Mainstream Nutritional Science and the Unconventional Nutritional Cancer Therapies
Macrobiotics–A Diet and a Way of Life
Today, macrobiotics is the most widely used unconventional nutritional approach to cancer in the United States. Best known for its primarily vegetarian, high complex carbohydrate, low fat diet, macrobiotics also offers a spiritual philosophy of life that is embraced to varying degrees by many thousands of practitioners around the world. Michio Kushi, the focus of this chapter, is the most influential macrobiotic teacher today. Kushi’s approach to macrobiotics is by no means the only one in the macrobiotic “movement,” but because he is the best-known macrobiotic teacher and made the choice to make significant claims for success with cancer, he is the proper focus for this analysis.
As the preeminent teacher in a very widespread movement, Kushi necessarily generates a wide range of responses–some critical, some laudatory–both from within and outside macrobiotic circles. But what is unquestionably true is that he is a philosophical thinker in the great tradition of what Aldous Huxley called the perennial philosophy–the philosophy that appears at the core of all the great spiritual traditions of the world. He is a contemplative observer of both the microcosm of human health and the macrocosm of planetary history and evolution. In this he is reminiscent of Rudolf Steiner, founder of anthroposophy, and Edgar Cayce, the American seer: all three provide their followers with a spiritual perspective based on the perennial philosophy, with prescriptions for healthy and balanced living, and with detailed recommendations for the treatment of disease, including cancer.
The word “macrobiotics” comes from the Greek macro, meaning “great” or “large,” and bios, “life.” In its current manifestation, macrobiotics originated in the late nineteenth and early twentieth centuries with an educator named Yukikazu Sakurazawa and a physician named Sagen Ishisuka. They reportedly cured themselves of serious illnesses by changing from the modern refined diet then sweeping Japan to a simple diet of brown rice, miso soup, sea vegetables, and other traditional Japanese foods. After restoring their health, they went on to integrate traditional Oriental medicine and philosophy with Vedanta (a Hindu spiritual tradition), original Christian and Jewish teachings, and holistic perspectives in modern science and medicine.1 (Some critics haveêasserted that Sakurazawa and Ishisuka never intended this theological base, and that later proponents of macrobiotics, particularly Michio Kushi, were responsible for the religious element.) When Sakurazawa came to Paris in the 1920s, he adopted George Ohsawa as his pen name and called his teachings macrobiotics.
Michio Kushi was born in 1926 in Japan. Kushi studied political science and law at Tokyo University, the premier university of Japan, during World War II. According to a biography of Kushi published by the Kushi Institute:
The atomic bombing of Hiroshima and Nagasaki made a deep impression on him, and he decided to devote his life to world peace. After the war, he continued graduate studies in Tokyo in international law. With the support of Norman Cousins, editor of the Saturday Review, Professor Shigeru Nanbara, chancellor of Tokyo University, and Rev. Toyohiko Kagawa, the Christian evangelist, he came to the United States in 1949 to pursue his studies of world order.2
Kushi continued graduate studies at Columbia University. He began to question the possibility of bringing about social change through political means and went to see Albert Einstein, Thomas Mann, Upton Sinclair, Robert M. Hutchins, Harold Urey, Pitrim Sorokin, and other prominent scientists, authors, and statesmen. They all offered encouragement with his search but told him they knew of no lasting solution to make humanity peaceful.3
Before leaving Japan, Kushi had studied briefly with George Ohsawa at the Student World Government Association. It was Ohsawa’s belief that food was the key to health and that health was the key to peace. By returning to a traditional diet of whole, natural foods, he believed that humanity could regain its physical and mental balance and therefore become more peaceful. While living in New York, Kushi experienced positive changes in his own health and consciousness after changing his own diet. Over the next 10 years, with the support of his wife Aveline, he began to study traditional and modern approaches to diet and health and to teach macrobiotics.4
In the 1960s, Kushi moved to Boston and founded Erewhon (one of the early natural foods distributors) to make available the foods necessary for a macrobiotic lifestyle. In 1971, his followers founded East-West Journal, and the following year the East-West Foundation was started to support macrobiotic education and research. In 1978, Michio and Aveline Kushi founded the Kushi Institute for One Peaceful World, with affiliate organizations throughout Europe. Kushi has met many national and international leaders, lectured to thousands of health professionals, and been profiled in dozens of leading newspapers and magazines.5
Today, Kushi describes macrobiotics as a unique synthesis of Eastern and Western influences. It is the way of life according to the largest possible view, the infinite order of the universe. The practice of macrobiotics involves the understanding and practical application of this order to our lifestyle, including the selection, preparation and manner of eating our daily food, as well as the orientation of consciousness. Macrobiotics does not offer a single diet for everyone, but a dietary principle that takes into account differing climactic and geographical considerations, varying ages, sexes and levels of activity, and ever changing personal needs.6
Twenty years ago, Kushi made an interesting, critical, and intriguing decision. He decided to present macrobiotics to the world with a major emphasis on its role in the prevention and alleviation of cancer. His son, Lawrence Kushi, Ph.D., a respected nutrition researcher, commented in a discussion I had with him, “Twenty years ago, macrobiotics was generally seen in its role as a philosophy of life focused on the order of the universe. Later it became most widely known for the cancer prevention diet. Michio Kushi moved in that direction. Some would ask whether that was the right decision, or whether cancer was necessarily the right disease.”7
The question is a fair one because Michio Kushi is not a careless man, but one who teaches and practices taking “the large view.” Granting that Kushi’s life purpose was to support a movement toward world peace through health, pure food, and right living, still there was no clear imperative for him to give a primary emphasis to the role of macrobiotics in preventing or “relieving” cancer. Moreover, a macrobiotic diet has not yet been scientifically demonstrated to be effective with cancer in the way it appears to have been with heart disease. In heart disease, the work of Dean Ornish, M.D., and others has suggested that a very low fat vegetarian diet in combination with yoga-based stretching and group support can not only decisively ameliorate the symptoms of angina8 but may slowly reverse arterial blockage.9 Similarly, Frank M. Sacks, M.D., of Harvard Medical School and his colleagues found that macrobiotic populations had much lower blood pressure and serum cholesterol levels than were found in the general population.10 Macrobiotics, like other nondairy vegetarian diets, is an effective preventive strategy for heart disease and hypertension and, very likely, if the studies by Ornish are confirmed by others, an effective approach to symptom control and reversal of arteriosclerotic blockage as well. Because of the more limited evidence for macrobiotics in the “relief” of cancer, the question remains whether or not cancer was the right disease for Kushi to choose as a focus.
With cancer, macrobiotics and similar vegetarian diets are arguably preventive for those cancers most closely associated with a high fat Western diet, although, again, this relationship is not nearly as clear as the relationship between high fat diets and heart disease. These diets may also some day prove to be effective for patients with some types of cancer, in the inhibition or reversal of tumor progression as well as in the extension of disease-free and overall survival after surgical or medical treatment. However, well-designed scientific research will be necessary to determine whether, and in what ways, macrobiotics is helpful with cancer, and the results of these studies will not be in for at least another decade.
The Cancer Prevention Diet
The Cancer Prevention Diet: Michio Kushi’s Blueprint for the Relief and Prevention of Disease,6 written with Alex Jack, is Kushi’s major treatise on the macrobiotic approach to cancer. The book, worthy of close study by any serious student of alternative cancer therapies, has three parts.
Part I, “Preventing Cancer Naturally,” discusses cancer, diet, and macrobiotics in the context of modern civilization. It argues persuasively that our increasingly unnatural lifestyles, out of touch with nature and the order of the universe, predispose us to a wide range of degenerative disorders, including cancer. There is little doubt that this is true.
Part II applies the general theory of macrobiotics to 14 of the most common types of cancer.
