
deal from eater to eater, however. (See Vegetarian
Diets.)
0004 Dietary planning and menu selection are based on
combinations of foods that are thought to be philo-
sophically appropriate according to macrobiotic
criteria but may not be so from the nutritional stand-
point. Certain food groups, such as dairy and meats,
are avoided. Milk and milk products are major
sources in American diets of calcium, phosphorus,
magnesium, vitamin D, riboflavin, and high-quality
protein. Meat, fish, poultry, eggs, and beans are good
sources of high-quality protein, ion, zinc, copper, and
many of the B-complex vitamins. Without careful
planning, when these food groups are avoided, it is
difficult to meet recommended levels of energy, vita-
mins B
12
and D, iron, calcium, zinc, and riboflavin.
Dietary deficiencies result when appropriate substitu-
tions of other foods rich in these nutrients are not
made. The extent to which dietary deficiencies arise
varies by life stage, type of diet adopted, and the
eater’s health status.
Lifestyles of Macrobiotic Practitioners
0005 Macrobiotic beliefs affect ways of living that influ-
ence health and go beyond diet. Macrobiotics practi-
tioners have some lifestyle habits that promote
health, such as abstinence or moderation in the use
of alcohol, nonuse of illicit drugs, and a physically
active life with adequate rest. However, some macro-
biotics smoke, and others eschew anticipatory
guidance from conventional health professionals,
avoid or delay the use of preventive measures such as
immunizations, and refuse to use vitamin mineral sup-
plements and prescription drugs. Some delay seeking
medical treatment for some illnesses until they are
quite ill, thus increasing the risks of secondary malnu-
trition. These attitudes are at variance with vegetar-
ians of other types. (See Malnutrition: Malnutrition in
Developed Countries; Vegetarian Diets.)
Health Effects of Macrobiotic Diets over
the Life Cycle
0006 Acceptable and appropriate diets must fulfill the diet-
ary reference intakes and the recommendations of
other expert groups on dietary balance, variety, and
moderation. Finally, they must be developmentally
appropriate. Table 1 presents a summary of the risks
and benefits of macrobiotic diets. Generally, macro-
biotics breast-feed their children through the first
year of life and introduce some complementary feed-
ing after 6 months. However, macrobiotic diets are
very bulky for weanlings. In addition, a source of
vitamin D should be provided after 6 months of age.
It is difficult to make the diet nutritionally adequate
and follow the pronouncements of macrobiotic
leaders. Use of at least 20–25 g of dietary fat, and at
least 100–150 g of fatty fishes, which are good
sources of vitamin D and also provide some vitamin
B
12
, improve the diets of weanlings in more favorable
directions. At least 150–250 g of milk and milk prod-
ucts per day are advised to assure adequate intakes of
calcium in early childhood. Alternatively, soy milk
that is fortified with vitamins B
12
and D and calcium,
highly fortified cereals, or vitamin mineral supple-
ments may be used as sources of nutrients rich in
the milk group. During later infancy and weaning,
iron intakes may also be unsatisfactory, and iron-
deficiency anemia may result. Iron-fortified cereals,
plant foods high in iron such as iron-fortified soy
formula, and iron-fortified cereals eaten with ascor-
bic acid-rich foods enhance iron bioavailabiliy and
decrease the risks of iron-deficiency anemia. The
macrobiotic diet also increases the risks of dietary
deficiencies at other times of life when nutrient
needs are particularly high. Similar adaptations of
the diet to increase intakes of essential nutrients are
also prudent during pregnancy and lactation, at
adolescence, and during recovery from illness. During
pregnancy, vegan-vegetarians and some macrobiotics
who eat virtually no animal foods at all may have
very low stores of DHA and EPA, and of vitamin B
12
.
Weight gain during pregnancy may not be satisfactory
either, increasing the risks of low birth weight.
0007During the past 25 years, adherents to the macro-
biotic philosophy have had a higher prevalence of
dietary deficiency disease than other vegetarians.
The reasons for this are probably several, and include
the restrictions on consumption and sources of nutri-
ents (prohibitions against vitamin mineral supple-
ments and fortified foods, other processed foods)
over and above those involving a vegan diet, attitudes
toward health and use of conventional medical care,
and the difficulties of fitting recommendations based
on philosophical considerations with nutrient intakes
based on modern knowledge of nutrition.
0008Most of the positive aspects of macrobiotic diets
associated with health benefits are because they are
not excessive. Among them are modest caloric intakes,
very low intakes of saturated fat, cholesterol, alcohol,
and caffeine, relatively low intakes of refined carbo-
hydrates, and high intakes of dietary fiber. The health
advantages associated with the macrobiotic diet
are due only in part to dietary composition. Other
positive lifestyle characteristics of the macrobiotic
lifestyle are also health-promoting. Macrobiotics
generally are lean rather than obese, tend to eschew
alcohol and illicit drugs, and lead orderly lives. The
macrobiotic dietary pattern provides no unique
3632 MACROBIOTIC DIETS