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. This entire thread is based on the Japan of years ago, before the introduction of the “American” diet. While it is true that it has been a rather slow change, that is no longer the case. Travel Japan today and you will find the “American” diet available just about anywhere, except out in the country, and that will eventually change as well, as demand requires it. Thirty years ago Japan was still pretty much its own world, nutritionally speaking, NOT TODAY. You can find ANY cuisine you want in any major city. And the Japanese will pay the price, probably sooner than they would like…. the “average” Japanese diet WAS healthy, past tense.

  2. Straight from the horse’s mouth

    Yuri talks about learning about food from elementary school, and whilst it’s true, what they learn is of little use and usually wrong.

    He also mentions yearly health checks but again I find that these are used to give poor information based on outdated or simply wrong ideas.

    Taka, whilst I can’t deny that many foreigners here do drink, coke, juice, energy drinks etc it’s not true to say that Japanese people drink Japanese tea. There are only a couple of millions foreigners in Japan yet every single convenience store has racks of refrigerators chock full of sugary drinks which are all marketed at and bought by Japanese people. Think Calpis or how about Shiso flavoured Pepsi (foreigners might take pics of it to post on fb but we certainly don’t drink it!) to name just a few.

    And whilst a few calorie obsessed Japanese people might drink small drinks at Starbucks many choose larger sizes and often order dessert too. Cafe culture is huge in Japan and I know many people who sit all day in such places and whilst a few might nurse the same drink for hours many don’t stop at one.

    Plus many restaurants serve huge portions think of stores like Coco Ichi, Yoshinoya, Sukiya, Matsuya etc where most meals consist of a huge amount of rice with a small amount of meat or veg on top. Then there are other places like Yayoiken etc where you can eat as much rice as you want and people do!

  3. Hi,

    The view point from a Japanese man , most foreigners drink coke or juice whenever they want to drink something.
    We usually drink Japanese tea (not green tea) instead of them.
    Additionally, all restaurant serves foods having little quantity.
    We take a short or tall Caffe latte at Starbucks. People in China or other Asian countries are same as others, they order grande one.

    Sushi isn’t healthy food to consider calories, so the secret isn’t Japanese foods.

  4. Advice
    Americans people need change to Cooking Methods
    Be less than one quarter the use sugar, salt, oil
    after meals drink green tea of Japan, oolong tea and Eucommia tea

    Do not drink chinese tea becouse there are many pesticide residues.
    Do not put absolute sugar in tea
    Do not drink carbonated beverages also
    after meals To walk about three kilometers

  5. How do you do
    I am Japanese. I live in USA now
    Japanese people know. why many obesity people in the American
    Americans people use too much sugar, salt and oil in cooking
    Japanese ingest will only use about one-quarter of Americans
    Sense of taste is wrong Americans.
    BMI over 30 chart
    http://ja.wikipedia.org/wiki/%E3%83%95%E3%82%A1%E3%82%A4%E3%83%AB:Bmi30chart.png
    USA 30.6%
    Japan 3.2%

    Chinese also because it uses a large amount of salt, sugar, and oil
    Obesity rate is over 10%

  6. 日本語で失礼します。

    西欧の食事に比べて日本の伝統食がヘルシーであることは間違いないと思いますが、
    日本の食事もかなり西欧化していますよ。

    日本人がスリムな人が多いのは色々な要因があると思いますが、
    日本では子供の頃から食と健康に関する様々な取り組みが行われています。

    日本では、小学校から食育を行っています。
    食品の栄養素やバランスの取れた食事、四季の食材、地域の食材の勉強します。
    1日30品目食べるようにと教わります。
    日本の学校では給食があり、必ず栄養士さんが栄養のバランスを計算してメニューが決まります。

    また、日本では毎年一度必ず健康診断を受けます。
    国や企業が実施しています。
    色々な種類の健康診断があります。
    例えば赤ちゃんは3ヶ月健診、6ヶ月健診などあります。
    40歳~74歳の人は、特定健診(別名メタボリック健診)という健康診断があります。

    日本人は全員、企業か国の健康保険に入っています。
    そして国家予算の半分にあたる52兆円が医療費です。
    日本人の死因の約6割が、癌、心疾患、脳血管疾患で、メタボリックシンドローム関連の疾患です。
    ですので国は、国民一人一人の健康意識を高め、病気を未然に防ぎ、
    医療費を抑える目的で健康診断を実施しています。
    (受けないと罰を受けるなんてことはありませんよ!)