Part III is entitled “Recipes and Menus” and also has a very important discussion of “home remedies based on traditional macrobiotic Oriental medicine and folk medicine, modified and adjusted for practical use in modern society.”11 The most intriguing “home remedy” is a clay-cabbage compress said to be capable of drawing a tumor up through the skin without surgery. I will discuss this remedy in some detail later in the chapter.
Though the title of Kushi’s book presents the program as primarily a dietary program, the text introduces the reader to the whole philosophical-spiritual and lifestyle system that macrobiotics encompasses. And while the title of the book emphasizes prevention, the text focuses primarily on the use of the program for “relief” of the disease. The text also often makes clear Kushi’s disapproval of many forms of conventional treatment. In fact, to a large degree this is a book about modalities that, from a commonsense perspective, could be described as adjunctive or complementary treatments. I raise these points neither as criticisms nor endorsements, only as observations.
Kushi, cautiously, does not choose to present macrobiotics as an adjunctive treatment system. He has stated emphatically in a letter to the Office of Technology Assessment that “macrobiotics is neither a treatment nor a therapy, but a commonsense approach to living.”12 But some of the specific recommendations he makes for cancer go beyond a simple “commonsense approach to living.”
Breast Cancer as an Example
Kushi’s chapter on breast cancer in The Cancer Prevention Diet is one of the best examples of Kushi’s approach to cancer, and I will report on it in detail because so many women with breast cancer consider adopting a macrobiotic diet. The chapter starts with a discussion of survival rates for patients with breast cancer who follow conventional treatment:
About 65 percent of women with breast cancer survive five years or more. In 1973 researchers at Italy’s National Cancer Institute in Milan reported that studies showed no difference in survival or recurrence rates between women who had complete mastectomies and those who had partial ones. In 1977 Dr. Jan Sytgersward, a Swiss cancer researcher, reported that breast cancer patients who received no radiation therapy survived 10 percent longer than those who received radiation treatment. On March 15, 1980, The Lancet, a British medical journal, noted: “The overall survival of patients with primary breast cancer has not improved in the last ten years, despite increasing use of multiple drug chemotherapy for the treatment of metastases. Furthermore, there has been no improvement in survival from first metastasis, and survival may even have been shortened in some patients given chemotherapy.”13
Two problems with Kushi’s book are that the medical references are not footnoted for the articles cited, and that references are often incomplete or selected in a biased manner. In this instance, Kushi’s first statement regarding the equivalence of partial and complete mastectomies for survival is generally regarded as correct. The second statement regarding the survival disadvantage of radiation treatment is too broad a statement to assess and would generally be regarded as incorrect. The third statement regarding the absence of progress in life expectancy in primary breast cancer is widely debated. The fourth statement regarding the lack of progress in life extension after first metastasis is widely regarded as correct. The general point I wish to make here is that, in his book and elsewhere, the citation of scientific studies is very loose, and the real scientific issues are not always fairly stated.
Kushi then discusses his views of the causes of breast cancer. While there is scientific support for his views on the role of a high animal fat, low fiber diet in the development of breast cancer (although the subject is still debated), his view of the mechanisms by which breast cancer develops are at most only partially shared by scientists. If we eat poorly over a long time, Kushi says, we lose our ability to discharge excess wastes and toxins. Thus far, he would find agreement. But his statement of the mechanism of tumor formation goes beyond currently accepted scientific theories of tumorigenesis:
This can be serious, if an underlying layer of fat has developed under the skin, which prevents discharge toward the surface of the body. Repeated overconsumption of milk, cheese, and other dairy products, eggs, meat, poultry, and other fatty, oily, or greasy foods brings about this stage. When it has been reached, internal deposits of mucus or fat begin to form, initially in areas with some direct access to the outside such as the sinuses, the inner ear, the lungs, the kidneys, the reproductive organs, and the breasts.14
According to Kushi, this deposit of mucus or fat in the breast can become a cyst, and the process is accelerated by ingesting ice cream, milk, soft drinks, fruit juice, and other foods with a “cooling or freezing effect.” Breast-feeding is protective against formation of cysts or tumors in mothers, Kushi says, and cow’s milk is unsuited for human consumption because of the differences between it and human milk: “The abuse of dairy food in the modern diet and its degenerating artificial quality are major factors in the rise of breast cancer, heart disease, and other serious illnesses. The quality of our food determines the quality of our blood. The quality of blood, in turn, determines the quality of mother’s milk and the biological strength of the next generation.”15
Many scientists would agree with Kushi’s comments on the role of excessive nutrient intake and the possible role of toxins in the etiology of breast cancer, as well as with his comments on the protective value of breast-feeding. However, the rest of the theory is unsubstantiated from a general mainstream perspective.
In a following section entitled “Medical Evidence,” Kushi cites a number of intriguing findings from the history of medicine and more contemporary science. The bulk of the evidence that Kushi reports supports his views that a grain-based diet can relieve cancer and permit the patient to live a long time; that artificial infant feeding is associated with an increased incidence of breast cancer among mothers; that caloric restriction results in a lower incidence of breast cancer in animals; and that a vegetarian diet prevents breast cancer.16
A section entitled “Diagnosis” first discusses conventional methods of diagnosis, and then diagnosis from a macrobiotic or Oriental medical perspective:
In addition to self-examination of the breasts, Oriental medicine looks for signs of developing mammary disorders in the condition and complexion of the cheeks. As a result of parallel embryonic development, the cheeks reflect underlying changes in the chest region, including the lungs and breasts, and in the reproductive region.
Cheeks with well-developed firm flesh and a clean, clear skin color show sound respiratory and digestive functions, especially if there are no wrinkles or pimples in the area. Red or pink cheeks, except during vigorous exercise or when out in the cold weather, show abnormal expansion of the blood capillaries, caused by heart and circulatory disorders due to the overconsumption of yin foods and drinks, including fruits, juices, sugar and drugs. Milky-white cheeks are caused by the overconsumption of dairy products such as milk, cheese, cream and yogurt. A pinkish shade mixed with the white indicates excessive intake of flour products and fruits. Both these colors indicate accumulation of fat and mucus in various regions of the body including the breasts, lungs, intestines, and reproductive organs.
Fatty spots that are dark, red, or white in color on the cheeks are a sign of fat accumulation in either the lungs or breast and often accompany the beginning of a cyst or tumor formation. Coffee or other stimulant, aromatic beverages may contribute to the appearance of this color in the cheeks. … Certain colors and marks appearing on the white of the eye also indicate abnormal conditions in corresponding areas of the body. … Green vessels appearing along the Heart Governor meridian or Lung meridian from the wrist toward the elbow on the inside softer side of the arm also show the development of cancerous conditions in the breast or lung region. [The references to “meredians” are to energy channels postulated in acupuncture.] 17
All of this is, of course, outside the ken of mainstream medicine.
The next major section of the chapter on breast cancer discusses “Dietary Recommendations” and begins with what should be avoided:
For breast cancer, all dairy food and all fatty, oily food including meat, poultry, eggs and other animal products are to be eliminated. Sugar, honey, and other sweeteners as well as soft drinks and other foods and beverages treated with sugar are also to be avoided. Tropical fruits, fruit juices, and vegetables such as potato, yam, sweet potato, asparagus, tomato and eggplant should not be consumed. Because they are excessively mucus-producing, all flour products are to be avoided except for occasional consumption of nonyeasted unleavened whole-wheat or rye bread. Chemicalized and artificially produced and treated foods and beverages are to be completely eliminated. Even unsaturated vegetable oil is to be completely avoided or minimized in cooking for a one- or two-month period. All ice-cold foods and drinks including ice-cream should be avoided. Although they are not the cause of breast cancer, all stimulants, spices, coffee, alcohol, and aromatic, fragrant beverages and drugs should be avoided because they enhance tumor development.18
Kushi then discusses the recommended diet for breast cancer, which involves relatively small modifications of his basic cancer prevention diet19:
Fifty to sixty percent of daily consumption, by volume, should be whole-cereal grains. The most preferred are pressure-cooked medium or small-grain brown rice and, frequently, millet or barley.
