agriculture and avoid
all animal products to help protect the planet. But environmental concerns are
only part of the ideology—raw foodists also believe that long life and
well-being are achieved by consuming “living” foods that are unadulterated
by cooking, heating, or processing. Living foods are believed to contain essential
enzymes that help us digest foods completely and heal naturally without the
need for medication. Raw food proponents argue that eating cooked foods decreases
immune function, hastens aging, and diminishes energy because cooking destroys
vitamins and minerals and promotes free radicals and carcinogens in food. On
the other hand, the antioxidants and enhanced digestion of living or raw foods
help boost immune function and “detoxify” the body.
Raw food enthusiasts promote organic whole foods, of which 75 percent (or more)
should be uncooked. Various food preparation techniques are encouraged, such
as blending, chopping, dehydrating, extracting, juicing, soaking and sprouting.
And, yes, many of these methods require specialized equipment, including a blender,
food dehydrator, food processor, grinder, juice extractor and mortar and pestle.
So, what do raw dieters eat? Typical foods and beverages include fresh fruits
and vegetables, beans and legumes, grains, nuts and seeds, dried fruits, freshly
made juices, coconut milk, and purified water. A one-day menu may look like
this:
Breakfast: Strawberry smoothie Morning Snack: Applesauce
Dried fig bar
Mixed nuts
Citrus fruit salad
Lunch: Oriental lettuce wraps Afternoon Snack: Carob shake
California sushi rolls
Veggie sticks
Sesame seeds
Orange slices
Tomato juice
Dinner: Gazpacho
Evening Snack: Sunflower seeds
Guacamole salad Dried apricots
Mango pudding
Papaya juice
Dietary Advantages
A raw food diet is rich in complex carbohydrates, found in fruits, grains, legumes,
nuts, seeds, and vegetables. The soluble fiber in complex carbohydrates helps
to lower blood sugar and serum cholesterol, and manage body weight. The insoluble
fiber provides bulk and improves intestinal motility. Accordingly, diets rich
in complex carbohydrates are recommended for the prevention and/or treatment
of many diseases, including cancer, diabetes, heart disease, and obesity.
A raw diet is also rich in phytonutrients, which are found in plant-based foods.
These chemical compounds are known for their ability to inhibit cell mutation
and tumor growth. The American Institute for Cancer Research associates high
vegetable intakes with reduced risk for cancer. Research studies have shown
a 23 percent decrease in cancer risk when consuming 400 grams of vegetables
per day, according to the Journal of Nutrition. It is important to note, however,
that no distinction is made between raw and cooked vegetables.
Typically, a raw food diet is plentiful in water-soluble vitamins, which include
eight B vitamins and vitamin C. These nutrients possessed by “living foods”
help form coenzymes necessary for metabolic pathways, energy production, and
transamination; and aid in chemical synthesis and cellular repair. Unfortunately,
water-soluble vitamins are easily destroyed by heat. Therefore, the highest
concentration of vitamins B and C (occurring naturally) is in raw foods.
Another plus for raw foods is they are naturally low in fat and sodium. These
attributes help reduce the risks for hypertension, heart disease and stroke.
With the exception of restrictive medical diets for diverticulosis, renal disease,
and the like, raw foods can be a part of a healthy diet regimen.
Dietary Pitfalls
A raw food diet may lead to unwanted side-effects, such as diarrhea, headaches,
skin irritations, stomach upset, and strong body odor. These symptoms are said
to be the short-term results of detoxification, as the body removes undesirable
substances byproducts of metabolism. However, symptoms that persist may actually
have a serious underlying cause and require medical attention. Keep in mind
that living foods are publicized to help the body “better resist and recover
from just about any kind of disease”, which may lead dieters to delay
or forego medical treatment. Healthcare practitioners should urge patients to
notify their primary care provider if symptoms persist. Other reported bodily
discomforts include “being hungry all the time,” “not feeling
satisfied,” “having uncontrollable gas” and “having
considerable food cravings.” These indications could signify the need
for more calories and nutrients. Raw foods are low in fat and calories and therefore
require continuous consumption; and individuals with increased needs for calories
and nutrients due to activity level, age, or health status may fall short of
their daily requirements. Consequently, a raw diet may be contraindicated for
specific health conditions that are associated with uncontrollable weight loss,
such as anorexia, cachexia, cancer and failure to thrive.
The challenge of meeting calorie and nutrient requirements is exacerbated by
the lower digestibility of many raw foods. The fiber and phytates abundant in
raw foods bind to certain nutrients (i.e. calcium, iron, and zinc) and interfere
with absorption. However, cooking raw foods increases the bioavailability of
these nutrients because phytates and similar substances are denatured by heat.
Furthermore, some phytonutrients increase in concentration when heated. Lycopene,
for example, is more abundant in processed foods such as spaghetti sauce and
ketchup than in fresh tomatoes. Therefore, raw food practitioners should include
some cooked foods or take a dietary supplement to reduce the risk for nutrient
deficiencies.
Another pitfall of a raw food diet is limited variety. The restriction of foods
and preparation methods limits the nutrient composition and the variation in
aroma, temperature, and texture. Science has long understood that the nutrients
found in food work synergistically to facilitate metabolic processes and provide
health benefits. When scientists isolate nutrients to manipulate their function,
the biological benefits and potency are often reduced. Subsequently, if food
groups are excluded (isolated) from the diet, the biochemical synergy and health
benefits may be reduced. Ultimately, the lack of variety and psychosocial challenges
of a raw diet make long-term success very difficult and could lead to nutrient
deficiencies and health risks.
Conclusions
Macrobiotics and raw foods are popular alternative diet therapies for disease
prevention and treatment. However, no clinical studies have demonstrated the
proposed health benefits of either diet. From a practical viewpoint, unproven
does not mean untrue. So, the efficacy of macrobiotics and raw diet therapy
is inconclusive. With regards to safety, potential food and drug interactions
exist, as well as deficiencies in essential nutrients, minerals, and vitamins.
Patients should be advised to keep a symptom diary and notify their health care
provider of new or persistent symptoms. Specific health concerns arise in patients
with poor nutritional status, since food and nutrient intakes are restricted.
Healthcare providers must closely monitor these individuals for signs of malnutrition.
Adverse health conditions could result from macrobiotic or raw diet therapies,
though no clinical cases have been documented.
Cristina Caro, MBA, RD, LD, is the Dietetic Internship Coordinator and instructor
for Life University‘s Department of Nutrition. Cristina has specialized
training in clinical nutrition, child and adolescent weight management, food
safety management, and health education. This Georgia native serves on the Board
of the Greater Atlanta Dietetic Association and participates in American Red
Cross community education programs. Caro conducts nutrition seminars and workshops
throughout Georgia and the southeastern states. You may contact her at www.MNTofGA.com.
sidebar
Resources For Alternative Nutrition
• Books:
“Raw,” Roxanne Klein and Charlie Trotter, 2003.
“Vegetables, Fruits and Herbs in Health Promotion,” R. Watson, PhD,
2001
• Websites:
For health information or research data on complementary and alternative medicine
visit http://nccam.nih.gov/
For information on current clinical research in human volunteers visit http://clinicaltrials.gov/
For information on raw food books, online-magazines, products, and supplements,
visit these web links
http://www.living-foods.com/
http://www.eatraw.com/
http://www.rawfood.com/
http://www.livingnutrition.com/
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