    これは外見的な肥満ではありません。
    身長、体重、BMI、腹囲、尿糖、尿蛋白、中性脂肪、HDLコレステロール、LDLコレステロール
    空腹時血糖またはHbA1c、GOT、GPT、γ―GTP、
    その他様々な検査結果から一定の条件にひっかかった人は、
    生活習慣の改善方法をアドバイスを受けます。

    お昼にカロリーの高い食事を取ったら夜は控えめにするなど、
    1日の食事量やバランスを考えて食事をしている人が多いと思います。

    その他、1日8000歩歩くのが良いと言われています。
    食事と運動のバランスを常日頃から考えている人が多いのかもしれません。

  7. Hi Chris,

    Thank you so much for your great and informative article. One factor why the Japanese diet is healthy is because they are one of the most homogenous populations in the world. Certain traits that lend themselves to longevity can be inherited.

  8. Just reading through the article and comments and have to say I’ve been living in Japan for more than five years now and much of what is written here, particularly the comments is way off mark.

    On a daily basis I talk to Japanese people about what they eat, how they cook it, what they think is healthy/unhealthy. I talk to them about their health issues. I see what they buy at the supermarket.

    I could quite literally write a very thick volume on the subject. Needless to say talking about a ‘Japanese diet’ is a nonstarter as diets vary massively here. I know many who eat almost no meat whatsoever, and many who remove all fat from their food. I know many who don’t eat fish. Talk of small portions or portion control again is nonsense. Whilst many girls will starve themselves eating meager amounts of food, it’s not uncommon for people to eat meals containing 4-500 grams of rice or more.

    Most people I know eat a lot of bread and I have never heard a single Japanese person talk about grains as being unhealthy. Most people also seem to believe that you need to eat some sugar everyday. Whilst people drink a lot of green tea they also consume massive amounts of sugary drinks along with sweets and cakes.

    On a daily basis people buy bento boxes for lunch that contain a lot of poor quality meats breadcrumbed and deep fried in vegetable oil.

    Everyday I witness or talk about the myriad health problems that seem to afflict people here. Alzheimer’s, cancer, heart disease and strokes, osteoporosis, scoliosis, periodontal disease, so many children with severe allergies so on and so forth.

    Needless to say I think that in the very near future the there will be a quite a significant drop in the life expectancies of Japanese people.

  9. Wenchypoo,

    Because good health starts and ends in the gut…. doesn’t matter how much exercise one gets if the digestive system is not healthy… this is THE basis for good health. Exercise is great, if you’re in decent health… otherwise it is just another stressor…

    • I agree that gut health is usually the place to start for someone needing to adopt an alternative health plan. I can’t see though that exercise is, on balance, a negative influence for someone with poor gut health, as you imply. Do you have a study to show this?
      I suggest you reply with any additional comments by hitting the “reply” button under the statement you are replying to — in the case of talking about Wenchypoo’s comment, hit “reply” beneath her comment. This will help the other readers of this forum to navigate and understand.
      Best of health to you, Mr. Paleo, and please comment more about gut health. I’m sure it may be critical to understanding the benefits of the Asian diet, but I have no data to support that, except that Asians seem to eat far less gluten than the rest of the world, and gluten is coming to be recognized as a great aggravator of leaky gut syndrome which leads to many chronic maladies.

      • Glenn,

        Actually, I did hit enter as a reply, have no idea what happened…

        First, let me clarify my response… this site is about health and nutrition, not exercise. I am also a certified personal trainer with extensive education in fitness and sports-medicine. I would never argue that “exercise” is not important to overall health… what I was trying to say is that without a body healthy from the inside out, all the exercise in the world won’t make you “healthier”. As my personal experience will attest to, those that came into the gym with “health” problems weren’t magically made better through exercise, I had to work with their dietary habits and sometimes medical conditions as well… I now work with a retired physician to treat everything from bipolar disorder to cancer with dietary changes at the forefront of our work… p.s., I am sixty years old, rarely if ever sick, have a 29″ waist, BMI of 19, and only occasionally have time to work out any more… most of which I attribute to my switch to a Paleo/Primal lifestyle.