Five to ten percent soup, consisting of two bowls per day of miso soup or tamari soy sauce broth cooked with kombu, wakame, or other sea vegetables and various land vegetables such as onions and carrots.
Twenty to thirty percent vegetables, cooked in a variety of forms.
Five percent small beans, such as azuki or lentils, may be used daily, cooked together with sea vegetables such as kombu or with onions and carrots.
Five percent or less sea vegetable dishes.
Kushi then goes on to specify condiments (sesame salt, kelp, or wakame powder). “Finely chopped scallions mixed and heated with an equal volume of miso and a small portion of grated ginger are helpful to soften hardening of tissues and tumor.”19
Mainstream medicine would find the diet nutritionally balanced but many of the specific recommendations nonsensical.
Kushi’s Recommended “Home Cares”
The following section, “Home Cares,” is one of the most intriguing and important. In it Kushi discusses home remedies that reportedly enable the tumor to be drawn out through the surface of the skin and purged through the application of clay-cabbage compresses:
For breast tumors, a towel soaked in hot water and squeezed out can be applied over the affected area for about three to five minutes to stimulate circulation. Afterwards, a compress containing about 50 percent green clay and 50 percent cabbage leaves or other natural plant leaves may be applied over the area to help facilitate the discharge of accumulated toxic matter. … This clay-cabbage compress may be left in place for about four hours or overnight, and it may be applied daily for up to one month, preferably under the supervision of an experienced macrobiotic counselor. This compress will gradually help draw the excess mucus and fat from the inner parts of the mammary tissues toward the surface of the skin. Eventually, the fatty mucus, sticky substances, and unclean blood that make up the tumor will drain out [emphasis added].
In cases where a breast has already been surgically removed and the surrounding lymph nodes, neck and in some cases arm have become swollen, a buckwheat plaster can be applied following a brief ginger compress.20
This section is intriguing because Kushi makes a specific claim that there is an alternative to surgery for the removal of some breast tumors. This claim is necessarily either true and important–in which case it should be scientifically validated–or untrue and potentially dangerous, because women would, in trying this method, avoid early removal of a breast tumor and wait until the tumor had progressed. The use of compresses must be approached with some caution, however. Keith Block, M.D., an Evanston, Illinois, internist-oncologist who serves on the faculty of the University of Illinois, reports observing some women who have been referred to him following prolonged use of compresses. In his experience, initial examination of some of these patients demonstrated tumors having grown so large that they broke through the skin and were draining fluids and blood; what might have been a simple resection earlier on now left these patients with limited options for recovery.21
A section entitled “Other Considerations” advises daily scrubbing of the whole body with a towel that has been immersed in hot gingerroot water as well as avoiding wool and synthetic fibers and metallic jewelry (“It is fine, though, to wear a wedding ring”).
Kushi also cautions against long periods in front of a television or other source of electromagnetic energy: “Radiation weakens the chest area.” Psychologically, he advises, “Breast-cancer patients are subject to depression and should do everything possible to maintain a cheerful and calm attitude. Smile, be optimistic, dance, sing, and enjoy each day for itself.”22
The last section in the breast cancer chapter is the case history of Phyllis Crabtree: “In October, 1972 … a fifty-year-old homemaker, nursery school teacher, and grandmother from Philadelphia, had an operation for cancer in which her uterus, ovaries, and Fallopian tubes were removed. By January, 1973, the tumor metastasized, and she had a modified radical mastectomy of the right breast.” Kushi then tells how her son Phillip, who had studied macrobiotics, brought her macrobiotic food in the hospital and how she gradually began to implement the macrobiotic diet. She then consulted Kushi, who recommended a stricter healing diet.
The next summer Mrs. Crabtree returned, and I told her that she was 60 percent healed and to continue eating carefully. By autumn of 1978, Phyllis had completed the five-year “cure” period for her original illness and outlived 85 percent of women who had had similar operations on the uterus and breast.
“I’m grateful to macrobiotics for more than a cancer `cure’, she stated. “For myself there has been an improvement in my aching back (caused by osteoporosis) and a urinary infection (both ailments of thirty years’ duration). The migraine headaches are fewer in number and less in intensity and duration. Even my motion sickness has lessened.
“My husband has benefitted from the diet through weight control. Michio’s lectures in Los Angeles many years ago were instrumental in returning Phil to us from his `hippy’ world. My daughter adopted a baby girl because she was unable to conceive. She now has three daughters, two of them `macrobiotically brewed’.”23
Analyzing Kushi’s Breast Cancer Program
In analyzing Kushi’s recommendations for breast cancer, five major points can be made:
1. As I have noted, the use of medical literature is profuse but sketchy and sometimes unbalanced. Often the implied criticisms of mainstream treatment are fair and would be acknowledged as such by objective oncologists, but these fair criticisms are placed side by side with poorly substantiated claims, and all are given equal weight.
2. Kushi’s theory of the causation of breast cancer combines the mainstream position that a high fat diet may contribute to breast cancer (which he does not acknowledge as debated) with the macrobiotic theory (of the formation of mucus into cysts and tumors), which is poetic, intriguing, and unproven.
3. Kushi’s discussion of the diagnostic system of macrobiotics incorporates a skeptical review of mainstream diagnosis with his own interpretation of Oriental medical diagnosis, which is unproven by conventional medicine.
4. Kushi’s dietary recommendations provide for a healthy and nutritionally balanced diet, but are based on a complex macrobiotic dietary theory that also has no foundation in scientific medicine. Moreover, the specific foods that are included and excluded by macrobiotics for breast cancer differ from those recommended by many other systems of diet coming from other traditional medicines of equally noble lineage. Ayurvedic medicine from India, for example, gives dietary recommendations for breast cancer that are quite different from, and often contradict, macrobiotic recommendations. So it is true not only that macrobiotics has a dietary theory that is “unproven” from a mainstream perspective but also that its system, in many respects, contradicts other traditional dietary regimens, such as naturopathic or Ayurvedic dietary programs. These other traditional dietary systems, incidentally, also contradict one another. However, Kushi would point out legitimately that although the dietary therapies of the great systems of traditional medicine differ in their details, they are generally united in their recommendation of fresh whole foods with a primary emphasis on grains. Kushi’s recommendation of sea vegetables is supported by suggestive scientific evidence, as we shall see later.
5. Perhaps most interesting is the astounding assertion (from the mainstream perspective) that a clay-cabbage compress applied regularly to a breast with a malignant tumor can draw the tumor up through the skin and out of the body. This assertion cries out for objective scientific evaluation. Can the success of this clay-cabbage compress be documented based on past case records, as Kushi states? Can this success be replicated by independent scientific observers? What is the further course of the disease in patients who have treated their tumors in this way as opposed to having them surgically removed? What is the comparative rate of metastasis? Are there medical complications with the compress method, and how do they compare with complications of surgery and radiation therapy? What are the comparative experiences with quality of life and life expectancy? What are the dangers in the procedure when the tumor enlarges or ruptures?
Given the observations of cases mentioned above, these are very serious issues indeed. The concept of using compresses to remove fat and mucus, thereby eliminating tumors, does not square well with current medical observation of the contents of breast tumors. And the dangers of delaying medical, radiological, or surgical treatment of breast cancer would be, from the physician’s point of view, grave indeed. On the one hand, if success with this treatment were documented, it could well represent an important advance in the treatment of breast cancer–potentially rivaling in importance the adjunctive role of diet as a supportive treatment. On the other hand, if the treatment does not work, it could be dangerously misleading or simply dangerous. It is a mark of the absence of careful studies of macrobiotics by researchers that this question, to my knowledge, has never been addressed.
