Health Lessons from International Cuisines: Japan | Chris Kresser
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Health Lessons from International Cuisines: Japan

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Healthy Japanese cuisine is about balance. istock.com/m_bielecki

In the first article of this series I talked about the French diet, and the Japanese diet is almost the polar opposite. Most of the foods that are staples in France – cheese, red meat, bread, butter – are consumed rarely in Japan, if at all. While France is known for their high-fat diet, Japan has one of the lowest-fat diets in the world, with meals built primarily on soy, fish, vegetables, and white rice. (1)

The Japanese have maintained one of the highest life expectancies in the world, and have been featured on many lists of the world’s healthiest countries. Public health experts hold the Japanese diet in high esteem, second only to the venerable Mediterranean diet. So what can we learn from the Japanese?

How can a high-carb, low-fat, soy-filled diet result in one of the world’s healthiest countries?Tweet This

The Asian Paradox

One of the most defining characteristics of Japanese cuisine is the ubiquitous presence of white rice. In Japan, white rice is almost always served for two meals per day, and will commonly be featured in all three. (2) When ‘Paleo’ was still synonymous with ‘low carb,’ many wondered about the Asian Paradox – how can Asians eat so many refined carbohydrates and stay lean?

But now that ‘safe starches’ have become more widely accepted, it doesn’t seem like so much of a paradox. You know my take on the matter: not everyone does well on starch, but many people do, and adding more starch can often give people more energy and help them achieve their weight loss or other health goals. Starch has been part of the human diet for a couple million years, and white rice is one of the most benign forms of starch available. Plus, Japan’s high consumption of white rice means they eat significantly less wheat than most modern countries, which is probably a good thing.

What about All That Soy?

You know I’m not really a fan of most modern soy foods, but one soy food that probably does deserve its badge of honor is natto. It’s a slimy soy ferment that I find somewhat disgusting, but it’s the single best source of vitamin K2 out there, and the fermentation process does appear to reduce the harmful compounds in soybeans. (3)

Traditionally, natto was used as folk medicine for heart disease and other ailments, and modern science is on its way to proving that traditional wisdom correct. (4) It turns out there’s a unique fibrinolytic enzyme in natto that scientists call nattokinase, which is being studied for use in treating atherosclerosis, stroke, hypertention, and other related diseases. (5) Studies have demonstrated its ability to directly break down the fibrin in blood clots, as well as its ability to activate the body’s natural fibrinolytic enzyme – plasminogen. These actions result in decreased plaque and lesion formation, and decreased formation of blood clots that could later cause a heart attack or stroke.

One neat thing about studying traditional diet patterns is noticing how the interactions between specific foods can help make the diet work as a whole. One concern about soy is that it’s a goitrogen, and can interfere with iodine uptake and use by the thyroid. (6) But while Japan is undoubtedly one of the top soy consumers (and not all of the soy they eat is fermented), they also have the highest iodine intake in the world thanks to their seaweed-rich diet. (7) One study shows that the Japanese have a unique ability to digest seaweed because of their gut bacteria, so they can eat more of it without experiencing digestive distress. (8) The high concentration of iodine in the Japanese diet likely goes a long way in protecting them from these negative effects of soy, and proves how important context is when evaluating a food.

The Lesser Known Japanese Staple

The media has latched onto fish, green tea, and soy as the trifecta behind Japan’s slim, long-lived population, but one thing they rarely mention is soup. We know how beneficial bone broth is, and studies have found that soup consumption is inversely correlated with BMI and circulating leptin levels. (9) But many people don’t realize that besides rice, soup is often considered to be the most important food in Japan. (10) Broth for the soup is usually made with sardines or other fish simmered with seaweed, resulting in a mineral-rich stock to which other ingredients (such as miso) can be added.

In the traditional Japanese diet, some form of soup is served with every meal. And although Japan is slowly adopting a more Western diet, a study conducted a few years ago found that the Japanese still eat soup an average of 7.6 times per week. (11) This is certainly more than most people manage, and it’s more than three times the average weekly soup consumption of France.

