Macrobiotic: a good plate of vegetables wrapped in very big promises.
Whole grains, vegetables, beans and miso soup, eaten in a spirit of balance. Done moderately, it's a perfectly decent way to eat. The trouble starts when it's sold as medicine.
The short version
- What it is
- About half whole grains, the rest vegetables, soups, beans and seaweed. Mostly plant-based, little or no processed food.
- Good for
- Fibre, vegetables and cutting junk. One small, short trial in type 2 diabetes looked promising.
- Bad at
- Protein, B12, vitamin D and calcium, especially in strict versions. Children have been badly harmed.
- Evidence
- Weak. Small trials; no evidence against cancer.
- Our take
- Borrow the grains-beans-vegetables base and the miso. Leave the strictness and the health claims.
What the macrobiotic diet actually is
Macrobiotics was developed in the 1920s by the Japanese philosopher George Ohsawa.1 It's a whole philosophy of life, not just a menu, built on the idea of balancing opposite forces in food, usually described as yin and yang. Foods are sorted by their supposed qualities, and meals are put together to keep things in balance, with attention to season, place and how food is cooked.
A typical modern macrobiotic plate, as Cancer Research UK describes it: about half organic whole grains (brown rice, barley, oats, buckwheat), up to a quarter locally grown vegetables and fruit, and up to a quarter soup, often with seaweed, beans, lentils and miso. Many followers are fully vegan; some eat small amounts of fish. Processed food is out, and so, in many versions, are supplements and microwave cooking.1
The philosophy itself isn't our business. What we look at is what happens to your body on the plate, and what the health claims attached to it are worth.
How it works in your body
The moderate version is essentially a high-fibre, low-fat, mostly plant-based diet. Lots of whole grains and beans means lots of fibre and slow-release carbohydrate. Little meat, dairy, sugar and processed food means little saturated fat and few empty calories. Cancer Research UK notes that long-term followers tend to have lower fat and cholesterol levels, and that a normal healthy diet does the same.1
The benefits come from the vegetables and beans, not from the yin and yang. And the problems come from what's missing: the stricter the version, the less protein, B12, vitamin D, calcium and iron.
What you eat, what you don't
Eat
- Whole grains: brown rice, barley, millet, oats, buckwheat
- Vegetables, mostly local and in season
- Beans: adzuki, lentils, chickpeas
- Miso soup, tofu, tempeh
- Sea vegetables: nori, wakame, kombu
- Some fish, nuts, seeds and fruit, in the less strict versions
- Green tea, roasted grain teas, water
Forget it
- Sugar, sweets, soft drinks
- Meat and poultry
- Milk, cheese and most dairy
- Processed and refined food, white flour
- Coffee and strong spices, in most versions
- Tropical fruit and nightshades, in stricter versions
Alcohol on the macrobiotic diet
OK, now and then
- A small sake with a meal
- A glass of dry wine
- Green tea, roasted barley tea, kombucha without added sugar: the everyday drinks
Not part of the pattern
- Sweet cocktails and liqueurs
- Spirits mixed with cola, juice or energy drinks
- Regular drinking of any kind
50 Club: one small sake or one glass of dry wine at the weekend.
Most macrobiotic practice keeps alcohol to a minimum, which suits the evidence. The World Health Organization says no safe level of alcohol has been shown.7 All the details are in our alcohol guide.
What it's good for, with proof
Blood sugar in type 2 diabetes, in one short trial
In the Italian MADIAB trial, people with type 2 diabetes ate either a macrobiotic diet called Ma-Pi 2 (whole grains, vegetables, legumes) or a standard diet recommended by diabetes societies, for 21 days. The macrobiotic group had bigger drops in blood sugar, HbA1c, LDL cholesterol and weight.2 Honesty corner: it was small, it lasted three weeks, all meals were served at hotels, and it was funded by a macrobiotic association. Interesting, not settled.
Lower fat and cholesterol
Long-term followers tend to have lower fat intake and cholesterol levels.1 That's what you'd expect from any high-fibre, mostly plant-based diet with little saturated fat. It's not unique to macrobiotics. If plants are your thing, our vegan article covers how to do it without gaps.
The uncomfortable truth
"A macrobiotic diet can cure cancer." No. Cancer Research UK says there is no scientific evidence that it treats, cures or prevents cancer, and it does not support its use by people with cancer.1 People with cancer often need more calories and protein, not fewer. If you or someone you love is being sold this as treatment, please talk to the cancer team first.