Kushi’s assertion that this procedure works at all would create incredulity–if not shock–in many mainstream physicians. But my suspicion that there may be something here worth studying was raised by my having met a cancer patient early in my research (before I realized the importance of documenting this assertion) who told me firsthand that her tumor had been drawn out through the skin using similar compresses. John Fink of the International Association of Cancer Victors and Friends in Santa Barbara also reported a case to me of a woman who had treated her cancer in this way. These reports add to my sense that this is an important area for objective assessment.
The lifestyle recommendations regarding maintenance of a positive attitude, avoiding wool, synthetic fibers, metallic jewelry, and electromagnetic fields from televisions and other apparatuses are harder to assess. Many psychotherapists would disagree with Kushi’s recommendation that women “do everything possible to maintain a cheerful and calm attitude,” and would instead encourage women to be aware of their inner states, including fear, anger, and so forth. Kushi’s recommendations are, nonetheless, consistent with many of the attitudinal recommendations of other Eastern traditions, which often teach that replacement of “negative” emotions with “positive” emotions is generally superior to the modern Western tradition that emphasizes expression of emotions so that one can “move through” them, rather than being caught in them.
The experience of Mrs. Crabtree with “metastatic breast cancer” is very problematic. Based on the available information, it does not sound as if Mrs. Crabtree had metastatic breast cancer at all. Rather, it sounds as though she had uterine or ovarian cancer which subsequently metastasized to the breast. This is very different from metastatic breast cancer. On the other hand, the recovery story is balanced; the point is made that at least 15% of women with similar cancers live as long as Mrs. Crabtree, and the story of the numerous health improvements experienced by Mrs. Crabtree and her family ring true to anyone familiar with the benefits of a program like macrobiotics.
Kushi’s Cancer Program in General
Kushi states that the cancers that respond best to the macrobiotic approach are cancers of the breast, cervix, colon, pancreas, liver, bone, and skin. Cancer of the lung, he says, is “more difficult to change,” and “cancers caused by eating eggs are among the most difficult, particularly when they appear deep within the body such as in the ovaries or testicles.”24
When Kushi moves from specific recommendations to a broader overview of cancer, he moves toward safer–though obviously still contested–ground. He believes that modern science has overlooked the root cause of cancer, which he suggests is the comprehensive biological decline brought about by modern civilization and modern diet.25 He believes that to respond to cancer we must enlarge our perspective and create a new civilization which is not primarily competitive and materialistic. He also believes we must overcome dualism in thinking about cancer, and understand the beneficial nature of disease. In his view: “cancer is only the final stage in a sequence of events in an illness through which individuals in the modern world tend to pass because we fail to appreciate the beneficial nature of disease symptoms.”26
A healthy organism, he believes, can discharge through normal channels of elimination a limited excess of nutrients and toxins, but if overconsumption continues, the body reverts to “more serious” measures of discharge such as fever, skin disease, and other superficial symptoms. If we suppress or ignore these symptoms, the body seeks to localize deposits of impurities in the form of fat deposits, chronic mucus, vaginal discharges, cysts, benign tumors, and other similar conditions. If we still persist in unhealthy living, a “critical mass” is reached where these accumulations may become malignant:
As long as we continue to take in excessive nutrients, chemicals and other factors that serve no useful purpose in the body, they must continue to accumulate somewhere in order to continue our normal living functions. If we don’t allow them to accumulate in limited areas and form tumors, they will spread throughout the body, resulting in a total collapse of our vital functions and death by toxemia. Cancer is only the terminal stage in a long process. … Cancer is the body’s last drastic effort to prolong life, even a few more months or years.26
In this line of reasoning, although not in all details, Kushi shares the company of many other practitioners of Eastern and Western nature-based healing systems.
Kushi’s Use of Yin and Yang in Individual Diet
The modification of the Cancer Prevention Diet to the type of cancer that the individual has is based on a fundamental division that macrobiotics posits of virtually all phenomena in the universe–as manifestations of the interplay of “yin” and “yang” forces.
Yin and yang are two ancient philosophical concepts from China said to represent the “universal laws of harmony and relativity.” Kushi traces them back to Confucius and Lao-tzu.27 Yin, the feminine principle, represents the outward, centrifugal, movement of matter or energy. It is expansive. Yang, the masculine principle, represents an inward, centripetal, movement of matter or energy. It is contractive. Virtually everything can be classified in terms of yin and yang, including foods and cancers. Kushi provides a classification table of yin and yang foods (see table 15.1).
One intriguing question is whether macrobiotics means the same thing by the terms yin and yang that traditional Chinese medicine means. A number of very knowledgeable persons, including Keith Block, Lawrence Kushi, and Gordon Saxe, have suggested that the meaning, or at least the application, of these concepts is significantly different in macrobiotics from the usage in traditional Chinese medicine. One respondent suggested that one of the reasons that some practitioners ultimately abandon macrobiotics or go on to study traditional Chinese medicine in more depth is because of their dissatisfaction with the ambiguities involved in the application of these terms in macrobiotics. Another felt that Ohsawa believed that Westerners would have difficulty comprehending the kinetic nature of yin and yang and so he used the terms based on a structure rather than dynamic interrelationships. Therefore the usage of the terms yin and yang in macrobiotics is often opposite to the usage in traditional Chinese medicine. Alex Jack, co-author with Michio Kushi of The Cancer Prevention Diet, takes a constructive view of the relationship between yin and yang in macrobiotics and traditional Chinese medicine: “As for the differences between the way yin and yang are used in traditional Chinese medicine and macrobiotics, modern macrobiotics approaches the subject with a dynamic understanding of structure and energy flow that is based on the traditional Oriental view. Contemporary Chinese medicine sometimes takes a more static perspective. However, these views are more complementary than antagonistic.”28
The debate underlines the broader point that macrobiotics is very much Michio Kushi’s own interpretation of certain underlying principles in traditional Chinese medicine viewed through the lens of his personal interest in health-promoting therapies.
Yin and Yang Foods
Strong Yang Foods = Refined salt, eggs, meat, cheese, poultry, fish & seafood
Balanced Foods = Whole-cereal grains, seeds, beans and bean products, nuts, sea vegetables, root, round and leafy vegetables, spring or well water, nonaromatic, nonstimulant teas, natural sea salt
Strong Yin Foods = Temperate-climate fruit, white rice, white flour, tropical fruits and vegetables, milk, cream, yogurt, oils, spices (pepper, curry, nutmeg, etc.), honey, sugar, refined sweetners, alcohol, foods containing chemicals, preservatives, dyes, pesticides, drugs (marijuana, cocaine, etc.), medications (tranquelizers, antidepressants, etc.)
From Kushi and Jack, The Cancer Prevention Diet, (New York: St. Martin’s Press, 1983), 118.
“Medically Terminal or Macrobiotically Hopeful”
Kushi’s broader recommendations for “preventing cancer naturally” are very much a part of the great perennial teachings found in all the great healing and spiritual traditions. In his version, these teachings include29:
Self-reflection to develop a more natural, harmonious, contemplative, appreciative, and contributory perspective on life.
Respect for the natural environment, so that we do not continue to degrade the earth for which we depend on life.
A naturally balanced diet, in harmony with evolutionary order, universal dietary traditions, the ecological order, the changing seasons, and individual differences.
An active daily life.