Soup is a staple in other Asian countries as well. Vietnam is known for serving soup with every meal, and traditional Vietnamese pho is famous for its gelatinous beefy broth. (12) In Korea, soup is recognized as a healing food and was always given to women after they gave birth, which is why this recipe is called ‘Birthday Soup.’

What Can We Learn from the Japanese?

In addition to reaffirming the merits of bone broth, I think the Japanese diet shows us how important context can be. For a metabolically damaged American, eating white rice at every meal might cause problems, but for the Japanese, it provides a safe source of carbohydrates that complements their traditionally nutrient-dense diet. And although they do eat soy, it’s not as worrisome in the context of their extremely iodine-rich diet and consumed alongside other traditional foods. And although I don’t think we all need to run out and buy a package of natto, the studies on its benefits reaffirm the value of traditional wisdom in making food choices.

  1. Spent 3 weeks travelling through Japan on vacation earlier this month. People are indeed much thinner than here in Australia. The much smaller portion sizes in restaurants were very striking, and were often only half to two thirds of equivalent dishes back home. Rice was eaten at most meals but generally came in small bowls that could be refilled rather than buckets. The rice was also generally lukewarm to cool (which is interesting from the perspective of resistant starch). Beef was very delicious, highly marbled, very expensive, and served in small amounts. Chicken and fish were more affordable but still not served in large quantities. Overall, my meals were much lower in fat and protein than what I was used to. The other thing I noticed was that the environment was potentially “obesegenic” (i.e. cakes, crepes, other deserts, soft drinks were absolutely everywhere).

  2. My father-in-law was a PhD food safety/food additives chemist at the FDA for many years and spent a year working in Japan through a National Science Foundation fellowship. I went to visit them for a month in Tokyo. Some observations:

    (1) They don’t allow a lot of preservatives and food additives in their food like we do, according to him. For instance, their bread doesn’t last as long as ours because of this, but they go to the grocery store several times per week and get fresh food when they need it. (Their kitchens and refrigerators are smaller than ours.) I was amazed that the shelves of bread were empty at the end of each day at the grocery store and this was in the summer – not due to an impending snowstorm!

    (2) They don’t eat much dessert and the dessert they do eat isn’t too sweet.

    (3) They are very active and exercise and walk or ride bikes a lot more than the average Americans. We were in Tokyo and most people don’t use cars, but use public transporation and/or walk/ride bikes.

    (4) Everything, including the public restrooms, is very clean. If they spill water on a public restroom counter, they wipe it dry. If someone has a cold, they wear a mask. This could positively impact health.

    (5) People are very polite, considerate and courteous. This also could positively impact health.

    As an aside, my father-in-law was very particular about what he ate and how much he ate. He avoided processed foods and meats, peanuts in shells (toxic molds), margarine, sugar and desserts, grilled & blackened foods and eating out and preferred natural/whole foods like fruits, vegetables, gently cooked food, meats, fish and rice. And this was 25 years ago! I often joked that from working at the FDA, he knew too much!!!

  3. “cheese, red meat, bread, butter – are consumed rarely in Japan, if at all.”

    Sorry, but this statement is nonsense from my own experience over 20 years. Many people I know eat bread every day in Japan, and that is certainly not my influence – they were doing it long before I met them. Also red meat is eaten relatively often I would say – 2 or 3 times a week is completely normal. I’ve never feel like eating it more often than that. Sure, butter and cheese are consumed less than in France, but they’re far from absent. Japan has some interesting high-fat dairy products that I love. For example, a bit old-fashioned now, but I still enjoy it: raisin butter (butter with some raisins and rum, formed into a roll, sliced and eaten as a snack. Can be bought in the supermarket. http://www.garethhinchley.com/2011/02/raisin-butter.html

    Also, I agree with the person stating that the Japanese know what food to reduce when they want to lose weight: rice. I’ve seen woman do that again and again, and it always works. They usually regain the weight when they resume their large rice servings.