"Stricter is purer, and purer is healthier." The opposite. Early strict versions, which narrowed down towards whole grains only, caused severe malnutrition and some deaths.1 A 1967 medical report described a woman on a Zen macrobiotic diet who developed scurvy, the vitamin C deficiency disease that sailors used to get.3
The risks
- Children. This is the serious one. In a Dutch study of infants raised on macrobiotic diets, deficiencies of energy, protein, vitamin B12, vitamin D, calcium and riboflavin were common, with slower growth, muscle and fat wasting and slower development.4 Rickets, the bone disease caused by too little vitamin D and calcium, was found in a high share of them.5 The researchers recommended adding fat, oily fish and dairy.4
- Vitamin B12 and D. Few or no animal foods and a dislike of supplements is a bad combination. B12 deficiency can damage nerves and blood, slowly and quietly.
- Protein and calories. Restrictive versions can leave people short on calories, protein, calcium and iron, and losing too much weight.1
- The wrong seaweed. The UK Food Standards Agency has advised people not to eat hijiki seaweed because of its inorganic arsenic, a cancer risk. Arame, kombu, nori and wakame didn't have that problem in its survey.6
- Salt. Miso, soy sauce and pickles are salty. Watch it if your blood pressure is high.
Allergies: watch the staples
| Macrobiotic staple | Allergen (EU list of 14)8 | Swap |
|---|---|---|
| Miso, tofu, tempeh, soy sauce, tamari | Soy | Chickpea miso, beans, lentils, coconut aminos |
| Barley, oats, seitan, wheat noodles | Cereals containing gluten | Brown rice, millet, buckwheat (soba made with 100% buckwheat) |
| Sesame seeds, gomasio, tahini | Sesame | Pumpkin or sunflower seeds |
| Fish, bonito flakes | Fish | Tofu (if no soy allergy), beans |
| Almonds, walnuts | Tree nuts | Seeds |
| Some soy sauces, miso and pickles | Cereals containing gluten (wheat) | Check labels; tamari is often wheat-free |
Don't do the macrobiotic diet if you…
- are feeding a baby or young child: please don't, without a paediatric dietitian
- are pregnant or breastfeeding
- have cancer or another serious illness and are thinking of using it as treatment
- are underweight, frail or over 70 and losing weight without trying
- have ever had an eating disorder
- have kidney disease or high blood pressure (salt, potassium) without medical advice
Healthen me asks about all of these and gives you a different plan if any apply.
How we use macrobiotic eating in your plan
We don't. It's an information article for us, not part of the engine: the strict versions carry real risks, and the evidence for the moderate version doesn't add anything a healthy plant-forward diet doesn't already give you.
What we do use are the foods. Miso, tofu, tempeh, seaweed, adzuki beans, buckwheat and brown rice are all in our food list, especially for users in Asia. If you like this style, the Okinawan diet is a closer match to our plan, and our Ayurvedic eating article covers another tradition built on balance.
This article is general information, not medical advice. If you have a medical condition or take medication, talk to your doctor before changing how you eat.
Sources
- Cancer Research UK. Macrobiotic diet. Last reviewed 23 September 2022. cancerresearchuk.org/about-cancer/treatment/complementary-alternative-therapies/individual-therapies/macrobiotic
- Soare A et al. The effect of the macrobiotic Ma-Pi 2 diet vs. the recommended diet in the management of type 2 diabetes: the randomized controlled MADIAB trial. Nutrition & Metabolism 2014;11:39. doi.org/10.1186/1743-7075-11-39
- Sherlock P, Rothschild EO. Scurvy produced by a Zen macrobiotic diet. JAMA 1967;199:794. doi.org/10.1001/jama.1967.03120110066009
- Dagnelie PC, van Staveren WA. Macrobiotic nutrition and child health: results of a population-based, mixed-longitudinal cohort study in The Netherlands. American Journal of Clinical Nutrition 1994;59(5 Suppl):1187S–1196S. doi.org/10.1093/ajcn/59.5.1187S
- Dagnelie PC et al. High prevalence of rickets in infants on macrobiotic diets. American Journal of Clinical Nutrition 1990;51(2):202–208. doi.org/10.1093/ajcn/51.2.202
- Food Safety News. Food Standards Agency issues seaweed warning (FSA advice not to eat hijiki), 5 August 2010. foodsafetynews.com/2010/08/food-standards-agency-issues-seaweed-warning
- WHO Regional Office for Europe. No level of alcohol consumption is safe for our health. News release, 4 January 2023. who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
- Regulation (EU) No 1169/2011 on food information to consumers, Annex II (the 14 allergens). eur-lex.europa.eu/eli/reg/2011/1169/oj