In a discussion of whether cancer patients are “medically terminal or macrobiotically hopeful,” Kushi addresses the truly difficult and delicate problem of the relationship of the macrobiotic regimen to conventional therapies:
The recovery of patients who have received medical intervention may be complicated and more difficult as a result of the side effects of treatment and the general weakening produced by chemotherapy, radiation, or other methods. With macrobiotics, we try to change the quality of the blood and cells through living a natural daily life and strengthening the body’s natural system of immunity …
A medically terminal case is one for which present treatments offer no hope of recovery. In some cases, an exploratory operation is performed and the patient is told that no treatment will be applied. Persons in this situation often have a better possibility of recovery on the Cancer Prevention Diet than those who were considered hopeful by modern medicine and who received conventional treatment.30
This is, again, a very concrete statement, and it would be interesting indeed to evaluate it scientifically. I would be very surprised if Kushi’s assertion turned out to be correct.
Kushi then lists factors that may interfere with the process of recovery. These include:
Lack of gratitude: A spirit of thankfulness is essential to the healing process. The person needs to see that his or her way of eating and living created the cancer and that he is fortunate to have the opportunity to change his diet and lifestyle. However, many cancer patients … constantly complain when the new diet is introduced. … Such persons think that cancer happened to them by accident and that they have done nothing to deserve it. … This type of person has no understanding of himself, nature, or God, and is incapable of self-reflection. … For such people, macrobiotics is just another pill to be taken and discarded when their symptoms disappear. They may survive for a while, but will never fundamentally heal themselves or be happy. The death certificate will say cancer, heart attack, or the flu, but the real cause is arrogance.
Inaccurate dietary practices: … Another mistake is to confuse the macrobiotic approach with other dietary or nutritional approaches to cancer and “to be on the safe side” try to combine them all.
Lack of will: In some cases persons who have no desire to live are introduced to the Cancer Prevention Diet, often by some well-intentioned family member or friend. Such persons, who frequently ignore the advice they are given, have a very slight chance of recovery. We can extend to them our love, sympathy and prayers, but ultimately we must respect a person’s decision to die.
Lack of family support: Among the many patients whom I have counselled were a number of middle-aged men who, although they were married, visited us by themselves. When asked why their wives had not come, they often replied that their wives did not agree with their desire to begin macrobiotics. … I have also met many women who did not have the support of their husbands or children whose parents were not sympathetic. I sympathize very much with these people because in a real sense they are alone. Their families lack the understanding, love and care that are essential for their recovery. … Despite their courage, the chances of succeeding are low. Among all the cancer patients I have met, those who recovered were primarily single and cooked for themselves or had the full support of their families, even to the extent that other family members also started the diet and learned to cook macrobiotically. Therefore, the cancer patient in this situation should investigate the possibility of another living situation until his or her condition improves.31
Kushi points to spiritual awareness, the experience of deep suffering leadingêtoêa desire to embrace the macrobiotic program, will and determination, and the love and care of family and friends as powerfully supportive of recovery.31
In his list of impediments to healing, the combination of perennial wisdom and the controversial application of particulars that characterizes so much of macrobiotic philosophy is vividly apparent. Kushi’s strong position on the patient’s need to accept that his way of life caused the cancer, and his rigorous condemnation of those who complain about the diet or who are not grateful for the opportunity cancer has given them to change their diet and lifestyle, are profoundly controversial among many progressive psychotherapists who share a more positive orientation toward nutritional and psychospiritual approaches to cancer.
Nor is Kushi’s strong position in this area universally shared among macrobiotic teachers. Those who take issue with his approach feel that it is irresponsible to insist that the patient “caused” his cancer, and that his denunciation of people who object to a macrobiotic diet, or who do not feel “grateful” for the opportunities cancer has afforded them, are prime examples of serious “guilt-tripping” and “blaming the patient,” which can be found in a number of New Age theories of cancer. But, in his defense, one anonymous Kushi advocate said:
The motivation behind this view is to provide the perspective that “if I caused the illness, then I can get rid of it.” This … has the potential of bringing the patient to see that he or she has the responsibility and means to take charge of his or her treatment/recovery. Thus, it can be an enlightening source of empowerment. …
I also point out that this idea that one has caused one’s cancer is directly substantiated by the growing evidence that one’s lifestyle (diet, smoking, exercise, etc.) strongly influences the risk of developing disease.
Kushi’s position that the macrobiotic diet should not be modified would also not meet with agreement among many clinicians who utilize a modified macrobiotic regimen. But his belief in the importance of the “will to live” and “family support” would certainly meet with deeper agreement.
Strategically, Kushi made some adept decisions in choosing to present macrobiotics as “a commonsense approach to living” and as an educational program. In contrast to the proponents of many alternative nutritional approaches, his book does not call his approach a cancer cure. While he gives examples of patients who reportedly recovered from metastatic or otherwise life-threatening cancers using macrobiotics, the cases often include explicit evidence that misdiagnosis might have been involved or that the case was not entirely hopeless from a mainstream perspective.
He also developed an educational model for delivering the program, as well as a systematic program for training many others in how to use it. He himself has written ten books and helped others write and publish books and articles on the use of the macrobiotic diet. For all of these reasons, macrobiotics was strategically placed at a comparative advantage over most of the medically based alternative nutritional programs that represented their approaches as cancer cures, thereby engendering a far more virulent opposition from the medical community.
One of the few other groups of practitioners who have exhibited similar strategic skill in avoiding serious conflict with mainstream medicine is, not coincidentally, the practitioners of traditional Chinese medicine; they have often (not always) been even more cautious than Kushi. They make no special claims about cancer; many practitioners even refuse to treat cancer; and those who do treat it emphasize the purely adjunctive nature of their treatment. As a result, tens of thousands of American cancer patients are able to avail themselves of the supportive treatment of traditional Chinese medicine. Strategic placement of treatments outside the medical mainstream are the skills of people from Oriental cultures, accustomed to taking the long view in strategy, and to achieving goals by indirect means when direct assaults on governmental authorities would be counterproductive or dangerous.
Case histories, physician reports, and scientific studies that relate to the use of macrobiotics in cancer are sketchy. But nonetheless they are suggestive that macrobiotics may have, at least, some positive impact for some people with cancer.
One of the most credible independent witnesses for a macrobiotic approach to cancer was Anthony Sattilaro, M.D., whose book, Recalled by Life,32 pub- lished in 1982, describes his recovery from prostatic cancer, which had metastasized to his skull, shoulder, spine, sternum, and ribs. He underwent conventional therapy, but his physician told him that he had at best only a few years to live. Then he turned to macrobiotics, experienced a spiritual awakening, and subsequently recovered. The story of his recovery did for macrobiotics something akin to what the story of New York Times columnist James Reston’s experience with acupuncture did for that approach: it brought a heretofore very foreign-sounding therapy to public attention through a single person’s account. The key point here is that both authors had credibility. Reston was a respected reporter and columnist. Sattilaro was chief executive of Methodist Hospital in Philadelphia, having previously served as chairman of the anesthesiology department. Some mainstream critics questioned whether Sattilaro’s cancer was truly as life-threatening as he portrayed it. (Sattilaro subsequently laid this debate to rest by dying of a recurrence of his cancer in 1989.)
After his initial recovery using macrobiotics, Sattilaro distanced himself from the macrobiotic movement, especially from its more particularistic components and its belief systems. But his belief in the importance of his own spiritual awakening and the whole-foods vegetarian diet remained.
A second important independent witness for the benefits of some of the nutritional building components of the macrobiotic approach is Keith Block, M.D., whose treatment program I discuss in chapter 17. Block is an especially credible observer because he clearly distinguishes between the particularistic and ideological components of macrobiotics and its fundamentals. Once a believer in macrobiotic nutrition, Block gradually moved away from macrobiotics and developed his own system:
I found problems within the macrobiotic system, but also a great deal that was significant and valuable in concert with certain other regimens whose principal emphasis has been on complex carbohydrates, high fiber, low fat and moderate protein intake.