        • I live in an area that has many Chinese people. Their idea of healthy “exercise” is based on a different paradimn, The manipulation of “Chi”..They get up early and perform Tai Chi or Chi Gong type of movements to expieate bad or stale Chi and take in good Chi from the fresh morning air and sunlight. Accupuncture also is based on this way of thinking. It is an error to focus on what is familar to us, walking and bike riding as their primary help.

          When we talk about the health of Asian peoples, we are not in Kansas anymore Toto.

  10. As I said in the French article–WHY ARE WE ONLY LOOKING AT THINGS FROM A FOOD ANGLE? Both Asians and French WALK MORE than we do because cars are prohibitively expensive–in Japan’s case, PARKING is extremely prohibitive!!

    We can look like them too if we ditched our cars and walked/rode the bus/train more.

    I’m willing to bet that any other country you come up with will have a similar movement component to go along with whatever food component exists.

    • I totally agree. Glad you brought this up. In spite of what Mr. Paleo says following this, it’s very hard to vote against moderate exercise. In fact, as long as we are talking exercise, it seems gyms and athletic fields and jogging circuits are used far less in Asia than in the US. They tend to exercise moderately. So in addition to exercise, the type of exercise may be a strong factor in longevity. I have been participating in forums for a while, and for over a year, I have questioned all the fitness advocates (mostly lifters, runners, and interval trainers) about providing one study showing longevity can be connected with strenuous exercise, and apparently, no study has been done. Only studies showing positive relationships between “markers” of heart health and strenuous exercise exist. So I would say, without proof of long-life-benefits of strenuous workouts, that moderate exercise may be the key, because that is what accompanies longevity in the longevity studies.

  11. Thanks Chris for this wonderful article. I eat white rice twice a day usually with fish and vegetables. I am a slim female. Is rice better than wheat for weight loss? What other foods besides natto have fibrinolytic enzyme?

  12. I’m enjoying the “Health Lessons from International Cuisines” series so far, hope to see more of these.

    “Soup” as a healing food or even a food group unto itself is a bit misleading though–it depends what you put in the soup. The Korean soup women eat after pregnancy is a seaweed soup. They also have 24 hr restaurants that serve a popular bone-broth soup (which, incidentally, is also considered a hangover food). Funnily enough, Koreans eat a kind of chicken soup when they are sick too.

    Regarding the “Asian exception”–one other thing that strikes anyone who’s spent any significant amount of time living in Asia is that the foods the different countries eat are actually very different from one another. The Korean diet, in particular, is typically said to lead to its own set of health problems–such as relatively higher incidence of stomach cancer, presumably due to high consumption of red pepper and soju (a kind of alcohol).

  13. I haven’t read the comments, so this may have been covered: my Japanese friend tells me that they don’t eat soy as the focus of a meal, like Americans eat a big slab of meat. It’s more of a condiment. Also, it’s usually fermented.

  14. I would like to add that people in Japan have a rate of diabetes which, though lower than the American rate, is still surprisingly high (something like ~5-6% vs ~8% in the US, by diagnoses). I know some Japanese who have T2DM. This surprises me because of the relatively much lower obesity rates. Perhaps it’s because the population is older, but I think it could be related to an emphasis on rice. As time goes on, lifestyles in Japan are becoming more sedentary as well, though as a baseline I’d say they walk and ride bicycles quite a bit more than Americans, on average.

    On a recent trip to rural southern Japan, I noticed a great many rice paddies had been turned into wheat fields. I’ll just let that speak for itself.

    • This higher current rate of diabetes in Japan is likely to the Westernization of the diet, not from the traditional diet with white rice. More McDonalds, more dairy, processed foods, sodas etc..

      Diabetes in rural China and non-Westernized parts of Japan do not have these higher rates of diabetes. In fact, in rural China where the traditional diet based on rice, diabetes is nearly non-existent. But Chinese and Japanese citizens who move to American end up w/ same rates of diabetes as other Americans. It’s definitely the food, but not the rice!

  15. For several years in the past, I was following a modified Japanese diet, it was macrobiotics, first in the Michio Kushi style, then in the Herman Aihara style. At first I lost weight and felt great, but after a couple of years, I regained the weight and then some, i suffered from digestive issues, farted like a truck driver. Looking back at this now, I was on my way to developing metabolic syndrome.

