Macrobiotic diet
Small, short trials in type 2 diabetes found the Ma-Pi 2 macrobiotic diet lowered blood sugar, HbA1c and weight more than a standard diabetes diet. A trial of a macrobiotic-style diet in 1,542 women after breast cancer found no fewer recurrences. Studies of Dutch and US macrobiotic families found vitamin B12, vitamin D, calcium and iron deficiency in children, with rickets, slower growth and lasting B12 shortfalls.
- Status
- A dietary pattern, not a regulated product.
- Also called
- macrobiotics, Ma-Pi diet, Ma-Pi 2, Ma-Pi 4, Zen macrobiotic diet
- Followed for
- blood sugar, type 2 diabetes, weight loss, cancer, general health
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help1
Reported risks6
- ModerateLinked to vitamin B12 deficiency in macrobiotic infants, children and adults, lasting into adolescence after children switched diets at age 6.
- LimitedLinked to signs of rickets in 28% of Dutch macrobiotic infants in late summer and 55% of those rechecked the next spring.
- LimitedLinked to calcium deficiency in Dutch macrobiotic infants, and low calcium availability was an independent factor in rickets.
- LimitedLinked to iron deficiency in 15% of Dutch macrobiotic infants against none of the matched omnivorous infants.
- LimitedLinked to slower growth, fat and muscle wasting and slower motor development in Dutch macrobiotic infants, with only partial catch-up by age 16.
- LimitedOne small trial found LDL cholesterol rose over 6 months on both diets, with a larger percentage rise on the Ma-Pi diet after adjustment.
What people follow it for, and what was found
Shown to help1
Blood sugar in type 2 diabetes
One small trial found the Ma-Pi 2 diet lowered fasting and after-meal blood sugar, HbA1c and weight more than a standard diabetes diet over 21 days.
Compared with a standard diet following Italian professional societies' guidelines for type 2 diabetes, Mediterranean in style and with the same calories [1]; the same standard diabetes diet, continued for 6 months [2]; before the diet, in the same people [3]
The numbers and sources
- Effect
- In a 21-day open-label trial, fasting and after-meal glucose fell more on Ma-Pi 2 than on a standard diabetes diet, as did HbA1c, insulin resistance, total and LDL cholesterol, BMI, weight and waist. Triglycerides fell more on the standard diet [1]. Over 6 more months, HbA1c fell a median 11.27% from baseline on the Ma-Pi diet against 5.88% on the standard diet (P < 0.001) [2]. A pooled analysis of four 21-day studies in Cuba, China, Ghana and Italy reported falls in blood sugar, lipids and blood pressure [3].
- Population
- 51 adults with type 2 diabetes, 40 of whom took part in the 6-month follow-up [1][2]; adults with type 2 diabetes in four countries [3].
- Sources
- [1], [2], [3]
- Caveats
- One small, short, open-label trial. Its abstract gives confidence intervals but not the size of the differences [1]. The pooled studies compared people before and after the diet, with no control group [3].
Not shown to help1
Cancer
One large trial of a diet drawn from macrobiotic and Mediterranean traditions found no fewer breast cancer recurrences over 5 years. Other cancer evidence is case reports.
Compared with a control group given the 2007 American Institute for Cancer Research and World Cancer Research Fund cancer prevention recommendations, which the diet group also received [12]; expected survival rates, in case series [13]
The numbers and sources
- Effect
- In 1,542 women with breast cancer at high risk of recurrence, 95 on the macro-Mediterranean diet and 98 controls had a recurrence over 5 years (HR 0.99, 95% CI 0.69 to 1.40). Pooling both groups, women in the top third for dietary change had fewer recurrences than the bottom third (HR 0.59, 95% CI 0.36 to 0.92) [12]. A review found that research on macrobiotics in cancer treatment consists of case reports, assembled case series and comparisons with expected survival, and called the evidence for or against it limited [13].
- Population
- 1,542 women with breast cancer, followed for 5 years [12]. Published case reports and case series of people with cancer [13].
- Sources
- [12], [13]
- Caveats
- The trial diet combined macrobiotic and Mediterranean principles, so it is not the full macrobiotic diet [12]. The link with dietary change is an observational analysis that crosses the randomized groups [12]. The case series had no control groups [13].