Do I believe that food cures cancer? Certainly not in and of itself. Do I believe food can cause cancer or militate against its control? I absolutely do. Do I believe that appropriate nutrition has a series of unacknowledged and complex consequences which affect other biochemical systems in the struggle to retard tumor growth and elaboration? I absolutely do.33
Block has collected a number of well-documented cases in which he believes his individualized and modified macrobiotic-based nutritional system played a significant role in controlling or reversing cancer. He has presented his cases to professional audiences and welcomes open evaluation of his results.33
While the scientific literature contains no published studies on macrobiotics and cancer treatment, there are three unpublished studies, each of them flawed but nonetheless intriguing both for what they show and what they do not show. Vivien Newbold, M.D., a charismatic young emergency-room physician, tells the following story:
In December, 1983, a close friend was found to have inoperable colon cancer that had spread to the liver. He was given just four to six months to live. Since there was then and, at this writing, still is no known treatment for this disease once it has spread beyond the intestines, and since chemotherapy could, at best, offer only a possibility of temporary prolongation of life, he chose not to receive any medical treatment, but instead to try macrobiotics. He and his family followed the macrobiotic diet one hundred per cent, without any deviations, and became totally involved in the macrobiotic way of life. Almost every night his wife and son gave him shiatsu massage. Within three months of being on the macrobiotic diet, he began running, and by September of 1984 he ran half a marathon. In November, 1985, a CT scan could find no sign of cancer and his present health is excellent. This is truly astounding in view of the fact that there is only one recorded case of spontaneous regression of metastatic colon cancer.34
Following this experience, Newbold set out to document the results of cancer of patients who (1) used macrobiotics with or without chemotherapy; (2) used macrobiotics for pancreatic or brain cancers in particular; (3) used macrobiotics for other serious illnesses; and (4) were documented cases of medically advanced, incurable, biopsy-proven cancer who had followed macrobiotics and recovered completely.35 Just as Gar Hildenbrand discovered in his effort to find “pure” Gerson recoveries for a best-case analysis of the Gerson therapy, Newbold found the task extremely difficult. After a very extensive search, she ultimately found six cases of complete remission from advanced malignant disease using both conventional therapies and macrobiotic diet. Newbold had the cases reviewed independently, and the diagnoses confirmed by pathologists and radiologists, and offers copies of clinical records to other researchers for confirmation.
Newbold offered her paper to three major medical journals, the New England Journal of Medicine, Lancet, and the Journal of the American Medical Association. She says, “On every occasion it was turned down for publication on the grounds of insufficient interest to their readership or similar reasons. On no occasion was any attempt made to review the evidence supporting the paper in depth.”36
In summarizing her study in another publication, Newbold wrote: “The number of patients in this … group is small, and although it does not prove that macrobiotics can bring about recovery from cancer, it indicates that for the patient who cannot be offered hope medically, it is certainly worth a try.”37
Efforts to Study Macrobiotics and Cancer Scientifically
James Carter, Chairman of the Department of Nutrition at the Tulane School of Public Health, and Gordon Saxe, M.P.H., a Ph.D. candidate in Epidemiologic Science at the University of Michigan, and their colleagues conducted two retrospective studies on the effects of the macrobiotic diet. The first study examined primary cancers of the pancreas to determine if patients following a macrobiotic diet survived longer than pancreatic cancer patients from the National Cancer Institute’s SEER (Surveillance Epidemiology and End Results–a national cancer registry) data from the same period. Pancreatic cancer was chosen because it has a very poor prognosis, is rapidly fatal (therefore a relatively short period of follow-up is required to see evidence of life extension), and is a cancer for which macrobiotics claims positive results.
Carter and Saxe studied pancreatic cancer patients treated from 1980 to mid-1984 by macrobiotic counselors and who reported following macrobiotic diets for at least 3 months. (Of 109 patients who had been counseled, 36 were reached and 23 met the study criteria.) Carter and Saxe compared mean and median length of survival, as well as the proportion of patients surviving at various time points (e.g., 1 year after diagnosis), for these 23 patients with that of all SEER patients who had pancreatic cancer diagnosed during the same period. The mean and median survival for the macrobiotic patients was 17.3 and 13.3 months, respectively, compared to 6.0 and 3.4 months for the SEER group. The 1-year survival rate was 52.2% for the macrobiotic group compared with 9.7% for the SEER subjects. Carter and Saxe observed that the macrobiotic patients lived significantly longer than the nonmacrobiotic population, but that this difference may have resulted from selection or other biases. They concluded that these results did not prove that dietary modification was the reason for the longer survival. However, they noted that these findings, taken together with several medically documented reports of remission in macrobiotic pancreatic cancer patients, was suggestive of a possible dietary effect.38
The important question is whether it was the practice of macrobiotics per se, or rather some type of selection or other bias, which accounted for the dramatic difference between the survival of macrobiotic patients and those in the SEER sample. The answer is uncertain. A related question is what happened to the 67% of macrobiotic patients that Carter and Saxe could not locate. If, hypothetically, Carter and Saxe’s 23 participants represented some of the top survivors among all the macrobiotic patients originally identified, and if all the other macrobiotic patients made the same marked dietary changes but had the same survival curve as the SEER patients (a very conservative assumption), then Carter and Saxe calculate the macrobiotic patients would have had a 1-year survival rate of about 20%, compared to the 9.7% reported for the SEER patients. If the group Carter and Saxe contacted were the longest-lived survivors among the macrobiotic patients, then the survival rate for the macrobiotic patients was only about 12% compared to 9.7% for the SEER group–virtually no difference at all in a sample this size.39
In a subsequent analysis, Saxe found that when the survival comparisons were restricted to those SEER patients alive at least 4 months after diagnosis, the difference shrank but was still statistically significant (and could, of course, still be accounted for by other biases). For example, after 1 year, the difference narrowed from 52.2% vs. 9.7% to 52.2% vs. 37.7%. On the other hand, he noted that few of the macrobiotic patients received adequate follow-up counseling, cooking instruction, dietary monitoring, or social support. As a result, dietary compliance may have been overestimated and the therapeutic potential of dietary modification underestimated.40
In my estimate, these studies suggests the possibility of a significant survival advantage for the patients who undertook the macrobiotic diet. The range of improvement reported is in keeping, incidentally, with the doubling of survival reported by David Spiegel in his study of psychological group support for women with metastatic breast cancer and, as we saw in chapter 10, similar reports from several other studies of psychological interventions that matched participants against historical controls or other partial controls. It appears to be an outcome in the same range that Lechner’s Austrian group found in its poorly controlled study of participation in the Gerson diet (see chapter 14).