    Btw, not many sardines find their way into what passes for stock nowadays.

  4. There is a paper attributing japanese health to high intakes of taurine from seafood, and magnesium.
    the taurine neutralises any excess of cholesterol in the diet. Dietary cholesterol as a cause of disease isn’t popular in Paleo circles, but in the context of the Western diet – processed meats and dairy low in taurine choline, and vitamins but retaining cholesterol, probably oxidised, and consumed with peroxidised heated seed oils – it is pretty likely to be a player.

  5. All of the observations in the article are spot on. I lived in Japan for nearly a year (1998-1999) in college while fulfilling my minors in Japanese and Asian Studies. When I got there I was maybe 35lbs overweight at 215 pounds (not my largest by any means). When I left I was MAYBE 175 and 15% body fat. While I did study several martial arts pretty heavily while I was there, I didn’t go to the ‘gym’ once. I merely ate what others ate, walked or rode my bicycle everywhere like everyone else, went to the dojo with my friends and was more mindful (which was a much more prevalent trait in the people I hung out with).

    I lived in the Kansai in a medium sized rice farming community on Lake Biwa (largest inland lake in Japan) so rice was in nearly every meal (noodles were available as well). When it came to home cooked meals, rice was served in small ratios (compared to a western diet) and complemented by other, small servings of multiple dishes.

    This article doesn’t, however, discuss the preponderance of prepacked, sodium laden food or the uptick in pancreatic cancer.

  6. The japanese have the highest consumption of iodine (about 12 mg). Most of the western world is deficient in iodine, the RDA is way to low. Iodine shortage means suboptimal thyroid function, contributes to low metabolism, leads to carbohydrate intolerance.

    Is there a connection between a low iodine intake and the obesity and hypothyroid epidemics? Definitely, yes.

    • Great point Harmen! Iodine is turning out to be critical to health. Not just because of it’s use by the thyroid. From my readings, I’ve found that the healthy human body contains about 1500 mg. of iodine. Only 50 mg. resides in the thyroid. 20% of one’s iodine is in the skin (300 mg.) and 32% is in the muscle (480 mg.). A shortage of iodine in the thyroid is indicative of a shortage in the whole body, and is bound to hamper the immune system.

  7. I also want to comment on the Japanese diet from my own observations (anecdotes, I know). Rice is indeed mostly served to end the meal, a small bowl, and often not finished because you’re full from the meal proper. Also, pork is an important part of the Japanese diet in my experience, especially pork belly either in soup or grilled. My Japanese friends also often had chicken liver and chicken hearts. And when I asked them how they would lose weight, they all said that to lose weight you just eat a bit less rice. To sum up, I see the Japanese diet as medium-carb, filled with fatty fish (basically at every meal, grilled for breakfast), fatty meats, organ meats, sea vegetables, some fermented vegetables, and bone broth. Half the country hates natto, but they eat modest amounts of traditionally prepared soy products. And I wonder if not the traditional soy sauce preparation reduces some of the harm from the wheat? Overall, it’s a great diet: delicious and healthy!

  8. You overestimate the amount of rice the Japanese eat. I spent two weeks in Japan and made a study what Japanese people ate in restaurants. An ice cream scoop of rice was served at the end of every meal to cleanse the palate-no more than 3 ounces.

    To illustrate my point, I saw two Japanese girls eating bowls of rice at a restaurant. One girl had an traditional ice cream scoop of rice in her bowl. She was thin as are most Japanese. The other girl had her rice bowl filled to capacity just as an American would. She was fat and was one of the few fat people I saw in Japan.

    I had no trouble eating low-carb paleo in Japan and I ate all the rice I was given.

  9. It’s also important to note that asian’s salivary glands and pancreases are much larger than caucasion’s so they are able to digest carbohydrates much better.
    Liz J.

