What Is It?
How Does It Work?

What You Can Expect
Health Benefits

How To Choose a Practitioner



Evidence Based Rating Scale

What Is It?

Macrobiotics is a philosophy embracing the idea that living life within the natural order will ultimately lead to good health, happiness, and an enhanced appreciation for the constantly changing nature of all things. The belief is based on the ancient Chinese principles of yin and yang, which represent opposite yet complementary forces believed to exist in all aspects of life and the universe. Things that are yin are flexible, fluid, and cool; things that are yang are strong, dynamic, and hot. According to macrobiotic theory, illness is the result of an imbalance in these two forces. Therefore, macrobiotic practitioners attempt to treat ailments by bringing yin and yang back into balance through diet and lifestyle changes.

Although the origins of macrobiotics stem from the ancient principles of Eastern medicine, the contemporary basis for it was developed in the late 19th century by a Western-trained Japanese Army doctor named Sagen Ishizuka. Dr. Ishizuka had become frustrated with allopathic (or Western) medicine's ineffectiveness in treating his own cancer, and he decided to try to cure himself by adopting a diet of brown rice, soybeans, fish, miso soup (made with soybean paste), sea vegetables, and other Oriental foods. He called this therapy shoku-yo, or food cure.

Ishizuka's findings were published and later used for reference by Yukikazu Sakurazawa, a Japanese philosophy student who adopted the pen name George Ohsawa in the 1920s. Ohsawa sought to integrate traditional Asian medicine with Christian teachings and some aspects of Western medicine. He believed that by returning to a basic diet of whole, natural foods, humanity could regain its physical and mental balance and the world become more peaceful. It was Ohsawa who popularized the term macrobiotics (from the Greek words makros, meaning "large" or "long" and bios, meaning "life").

In 1959, Ohsawa brought macrobiotics to the United States, where it was promoted by his students Michio and Aveline Kushi in Massachusetts and Herman and Cornelia Aihara in California. By the time of his death in 1966, Ohsawa had written more than 300 books in French, German, Japanese, and English, and he was the hero of thousands of young Americans who flocked to macrobiotic restaurants and natural-foods stores across the country to embrace his teachings.

Today, those who follow a macrobiotic regimen are urged to avoid foods that are processed or refined, or that are too yin (sugar, pungent spices, alcohol, and caffeinated tea and coffee, for example) or too yang (meat, poultry, eggs, and dairy products). Recommended instead is a balance of good yin foods (such as seasonal, local fruits and leafy green vegetables, seaweed, and tofu) and good yang foods, such as brown rice and other whole grains, legumes, soups made with miso (soybean paste), and fish and shellfish. According to strict macrobiotic diet guidelines, recommended foods are those that are local and organically grown. Thus, the macrobiotic diet in Florida might be different from the one in Massachusetts.

There are also specific guidelines regarding the preparation of foods according to yin/yang principles. For example, gas stoves are recommended over electric, because foods cooked on an electric stove are believed to have less-harmonious energy. And, according to the principles of macrobiotics, utensils should ideally be constructed of wood, ceramic, or stainless steel rather than aluminum or copper.

In addition to the proscribed diet, macrobiotics is also a spiritual and social philosophy of living. Five specific daily practices are encouraged: Greet everyone with a sense of appreciation and joy; maintain regular and positive communication with your family; enlarge your circle of friends; share your food by including more people in your life; and make time for introspection and reflection.

How Does It Work?

Macrobiotic practitioners believe that the macrobiotic diet improves the condition of the blood plasma, which in turn improves the condition of the body in general. When starting a macrobiotic diet, a number of basic changes may occur during the first ten days. These changes, practitioners say, will mainly be reactions to the "discharge process," or cleansing of the plasma and the body. Fatigue, irritability, sweating, insomnia, and cravings are all common symptoms of this cleansing. After the first 10 days, the reactions tend to vary, but most people report feeling calmer, more alert, and more focused.