    I still retain elements of the diet, such as seasonal food choices, a high fish and seafood, sea vegetables intake, a love of Japanese style green tea.
    The most important thing I took away from macrobiotics, was the appreciation for the sacredness of food, my knife and cutting board, were an altar, in the chapel of my kitchen.

    • Iron Chef Bobby Flay vs Murimoto. When Flay won he got on the counter and stood on his cutting board. This was unforgivable in Morimoto’s eye’s. He explained that to the Japanese such things are considered sacred to a Chef. He was visibly upset..

  16. What about the reports that pickled food is Asian countries is associated with higher stomach cancer rates?

  17. This is very informative! I usually eat white rice once a day. I learned it from my Asian relatives. I don’t have any problems with my weight and I enjoyed eating every meal. 😀

  18. Another factor that could have a part to play is Japenses diet is supposed to be very low in advanced glycation end-products (AGES) due to there low heat cooking methods.

  19. I lived in Japan for 3 1/2 years recently, working at a company in Kyoto where I was the only white person amidst 200 Japanese. We had a “cafeteria” in the office where lunch was prepared for all the staff daily (we had several full-time cooks) which was generally standard Japanese food.
    Rice and some sort of soup (generally miso but not always) were a standard at every meal. We ate a lot of fish, and occasionally red meat (usually in the form of ground mince as hamburger patties, probably more cost efficient) as well as other seafood. There were a lot of fresh salad mixes as well, and a fair bit of fermented sides. Everything was set out on a buffet and people would fill little dishes — a plate with fish, a plate with one salad, a plate with another salad, along with the bowl of rice and the bowl of soup. Everyone ate rice with their meal, and the male staff often went back for seconds. Occasionally we’d have udon or katsudon or something, which was then just a single big bowl with the rice/noodles, meat, veg, etc in the one bowl. All the ingredients were bought fresh and prepared the same day, and everything was seasonal — we ate very differently in summer than we did in winter.

    Also, I primarily socialised with Japanese people, and restaurants are much the same — fresh food, fish and veggies, sometimes red meat. Going out for yakiniku was a special occasion, but much enjoyed, where we ordered big slabs of sliced red meat and cooked them at our table, with fresh salads as a side.

    Most of the people I socialised with knew a lot more about traditional Japanese cooking and were quite accustomed to being able to buy a random set of vegetables and fish/meat from the grocery store and being able to cook with it. At the supermarkets, the fresh veggie section was a lot bigger, as was the fish section, although the meat section was more limited (and expensive). People seemed to shop more regularly (every few days) and relied on always having access to fresh foods, and were inclined to cook seasonally.

    That said, I have noticed that there is a lot of influence now of chocolates, pastry shops/bakeries and fast food restaurants, and because these are an “imported” thing, they are seen as very hip and cool and stylish, so more and more young people are going to cake shops regularly, or eating pastries regularly. Plus convenience stores sell a LOT of bakery-type products which are often eaten by people now as they rush to work, instead of breakfast, and they also sell microwave dinners, which can even be heated for you in-store, but which are woefully nutritionally deficient. More and more people are just living on this “convenience food” because when you’re so overworked it’s easier than cooking for yourself.
    And you can almost see the generational difference in weight as well — 50yo Japanese are by and whole thinner than 30yo Japanese, who are by and whole thinner than the teens and young children that I saw regularly in the suburbia area I lived. And the 20yo girls I worked with knew less about cooking and nutrition than the 40 and 50yo women I worked with, and also ate more “Western” snacks (made with weight), were generally chubbier, and worried more about how hard it was to lose weight. There were several noticeably overweight girls in the 20-30 age range at my work, but none in the 40-60 age range. The younger girls were also much frailer than the older women, too — anemia was a VERY common problem, as was lack of menstruation, getting cold too easily, and passing out from overheating during summer, and a variety of other things that reinforced the idea that women are “weak”.

    I worry that the more Westernized Japan becomes, the less their diet will protect them from ill health. That said, for now they are still overall much thinner. When I returned to Australia after my 3 1/2 years in Japan, I spent several weeks in confused shock about how fat everyone is here (comparatively). :/

    • Ahem. The Western snacks are “made with WHEAT”, not made with weight. That was a Freudian slip if ever I saw one. 😉