    • Where did you hear this? I am Asian and have type 2 diabetes. So does a whole bunch of Asians over 50 whom I know. As an ethnic group Asians are predisposed to it. So I don’t think our “much larger” pancreases are helping us out there.

  10. What about portion size? I think that’s a factor, too. Americans eat just plain more of everything at each sitting than most Asians or Europeans.

  11. The Japanese, and other Asians, do not eat anywhere near the amount of soy that Americans do because it’s not part and parcel of almost every food product they eat as it is here in the US. Virtually every processed food in the US contains soy which probably puts the US at a much higher level of soy intake per capita than any other country in the world given the amounts of processed foods most American people eat. The key is eating unprocessed foods, staying away from the center of the grocery store where the processed foods lurk, and, if you eat soy, do so in the fermented form.

    • thanks for your well-written blog! often i’ve gotten into discussions on nutrition wherein specific foods are cited as healthy or bad-fer-ya, but rarely do i encounter those who take the whole diet of a people or region–let alone food and culture together– into consideration. and i emphatically redouble Sue’s comment about the disturbing pervasiveness of processed soy byproducts in america’s food supply. i strongly suggest a book by a man named tobe, the “book of health knowledge” written about 40-50 years ago. he saw what was happening to americans as they shifted from ancestral and homestead foods to factory people-feed, and it saddened and repulsed him. he specifically despises all the processed soy that cheaply fills and saturates an increasing number of “foods” even in the 1960s and 70s. he does note that whole soybeans, raw, fermented or sprouted, are good food, and seaweed even better!

  12. We hear so much these days about ancestral diets so it is great to see you digging into what that means specifically. The one question I have struggled with is knowing which ancestral diet is most applicable to me. With so much globalization and inter-cultural marriage etc many of us are no longer intimately in touch with our ancestral roots. For me it’s even harder because I was adopted as a baby.

    • The Japanese Diet isnt really low fat. Several diets that produce good health have wrongly been labeled low fat until looked at more closely.

      The Mediterranean Diet was supposed to be low fat, but the study was stupidly flawed. Same with the Okinawan Diet which we were told was 85% carbs, until we figured out it really wasn’t.

      Same with the Japanese. They have no fear of dietary fat. They prefer the fatty cuts of meat and they eat organ meats and fatty fish. They drink whole milk.

      • I don’t agree that the Japanese drink notable amounts of whole milk, though perhaps when they do drink it, it’s usually whole. Fatty fish in general can be expensive and is more of a treat, though it is well liked. Meat (organ or otherwise) is consumed substantially less in Japan than in the US, IMO.

        I think it’s accurate do describe the Japanese diet as low fat, especially compared to American or French diets.

        • each time I have visited Japan, I have witnessed the locals practically arm-wrestling for the raw fish eyeballs with all connecting globs of stuff intact. They are definitely not averse to fat. And the fattiest cuts of fish and meat are desired.

          • fish eyes? yes, those taste good. fish head also makes a good stock.
            (Asians traditionally eat a lot of strange cuts of animals)

            Chris made a good point that it is not possible to duplicate the health results just by taking some isolated factors like soy, seaweed, red wine, green tea. so an American can take tons of green tea pills (or other “in” supplement at the moment) still won’t get as healthy. it’s the whole food culture.

            cheers,

          • The fat of fish consists of unsaturated fatty acid such as DHA, EPA,etc, which is essential for human body and can reduce bad cholesterol.