According to practitioners, after six to eight months on a macrobiotic program, the blood will become perfectly balanced and the body will show even more changes for the better. Those with chronic conditions may also start to experience noticeable improvements.

To undergo a macrobiotic diet for any length of time, however, it is important to be under the guidance of a licensed nutritionist or nutritionally oriented physician. In the 1960s, an incorrectly practiced form of macrobiotics was so nutritionally deficient that a few deaths from malnutrition were reported.

Today, macrobiotics offers many options, and nutritional deficiencies should not occur. Even so, it is still important to eat a wide variety of foods to ensure the proper amounts of key vitamins and minerals--particularly vitamins B12 and D, and the minerals calcium, and iron. For those avoiding meat or poultry, it is also important to take a separate Vitamin B12 supplement. And because the fluid restrictions on some macrobiotic diets can create serious health problems over time, drinking plenty of water is important.

Some people do need to take special care when following a macrobiotic regimen. Studies have repeatedly demonstrated that among individuals who have increased nutritional needs, such as infants, children, and pregnant or breast-feeding women, a macrobiotic program can produce serious deficiencies, which can be only partially corrected by adding dairy or vitamin supplements. In addition, macrobiotics limits total Calorie intake, which may not be advised for these groups. In all cases, medical supervision is a good idea.

What You Can Expect

Certified macrobiotic practitioners, like acupuncturists and other practitioners of Traditional Chinese Medicine, are trained in Oriental diagnosis. Depending on the symptoms and severity of the condition, the practitioner may recommend a conventional diagnosis before prescribing nutritional therapy.

The initial examination by a macrobiotic practitioner will likely follow the procedures typical of Chinese medicine. The practitioner will take a careful medical history, noting the body's reactions to stress and tendencies for showing illness symptoms. The practitioner will also ask about diet and lifestyle habits. As part of the diagnosis, the practitioner will note the color and form of the patient's face and body, listen to the voice, record the condition of skin and nails, smell the breath, and observe posture and demeanor. The tongue will be examined for shape, color, and coating, which indicate how circulation and metabolism are affecting the internal organs. The patient's pulse will be taken at three different points on each wrist, each point corresponding to a different part of the body.

After evaluating all this information to get a sense of the patient's current level of function, the practitioner will provide advice in three general areas: diet, lifestyle and philosophical attitude. To correct the diet, the practitioner advises which foods to add to the diet and which to avoid; to improve lifestyle, the practitioner will address matters such as exercise, personal hygiene, and clothing; and regarding philosophical attitude, suggestions will be offered for living a more harmonious life.

Normally, two, hour-long sessions spaced about a month apart are required with a macrobiotic practitioner. To be on the diet for any length of time, additional sessions may be required, as well as visits with a nutritionist or nutritionally oriented physician.

Health Benefits

A sensible macrobiotic diet is low in Fat, cholesterol, and calories and high in fiber and complex carbohydrates. According to studies, people who follow such a diet tend to have much lower blood pressure and cholesterol levels than the average American. In addition, the macrobiotic diet is believed to help strengthen the immune system, increase stamina, and prevent or reduce digestive complaints, obesity, fatigue, and poor concentration, although research is lacking. On a scientific basis, research has demonstrated that diets high in soy and low in animal fat may be of value in decreasing the risk of breast and other cancers.

Some practitioners claim that a macrobiotic diet can help treat diseases such as arthritis and some forms of cancer. There is no scientific evidence supporting any claim that a macrobiotic diet can actually cure a specific illness. However, the macrobiotic emphasis on fresh, unprocessed foods may prove helpful for those with food allergies or chemical sensitivities.