How trials defined it
The Ma-Pi 2 diet supplied about 12% of energy from protein, 18% from fat and 70% from carbohydrate [3]. The diabetes trial ran 21 days against a standard diet advised by professional societies, after which the Ma-Pi group moved to the Ma-Pi 4 diet for 6 months [1][2]. In the Dutch child studies, families ate a macrobiotic diet based mainly on whole-grain cereals, pulses and vegetables [4], described as vegan type in early childhood [5].
Risks
Reported risks6
Vitamin B12 deficiency
Linked to vitamin B12 deficiency in macrobiotic infants, children and adults, lasting into adolescence after children switched diets at age 6.
The numbers and sources
- Effect
- Dutch macrobiotic infants had plasma B12 far below matched omnivorous infants (geometric mean 149 against 404 pmol/L) [6]. In a US macrobiotic community, 51% of adults had low serum B12 and 30% high urinary methylmalonic acid, and 55% of children had high methylmalonic acid [7]. Among adolescents fed a macrobiotic diet until age 6, 21% still had abnormal methylmalonic acid and 37% low B12 years later, despite eating dairy and fish, meat or chicken 2 to 3 times a week [8]. In 48 such adolescents, 31 were B12 deficient, and deficiency was linked to lower scores on a fluid intelligence test (r -0.28, 95% CI -0.48 to -0.08) [5].
- Population
- 50 Dutch macrobiotic infants and 57 controls [6]; 110 adults and 42 children in a New England macrobiotic community [7]; 73 Dutch adolescents and 94 controls [8]; 48 formerly macrobiotic adolescents and 24 controls [5]. Observational.
- Sources
- [5], [6], [7], [8]
- Caveats
- Observational. Most data come from one Dutch cohort studied by overlapping research teams [5][6][8]. In both adults and children, B12 status was better with more dairy or animal food [7].
Vitamin D deficiency and rickets
Linked to signs of rickets in 28% of Dutch macrobiotic infants in late summer and 55% of those rechecked the next spring.
The numbers and sources
- Effect
- Physical signs of rickets were present in 28% of macrobiotic infants in late summer. Those with signs had lower vitamin D (34.0 against 49.7 nmol/L). In 25 infants rechecked in March and April, 55% had signs of rickets and mean vitamin D was 12.3 nmol/L [9]. A broader report found vitamin D deficiency common in macrobiotic infants [4].
- Population
- 53 Dutch macrobiotic infants aged 10 to 20 months and 57 matched omnivorous infants [9]; Dutch infants aged 4 to 18 months [4]. Observational.
- Sources
- [4], [9]
- Caveats
- One Dutch cohort studied in the 1980s [4][9].
Low calcium
Linked to calcium deficiency in Dutch macrobiotic infants, and low calcium availability was an independent factor in rickets.
The numbers and sources
- Effect
- Low calcium availability in the macrobiotic diet was an independent factor in the high rate of rickets in summer [9]. Calcium deficiency was found in macrobiotic infants, and breast milk from macrobiotic mothers contained less calcium [4].
- Population
- Dutch macrobiotic infants and their mothers [4][9]. Observational.
- Sources
- [4], [9]
- Caveats
- One Dutch cohort [4][9].
Iron deficiency
Linked to iron deficiency in 15% of Dutch macrobiotic infants against none of the matched omnivorous infants.
The numbers and sources
- Effect
- Iron deficiency, defined by low hemoglobin, low ferritin and raised erythrocyte protoporphyrin together, was found in 15% of macrobiotic infants and none of the controls (p = 0.003) [6].
- Population
- 50 Dutch macrobiotic infants aged 10 to 20 months and 57 matched controls [6]. Observational.
- Sources
- [6]
- Caveats
- One cohort of infants [6].
Slower growth in young children
Linked to slower growth, fat and muscle wasting and slower motor development in Dutch macrobiotic infants, with only partial catch-up by age 16.
The numbers and sources
- Effect
- Growth slowed mainly between 6 and 18 months, with fat and muscle wasting and slower psychomotor development, alongside shortages of energy, protein, vitamin B12, vitamin D, calcium and riboflavin [4]. Linear growth tracked the protein content of the diet, and children whose families added fatty fish or dairy grew faster afterward [10]. By ages 7 to 16, children had caught up partly in height but were still below the reference for height and skinfolds [11].
- Population
- 243 Dutch children aged 0 to 8, and 53 macrobiotic infants with 57 controls [10]; 209 children followed to ages 7 to 16 [11]. Observational.
- Sources
- [4], [10], [11]
- Caveats
- One Dutch population studied by overlapping research teams [4][10][11].