  13. I guess looking at cuisines, country by country is about all we can do to determine foods that give health and longevity. The human race is just not open for long term experimentation. I’m hoping that other studies are forthcoming though on cultural differences in diet.
    I took a look at comparing Japanese diets in general with those of the Okinawan islands, known for low rates of degenerative disease and the resultant health and sometimes increased longevity. There are some significant differences. From these differences, it’s still hard to deduce whether longevity is more dependent on calorie restriction, meat restriction, increases in flavonoids (sweet potatoes), increases in roughage (sweet potatoes vs white rice), increases in tumeric consumption (curcumin), percentages of fat in the diet (roughage such as in vegetables, including sweet potatoes, is converted to short-chain fats by intestinal microflora, but white rice is short on roughage), or some other difference between Okinawan and non-Okinawan diets. Still, it’s interesting to read about all the potential for improving even a typical Japanese diet.
    http://en.wikipedia.org/wiki/Okinawa_diet
    http://www.faboverfifty.com/intheknow/our-health/diet-secrets-centenarians
    and it’s the comments with quotes from studies that are most interesting here:
    http://stan-heretic.blogspot.cz/2009/10/beware-of-okinawa-diet-scam.html

    • And of course another factor is the higher percentage of those living a rustic, low-stress, higher-exercise, better-sleep life-style in Okinawa. Who knows how much food even matters. Sad that I have to admit this, but it is possibly mostly true. Not probably, but possibly.

    • Take a look at the Blue Zones web page. They study populations who have long life spans. They caution that there is no consistent longevity diet. They observe several factors not the least of which is how the elderly are made part of the community and get alot of love and support.

  14. Having been in Japan for work, an aspect of the Japanese diet that impressed me was it “purity”. Saw them eat raw chicken. I recoiled at this and they commented how contaminated the American food supply is. One of the big commercial US agricultural magazines described how the US pork farms growing for the Japanese market had to allow the Japanese to dictate and inspect every step of the process. This substantially increased the cost compared to what we have in our supermarkets, but also the quality.

  15. There are a couple of other things to factor in to why the Japanese diet is healthy.

    First of all, they do not eschew fat. When they eat meat they prefer very fatty cuts and do not cut fat off of food.They also eat organ meats. The claim that the Japanese eat a low fat diet is not entirely true.

    Second, they do not beleive grains are good for you. They fully understand that rice can make you fatter and when they see themselves getting chubby they cut back their rice consumption. They normally eat lots of rice ( like an addiction which is another topic concerning grains) but they have no delusions about it.

    Third, the Japanese are one of the most homogenous populations in the world. Certain traits that lend themselves to longevity can be inherited.

    • Good comments Marc, I totally agree. Having traveled to Japan many times in the last 10 years, I’m always surprised when I see their diet referred to as low fat. They seem to always eat the fattiest/oiliest fish and – as you said – prefer fatty cuts of meat and do not cut the fat off.

      I find the diet to be extremely high in salt, but perhaps that’s just because I’m always eating in restaurants rather than home cooking.

    • i don’t think they (or other Asians) consume all that much of soy tho.

      what i mean is, we do eat soy _frequently_, in the form of edamame, soy source, natto, miso, tofu, fermented tofu, fermented soy bean, bean sprouts (which is more of a vegetable), soy bean “curd” (pudding like texture),

      but i don’t believe it’s all that much from soy (in terms of calories), except for a Buddhist.

      the traditional form of consuming soy is not “soy dogs” & soy ice cream, soy cheese, flavored soy drinks, or other soy based processed food.

      FYI: i’m Chinese. most adults like soy milk w/ soy source + vinegar w/ some toppings (shrimp , meat & green onions, maybe some other veg, egg). children usually prefer sweetened. traditional soy milk tastes very beany & nothing like those fancy flavors in American market.

      & yes, agree that fatty cuts of meat is traditionally preferred. & my grandma cooked w/ lard.

      but i also believe that the longevity of Japanese is a little exaggerated.

      regards,

  16. Chris, this is a great series and an examply why I always like your posts. Your thoughts and research are well balanced and you are always willing to think outside your box. With that in mind, and on a totally different topic, I would be really interested in a comprehensive review of your experience with the GAPS diet sometime in the future: what works what doesn’t, differences among patients, long term effects, relapses etc etc. There just isn’t a good review out there that I feel I can trust on the same level as your posts. Now I don’t want to highjack your comment thread with this comment so feel free to delete my comment… just wanted to let you know. Keep up the good work.