Specifically, macrobiotics may help to:

Reduce the risk of heart disease. Researchers who conducted the landmark, decades-long Framingham Heart Study found that people eating diets low in cholesterol and saturated fat and high in complex carbohydrates, such as the macrobiotic diet, had the most ideal blood pressure and cholesterol levels, thereby reducing risk of heart disease. (1-8) When comparing the macrobiotic diet to other diets such as non-vegetarian, semi-lactovegetarian, (vegetarian diet that includes dairy products), or lactovegetarian; total cholesterol concentrations were slightly lower in the macrobiotic group compared to other groups, but no significant differences were noted in HDL (good) cholesterol levels with the macrobiotic diet compared to the other diets. (9) Like the macrobiotic diet, the Mediterranean diet plan relies on high consumption of vegetables, fish, and olive oil and has been shown to lower blood pressure. (10, 11) However, research specifically evaluating the macrobiotic diet to prevent heart disease is lacking. More research is needed.

Prevent and treat cancer. Most research regarding macrobiotic therapy has focused on its potential to prevent many types of cancer. Diets high in fat and low in fiber have been associated with a higher incidence of colorectal, breast, and other types of cancer, so it makes sense that the macrobiotic approach may play a role in preventing these cancers. However, no studies have shown that the macrobiotic diet can be used to prevent or cure cancer. A pilot study is underway by the National Center for Complementary and Alternative Medicine at the National Institutes of Health to determine whether a macrobiotic diet may decrease the risk of cancer. (12)

Preliminary evidence in the 1980s found the macrobiotic diet is high in lignans and plant phytoestrogens that have anti-carcinogenic properties. (13) In 1989, the American Cancer Society reviewed 11 major scientific databases and found no peer-reviewed documentation that the macrobiotic diet was effective in treating any type of cancer. (14) A 1991 review of case studies showed that the macrobiotic diet increased longevity in patients with cancer. (15) However, the Annals of Internal Medicine later noted that the review was "limited to two retrospective case studies with serious methodological flaws." (16) A 1994 study of 600 cancer patients found that one-third of the patients who followed a macrobiotic diet lost weight, resulting in other problems. Researchers attributed the resulting problems to expense or inaccessibility of some of the required foods, time spent preparing meals, restrictions and/or the unpleasant nature of the diet. (17) Further studies have shown the macrobiotic diet may help to improve quality of life and, together with conventional treatment, may increase survival time in some patients with cancer. However, all of the studies warn against using the macrobiotic diet as a "cure" for cancer without conventional medication. (18-21)

How To Choose a Practitioner

No licensing is required for macrobiotic counselors in the United States. However, the Kushi Institute, founded by Michio and Aveline Kushi and located in Becket, Massachusetts, offers training programs for macrobiotic counseling. Counselors who successfully complete the testing process are awarded a Macrobiotic Educators' Association certificate. To obtain the names of certified counselors, contact the Kushi Institute.


Consult a nutritionist or nutritionally oriented physician if you plan to be on a macrobiotic diet for any length of time.

If you have cancer or heart disease, do not substitute a macrobiotic plan as sole therapy in lieu of proven treatments for the disease.

If you are pregnant or breast-feeding, consult your obstetrician or pediatrician before adopting a macrobiotic diet.

Never put an infant or young child on a macrobiotic diet. Infants fed a high-fiber diet without any milk or meat may develop rickets, Scurvy, anemia, or osteoporosis.

The lack of animal Protein in the macrobiotic diet can ultimately cause a deficiency of vitamin B12. Include unfermented soy products fortified with B12 or take a B12 supplement. A B12 deficiency can cause a condition called pernicious anemia, manifested as fatigue, paleness, sore tongue, shortness of breath, and numbness/tingling in the hands and feet. A physician should be consulted if any of these symptoms appear.

See a doctor if symptoms of general nutritional deficiency, such as fatigue, muscle or joint pain, poor concentration, irritability, or susceptibility to infections develop while following a macrobiotic diet.  Even when supplemented with missing nutrients a macrobiotic diet may have too few calories to support those who expend a lot of energy.