In a second study, Carter and colleagues examined 11 cases of prostate cancer. The 11 men, all of whom were receiving conventional treatment and following a macrobiotic diet, were matched with controls receiving conventional treatment only, and also were compared with similar-stage cancer patients reported in the literature. The median survival of the macrobiotic group was 81 months, compared to 45 months for the nonmacrobiotic population. In describing the study, the Office of Technology report Unconventional Cancer Treatments concluded that the same methodological difficulties that were present in the first study also made it impossible to interpret the results of the second.41
Barry R. Goldin of the New England Medical Center Hospital in Boston and his colleagues compared the excretion of estrogens in healthy pre- and postmenopausal macrobiotic and omnivorous women. They found that “vegetarian” (macrobiotic) women excrete two to three times more estrogens in feces than do omnivores and that omnivores have about 50% higher mean plasma levels of estrogen products than do vegetarians. “[The] data suggest that in vegetarians a greater amount of the biliary estrogens escape reabsorption [in the intestines] and are excreted with the feces. The differences in estrogen metabolism may explain the lower incidence of breast cancer in vegetarian women” [emphasis added].42
Scientific Studies Supportive of Elements in Macrobiotic Diets
Evidence also exists that a macrobiotic diet might influence important prognostic factors in breast cancer. L.E. Holm and his colleagues at the Karolinska Hospital in Stockholm studied women who had had surgery for breast cancer and found that tumor size at the time of surgery was inversely related to fiber intake, and that patients having estrogen receptor-rich tumors received proportionately more calories from carbohydrates and foods containing retinol. They concluded that “these results suggest that the dietary patterns of the western world (e.g., high fat intake and low intake of carbohydrates and fiber) affect certain prognostic factors in breast cancer, such as tumor size and ER [estrogen receptor] content of the tumor.”43 Similarly, in a preliminary analysis of a recent study involving 225 breast cancer patients at the University of Michigan Hospital, Saxe found that overweight patients were almost three times as likely as lean patients to be diagnosed with an advanced-stage malignancy.44
Takeshi Hirayama of the National Cancer Center Research Institute in Japan reported in 1981 that daily intake of soybean paste (miso) soup correlated with dramatically reduced gastric cancer rates in a large-scale prospective study of over 260,000 Japanese men and women. The standardized mortality rates for men who drank miso soup daily was 171.9 per 100,000 compared to a rate of 255.9 for men who never drank miso soup, with intermediate values for men who drank miso soup occasionally or rarely. The rates for women were 77.8 for daily miso soup drinkers and 113.6 for women who never drank miso soup. Hirayama noted that the results could result from beneficial compounds such as protease inhibitors or other nutritious factors in the soybean paste, or that it could reflect other beneficial foods that frequently accompany soybean soup consumption, such as intake of green and yellow vegetables.45
Another study by Goro Chihara and his colleagues at the same institute in Japan found that two polysaccharide preparations from Lentinus edodes, a mushroom eaten frequently in the macrobiotic diet, had strong antitumor effect in the growth of sarcoma 180 implanted in mice.46
Two studies on seaweeds used in macrobiotics are of interest. Jane Teas of the Harvard School of Public Health and colleagues, noting that breast cancer is three times lower in premenopausal Japanese women than in premenopausal American women, decided to look at the possibility that brown seaweed (kelp), which is widely consumed by Japanese women, might be a factor. “Several studies have shown that seaweed extracts can prevent the growth of tumors transplanted to laboratory animals. We were interested in whether the regular intake of dietary seaweed could be prophylactic for carcinogen-induced mammary tumors in rats.”47
The Sprague-Dawley rats treated with the carcinogen DMBA (7,12-dimethylbenzanthracene) were considered a good model because the breast cancers in rats arise, as in humans, in the ductal system of the mammary gland. The tumors are hormone-dependent and are thus analogous to estrogen receptor-positive breast cancer in women. Experimental rats fed kelp took almost twice as long to develop tumors as the control rats and had a 13% reduction in the number of adenocarcinomas that developed.47
The second seaweed study, by Y. Tanaka and his colleagues at McGill University in Montreal, looked at the role of polysaccharides from brown seaweed (kelp) in inhibiting the intestinal absorption of radioactive strontium:
Polysaccharides prepared from brown seaweeds are unique agents from the practical as well as the theoretical point of view because they selectively bind strontium. … We became interested [in them] because of their importance as a source of material that can prevent the intestinal absorption of radioactive products from atomic fission, and in their possible use as natural decontaminators because of their ability to concentrate metal ions from seawater.48
Whether this ability of kelp to prevent the absorption of radioactive products is of value to patients undergoing radiation therapy is a question of some interest.
A small cluster of epidemiological studies also lends credence to the value of assessing the role of macrobiotic diet as a preventive measure for breast cancer. Ernst Wynder of the American Health Foundation in New York and his colleagues describe research showing a marked increase in the incidence of breast and prostatic cancer among Japanese migrants to Hawaii.49 This increase is best explained by the adoption of American diets by these migrants and by their offspring, whose cancer incidence rates approach the rates for Hawaiian whites. Similarly, the gradual increase in breast and prostatic cancer rates in Japan since the 1950s can be correlated with the increase in dietary fat intake in that country. Wynder et al. conclude that a threshold exists between 20% and 30% of caloric intake in the form of fat where the stimulatory effect of fat on breast carcinogenesis manifests itself. The researchers therefore recommend a diet for the population at large, and particularly for high-risk women, that limits fat intake to 25% of total calories.
Analyzing breast cancer survival rates, Wynder et al. cited studies indicating that these rates are higher for women in Japan than in the United States and that the major survival difference is found among postmenopausal women. These findings are compatible with case-controlled studies showing that breast cancer patients on high fat diets have poorer survival times than those on low fat diets. Wynder et al. conclude, “We are surprised that most physicians pay so little attention to the likelihood that metabolic overloads in terms of nutritional intake could have a deleterious effect, aside from obvious obesity, on many bodily functions. Therefore, nutritional adjustments are very likely to be an effective pharmacologic intervention, particularly when used early in a disease process; in fact, `we are what we eat’.”49
The macrobiotic diet, then, might well be a good model for individuals interested in implementing a diet based upon the above recommendations, since it is to a large degree derived from the traditional Japanese diet. But the data on breast cancer cited by Wynder et al. can be interpreted in several ways. It may suggest that a Japanese-style diet might have its greater effect on older American women, who are less likely today to be attracted to it, and is much less likely to help younger American women, who are more likely to belong to the subcultures that more readily accept such diets. Following this interpretation, a key issue is the level of cultural stress involved for older women in adapting to such a diet. Acute stress, I pointed out in chapter 10, is often a proven enhancer of tumor development in animal studies, and is also believed to be a tumor promoter for humans. If adopting a radically different diet is experienced by some older women as a major life stress, the stress effect could very plausibly offset any potential benefit of the low fat diet.
A second interpretation of the Wynder et al. data suggests that at the time the authors did their study, older Japanese women were more likely to be eating a traditional, low fat diet than younger women, who had westernized their diets. Therefore, this–rather than biological or hormonal factors–may account for the fact that younger Japanese women had nearly the same survival as younger American women. If this were the case, a Japanese or macrobiotic diet might be useful to premenopausal women with breast cancer as well as to older women.
In summary, the scientific evidence, case reports, and clinical assessments by physicians lead us to much the same conclusions about the macrobiotic diet that we reached about the Gerson diet. The macrobiotic program is clearly not any kind of definitive “cure” for any cancer. If it were, the researchers who worked hard to gather “best cases” for analysis would have found many more striking recovery stories.
On the other hand, there are a considerable number of well-documented, unexpected recoveries, including recoveries from metastatic cancers. The available data suggest, as the Gerson data suggest, that the kind of person who chooses the rigors of the macrobiotic program may be likely, for psychological reasons, to have a somewhat more optimistic outlook regarding his quality of life and life extension, in addition to possible positive effects of the diet. To venture a grossly rough guess on the magnitude of the effect of macrobiotic diet in the instances when it appears helpful, it might be in the range of doubling the length of survival, which is the same rate reported by a number of the psychological interventions and, with some cancers, for the Gerson regimen.
But is this hypothetical enhancement of survival to be credited to the diet? Lawrence Kushi, Michio Kushi’s son, believes that, although it is not the macrobiotic diet per se that has an anticancer effect, but probably any healthy vegetarian diet (that does not contain substantial amounts of dairy food), still the macrobiotic philosophy “helps to provide a framework by which to evaluate potential dietary approaches to cancer therapy. … Certain principles of application are likely to have some benefit; however, how these are applied may not resemble (superficially, at least) a `macrobiotic’ diet as most people consider it.”50 Certainly, if similar effects are found for some patients with vegetarian diets as diverse as the Gerson diet and macrobiotics, it is not a single vegetarian diet that achieves these effects.