LDL cholesterol in the diabetes follow-up
One small trial found LDL cholesterol rose over 6 months on both diets, with a larger percentage rise on the Ma-Pi diet after adjustment.
The numbers and sources
- Effect
- Total and LDL cholesterol rose in both groups over the 6-month follow-up. After adjusting for age and sex, the Ma-Pi diet was linked to a larger percentage LDL rise. All participants stayed below 200 mg/dL total and 100 mg/dL LDL cholesterol [2].
- Population
- 40 adults with type 2 diabetes [2].
- Sources
- [2]
- Caveats
- Small follow-up, and the LDL interval in the abstract is reported unusually [2].
Supplements to consider
The nutrients research linked to this diet running short, each with its own page.
Vitamin B12
Moderate Linked to vitamin B12 deficiency in macrobiotic infants, children and adults, lasting into adolescence after children switched diets at age 6.
Vitamin D
Limited Linked to signs of rickets in 28% of Dutch macrobiotic infants in late summer and 55% of those rechecked the next spring.
Calcium
Limited Linked to calcium deficiency in Dutch macrobiotic infants, and low calcium availability was an independent factor in rickets.
Iron
Limited Linked to iron deficiency in 15% of Dutch macrobiotic infants against none of the matched omnivorous infants.
Sources
- Soare A, Khazrai YM, Del Toro R, 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. https://doi.org/10.1186/1743-7075-11-39
- Soare A, Del Toro R, Khazrai YM, et al. A 6-month follow-up study of the randomized controlled Ma-Pi macrobiotic dietary intervention (MADIAB trial) in type 2 diabetes. Nutrition & Diabetes. 2016. https://doi.org/10.1038/nutd.2016.29
- Porrata-Maury C, Hernández-Triana M, Ruiz-Álvarez V, et al. Ma-Pi 2 macrobiotic diet and type 2 diabetes mellitus: pooled analysis of short-term intervention studies. Diabetes/Metabolism Research and Reviews. 2014. https://doi.org/10.1002/dmrr.2519
- Dagnelie PC, van Staveren WA. Macrobiotic nutrition and child health: results of a population-based, mixed-longitudinal cohort study in The Netherlands. The American Journal of Clinical Nutrition. 1994. https://doi.org/10.1093/ajcn/59.5.1187S
- Louwman MW, van Dusseldorp M, van de Vijver FJ, et al. Signs of impaired cognitive function in adolescents with marginal cobalamin status. The American Journal of Clinical Nutrition. 2000. https://doi.org/10.1093/ajcn/72.3.762
- Dagnelie PC, van Staveren WA, Vergote FJ, et al. Increased risk of vitamin B-12 and iron deficiency in infants on macrobiotic diets. The American Journal of Clinical Nutrition. 1989. https://doi.org/10.1093/ajcn/50.4.818
- Miller DR, Specker BL, Ho ML, et al. Vitamin B-12 status in a macrobiotic community. The American Journal of Clinical Nutrition. 1991. https://doi.org/10.1093/ajcn/53.2.524
- van Dusseldorp M, Schneede J, Refsum H, et al. Risk of persistent cobalamin deficiency in adolescents fed a macrobiotic diet in early life. The American Journal of Clinical Nutrition. 1999. https://doi.org/10.1093/ajcn/69.4.664
- Dagnelie PC, Vergote FJ, van Staveren WA, et al. High prevalence of rickets in infants on macrobiotic diets. The American Journal of Clinical Nutrition. 1990. https://doi.org/10.1093/ajcn/51.2.202
- Dagnelie PC, van Dusseldorp M, van Staveren WA, et al. Effects of macrobiotic diets on linear growth in infants and children until 10 years of age. European Journal of Clinical Nutrition. 1994. https://pubmed.ncbi.nlm.nih.gov/8005079/
- van Dusseldorp M, Arts IC, Bergsma JS, et al. Catch-up growth in children fed a macrobiotic diet in early childhood. The Journal of Nutrition. 1996. https://doi.org/10.1093/jn/126.12.2977
- Berrino F, Villarini A, Gargano G, et al. The Effect of Diet on Breast Cancer Recurrence: The DIANA-5 Randomized Trial. Clinical Cancer Research. 2024. https://doi.org/10.1158/1078-0432.ccr-23-1615
- Kushi LH, Cunningham JE, Hebert JR, et al. The macrobiotic diet in cancer. Journal of Nutrition. 2001. https://doi.org/10.1093/jn/131.11.3056s