1. Castelli WP. Diet, smoking, and alcohol: influence on coronary heart disease risk. Framingham Heart Study. Am J Kidney Dis. 1990 Oct;16(4 Suppl 1):41-6.
2. Sonnenberg LM, Posner BM, Belanger AJ, et al. Dietary predictors of serum cholesterol in men: the Framingham cohort population. J Clin Epidemiol. 1992 Apr;45(4):413-8.
3. Posner BM, Cupples LA, Gagnon D, et al. Healthy People 2000. The rationale and potential efficacy of preventive nutrition in heart disease: the Framingham Offspring-Spouse Study. Arch Intern med. 1993 Jul 12;153(13):1549-56.
4. Posner BM, Cupples LA, Franz MM, Gagnon DR. Diet and heart disease risk factors in adult American men and women: the Framingham Offspring-Spouse nutrition studies. Int J Epidemiol. 1993 Dec;22(6):1014-25.
5. Millen BE, Quatromoni PA, Nam BH, et al. Dietary patterns and the odds of carotid atherosclerosis in women: the Framingham Nutrition Studies. Prev Med. 2002 Dec;35(6):540-7.
6. Millen BE, Quatromoni PA, Nam BH, et al. Dietary patterns, smoking, and subclinical heart disease in women: opportunities for primary prevention from the Framingham Nutrition Studies. J Am Diet Assoc. 2004. Feb;104(2):208-14.
7. Panagiotakos D, Sitara M, Pitsavos C, Stefanadis C. Estimating the 10-year risk of cardiovascular disease and its economic consequences, by the level of adherence to the Mediterranean diet: the ATTICA study. J Med Food. 2007 Jun;10(2):239-43.
8. Lerman RH, Minich DM, Darland G, et al. Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial. Nutr Metab (Lond). 2008 Nov 4;5:29.
9. Knuiman JT, West CE. The concentration of cholesterol in serum and in various serum lipoproteins in macrobiotic, vegetarian and non-vegetarian men and boys. Atherosclerosis. 1982 may;43(1):71-82.
10. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 2004 Oct;80(4):1012-8.
11. Alonso A, de la Fuente C, Martin-Arnau AM, de Irala J, Martinez JA, Martinez-Gonzalez MA. Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study. Br J Nutr. 2004 Aug;92(2):311-9.
12. American Cancer Society. Macrobiotic Diet. Accessed March 22, 2010.
13. Adlercreutz H, Fotsis T, Bannwart C, et al. Determination of urinary lignans and phytoestrogen metabolites, potential antiestrogens and anticarcinogens, in urine of women on various habitual diets. J Steroid Biochem. 1986 Nov;25(5B):791-7.
14. American Cancer Society: Unproven methods of cancer management: Macrobiotic diets for the treatment of cancer. CA 1989;39:248-51.
15. Carter JP, Saxe GP, Newbold V, et al. Hypothesis: dietary management may improve survival from nutritionally linked cancers based on analysis of representative cases. J Am Coll Nutr. 1993 Jun;12(3):209-26.
16. Welger WA, Smith M, Boon H, et al. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med. 2002;137:889-903.
17. Downer SM, Cody MM, McCluskey P, et al. Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. BMJ. 1994 Jul 9;309(6947):86-9.
18. Weitzman S. Alternative nutritional cancer therapies. Int J Cancer Suppl. 1998;11:69-72.
19. Sparber A, Bauer L, Curt G, et al. Use of complementary medicine by adult patients participating in cancer clinical trials. Oncol Nurs Forum. 2000 May;27(4):623-30.
20. Kushi LH, Cunningham JE, Hebert JR, et al. The macrobiotic diet in cancer. J Nutr. 2001 Nov;131(11 Suppl):3056S-64S.
21. Weitzman S. Complementary and alternative (CAM) dietary therapies for cancer. Pediatr Blood Cancer. 2008 Feb;50(2 Suppl):494-7; discussion 498.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.








Some evidence indicates efficacy in improving quality of life and longevity in conjunction with conventional treatment. Ineffective when used alone. Not recommended to treat cancer. (13-21)

Cancer prevention  
No evidence exists to support this use. (12)
Heart disease  

Similar diets have been shown to reduce risk factors. Research evaluating macrobiotic diet, specifically, is needed. (1-11)


Date Published: 04/19/2005
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