I believe, as Michio Kushi clearly believes, that the will to live, a healthy attitude toward life, and the macrobiotic diet work together to produce whatever outcomes are possible. I must also say that for myself, a 10-year vegetarian, a broad and somewhat flexible macrobiotic diet generally makes me feel better than any other vegetarian diet. I feel grounded, stronger, and experience fewer addictive food cravings than when I eat a wholly flexible vegetarian diet. Once old cravings from an earlier diet have been overcome, I believe that how one feels is often an excellent guide to what diet really works for oneself. Therefore, for me, I suspect that a macrobiotic-oriented diet is more than a bizarre, restricted variation of a healthy vegetarian diet, but has some real wisdom to it. I suspect that a large portion of my benefits re- sult from the proportions of different recommended food types, the food preparation methods, the sea vegetables, and the miso soup. Before moving gradually toward a broadly macrobiotic diet, I had for years eaten too many salads and raw vegetables, which left me feeling weaker and with a craving for oils and dairy products. Increasing grains to 50% of my intake played a major role in changing that. So my guess is that a very broadly based macrobiotic diet is, at least for some vegetarians, including myself, healthier than other vegetarian diets.
It is striking, however, that a community as large, intelligent, and generally well situated as the macrobiotic community has produced so little in the way of definitive research on the effects of macrobiotics on cancer. The available evidence is certainly suggestive that macrobiotics may be of at least modest help in some types of cancer, but it is no more than suggestive. I think it is incumbent on the macrobiotic physicians and their colleagues in the medical research community to move beyond suggestive studies, case histories, and the clinical-philosophical treatises of Michio Kushi and other macrobiotic teachers and to do some serious studies. The studies should evaluate both the diet and some of the more striking “home remedies”–most notably the clay-cabbage compresses said by supporters to be capable of drawing tumors out through the skin and by critics to be potentially dangerous. For a community that defines itself as taking the long view, the time has come to do some small but well-designed case-control, prospective, or randomized clinical trials with cancer. Given the resources that the Kushi Institute and other macrobiotic programs generate nationally, and the willingness of well-qualified macrobiotic researchers to stretch dollars and work inexpensively, there should be no need to wait for federal research support. The money should be raised within the macrobiotic community and the prospective clinical trials undertaken.
As this book was going to press, Alex Jack, co-author with Kushi of The Cancer Prevention Diet, wrote to me regarding the extensively revised and expanded edition that was published in 1993:
The new edition incorporates ten years’ of refinement and evolution in Michio’s understanding and approach, including some new dietary recommendations, new home cares, and new recipes and menus. On the surface, these may notêappear to be significant to the general reader, but to the experienced macrobiotic teacher or health care professional they represent an important development.
Overall, I think the last ten years have seen a detente or rapprochement between holistic health and conventional medicine, including macrobiotics. I think macrobiotic teachers are more appreciative of the usual medical doctors and therapies and willing to integrate them or refer others in that direction if necessary. Similarly, the medical profession is more tolerant of macrobiotics and a good number of doctors are very supportive and encouraging. This coexistence, I believe, is reflected in the new edition of The Cancer Prevention Diet and many of the sections critical of modern medicine have been deleted. In fact, Michio added a section on adjusting dietary recommendations for those undergoing radiation, chemo[therapy], or other conventional therapy.51
Notes and References
1 Biography of Michio Kushi, Kushi Institute, undated, 2.
5 Ibid., 3.
6 Michio Kushi with Alex Jack, The Cancer Prevention Diet: Michio Kushi’s Nutritional Blueprint for the Relief and Prevention of Disease, (New York: St. Martin’s Press, 1983), 17.
7 Lawrence Kushi, telephone conversation with author, July 1990.
8 Dean Omish et al., “Effects of Stress Management Training and Dietary Changes in Ischemic Heart Disease,” Journal of the American Medical Association 249(1):54-9 (1983).
9 New York Times, “Health Section,” 16 November 1989.
10 Frank M. Sacks et al., “Blood Pressure in Vegetarians,” American Journal of Epidemiology 100(5):390-8.
11 Kushi, The Cancer Prevention Diet, v-vi.
12 Michio Kushi, letter. Cited in U.S. Congress Office of Technology Assessment, Unconventional Cancer Treatments, (Washington, D.C.: Government Printing Office, September 1990), 59.
13 Kushi, The Cancer Prevention Diet, 146.
14 Ibid., 147.
15 Ibid., 149.
16 Ibid., 150-5.
17 Ibid., 156-7.
18 Ibid., 157.
19 Ibid., 159.
20 Ibid., 160-1.
21 Keith Block, M.D., letter to the author, 27 November 1991.
22 Kushi, The Cancer Prevention Diet, 161.
23 Ibid., 162-3.
24 Ibid., 76-7.
25 Ibid., 19.
26 Ibid., 24.
27 Ibid., 58.
28 Alex Jack, personal communication with the author, 16 April 1991.
29 Cancer Prevention Diet, 26-34.
30 Ibid., 90.
31 Ibid., 90-7.
32 Anthony Sattilaro, Recalled by Life (New York: Avon Books, 1982).
33 Block presented some of his cases where diet and psychosocial factors may have played a significant role in controlling or reversing cancer at the Symington Foundation Conference on New Directions in Cancer Care at Commonweal in February 1989 to an international audience of oncologists, psychotherapists, and other professionals concerned with cancer.
34 Vivien Newbold, “Macrobiotics: An Approach to the Achievement of Health, Happiness and Harmony.” In Edward Esko, ed., Doctors Look at Macrobiotics (New York: Japan Publications, 1988), 45.
36 Vivien Newbold, letter to Helen E. Sheehan, Director of Professional Education Programs, American Cancer Society, 4 March 1988.
37 Newbold in Esko, ed., Doctors Look at Macrobiotics, 46.
38 James Carter et al., “Cancers with Suspected Nutritional Links: Dietary Management?” Typescript, Nutrition Section, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, February 1990. Cited in Office of Technology Assessment, Unconventional Cancer Treatments, 64-5.
39 Gordon Saxe, telephone conversation with author, July 1990.
40 Gordon Saxe, personal communication with the author, 31 January, 1991.
41 Carter et al., “Cancers with Suspected Nutritional Links.” Cited in Office of Technology Assessment, Unconventional Cancer Treatments, 65.
42 Barry R. Goldin et al., “Effect of Diet on Excretion of Estrogen in Pre- and Postmenopausal Women,” Cancer Research 41:3771-3 (1981).
43 L.E. Holm, “Dietary Habits and Prognostic Factors in Breast Cancer,” Journal of the National Cancer Institute 81(16):1218-23 (1989).
44 Gordon Saxe, personal conversation with the author, 21 August 1991.
45 Takeshi Hirayama, “Relationship of Soybean Paste Soup Intake to Gastric Cancer,” Nutrition and Cancer 3:223-33 (1982).
46 Goro Chihara et al., “Fractionation and Purification of the Polysachharides with Marked Antitumor Activity, Especially Lentinan, from Lentinus edodes (Berk.) Sing. (An Edible Mushroom),” Cancer Research 30:2776 (1970).
47 Jane Teas et al., “Dietary Seaweed (Laminaria) and Mammary Carcinogenesis in Rats,” Cancer Research 44:2758-61 (1984).
48 Y. Tanaka, “Studies on Inhibition of Intestinal Absorption of Radioactive Strontium,” Canadian Medical Association Journal 99:169-75 (1968).
49 Ernst L. Wynder et al., “Diet and Breast Cancer in Causation and Therapy,” Cancer 58:1805-11 (1986).
50 Lawrence Kushi, personal communication with author, 24 January 1991.