How does Japan view the boundary between food and medicine?
In his third column, Sepe Sehati paints a picture of how the Japanese health care is benefiting from a well-thought-out, joined-up regulatory approach to food as medicine.
As early as 300 BC humans were cultivating food crops for medicinal purposes1. Although they knew that diet was powerless against epidemic diseases, food as medicine and food as preventive medicine remained an integral component of many Eastern healing and staying well practices.
Most cultures, in particular Western cultures, however, slowly broke away from using food as medicine.
Ultimately there was a huge a shift away from nutrition-based medicine towards allopathic medicine – a system in which health care professionals treat symptoms and diseases using drugs, radiation, or surgery. As we saw last month,2 allopathic medicine is often not only not delivering the promised goods but is also threatening the fiscal stability of nations. Despite the various clinical and scientific discoveries alas, rather than having a sustainable “health care” system we have effectively ended up with a wholly unsustainable “disease care” system.
Given the well documented problems with medicine today, smart nations such as Japan are once again facilitating the use of food-based practices to actively help towards achieving relatively miraculous health care results.
The actions of nations such as Japan is not only influenced by historical use of dietary interventions but also robustly supported by the latest evidence-based research demonstrating that a nutritious diet can have a significant impact on the prevention, treatment, co-treatment, and outcome of many disease states3-12.
For example, epidemiological studies have demonstrated a consistent association between nutrition and mental health13. Several systematic reviews have shown healthy dietary patterns (characterised by high intake of vegetables, fruit, wholegrains, nuts, seeds and fish, with limited processed food) to be inversely associated with the risk of depression14-16.
Conversely, diets consisting of processed, high-fat, high-sugar foods are associated with mental disorders such as depression and anxiety, as well as other neuropsychiatric conditions. These conditions have both neurological and psychiatric features. Additionally, vitamin deficiencies have also been shown to impair mental health and cognition17-19.
The link is strongest for vitamin B12 deficiency which has been shown to affect cognition, cause brain shrinkage, and can be associated with depression. Deficiency in omega-3 fatty acids has also been linked to a higher risk of depression and suicide.
Japan has one of the lowest rates of obesity and highest average lifespans in the world, and there is a growing research-based argument that diet plays a significant role in such statistics.
The Japanese System
For diet to be permitted to play its role in the health of a nation, a well-thought-out, joined-up holistic regulatory approach is required.
The Japanese scientific academic community defined ‘functional food’ early in the 1980s. Accordingly, functional foods are those that have three functions. The primary function is nutrition. The secondary function is a sensory function or sensory satisfaction. The third is physiological. The Japanese Ministry of Health, Labour, and Welfare set up ‘Foods for Specified Health Use’ (FOSHU) in 1991 and this was later followed by two more categories – namely, Foods with Nutrient Function Claims (FNFC) and Foods with Function Claims (FFC).
Foods for Specified Health Uses
Foods for Specified Health Uses (FOSHU) are scientifically recognised as helpful for maintaining and promoting health and are permitted to bear claims such as “Slows cholesterol absorption.” The government evaluates the claimed effects and safety, and the Secretary-General of the Consumer Affairs Agency gives approval for the labelling of each food product that satisfies the requirements.
FOSHUs can be approved for certain specified uses such as: changing gastrointestinal health, lowering blood cholesterol, regulating blood sugar levels, impacting blood pressure, assisting in dental hygiene, aiding in mineral absorption, and encouraging bone growth. FOSHU requires manufacturers to undertake efficacy and safety clinical trials.
Foods with Nutrient Function Claims
Foods with Nutrient Function Claims (FNFC) can be used to supplement or complement the daily requirement of nutrients (vitamins, minerals, etc.) which tend to be insufficient in everyday diet. Given that the food product contains certain amounts of nutrient whose function has already been substantiated by scientific evidence, it can bear a nutrient function claim prescribed by the Standards without submitting a notification to the government.
Foods with Function Claims
Under the food business operator’s own responsibility, Foods with Function Claims (FFC) can be labelled with function claims based on scientific evidence. Information on the evidence supporting the safety and effectiveness of the product is submitted to the Secretary-General of the Consumer Affairs Agency before the product is marketed.
However, unlike FOSHU, the product is not individually pre-approved by the Secretary-General of the Consumer Affairs Agency. Critically, also unlike FOSHU, the FFC category can leverage scientific evidence already available in the form of systematic review of the functional substance used or the finished product.
Japan undoubtedly continues to benefit from enviable health statistics. There will be several reasons for this – prominent amongst which is their approach to diet, how it is regulated, communicated and made available to consumers. The big question is whether we can learn from the Japanese and similar approaches by other nations and if so, how best to go about it. Watch this space.
For more columns by Sepe Sehati, click here.
- Curran J. The Yellow Emperor’s Classic of Internal Medicine. BMJ. 2008;336(7647):777
- Can healthy food help save the NHS? Accessed 6 September, 2022. https://www.newfoodmagazine.com/article/167151/uk-food-behaviourisms/
- Mehmood M. Food as Medicine: Prevention Is better but Could It Cure? J Am Coll Cardiol 2021 Mar 9;77(9):1267. doi:10.1016/j.jacc.2020.11.078
- Ornish D, Brown SE, Scherwitz LW, et al. Can Life- style Changes Reverse Coronary Heart Disease? The Life- style Heart Trial. Lancet 1990 Jul 21;336(8708):129-33. doi:10.1016/0140-6736(90)91656-U
- How Dietary Factors Influence Disease Risk. 2017. National Institutes of Health. Accessed 6 September, 2022. https://www.nih.gov/news-events/nih-research-matters/how-dietary-factors-influence-disease-risk
- Poor Nutrition. 2021. National Center for Chronic Disease Prevention and Health Promotion. Accessed 6 September, 2022. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm
- Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Re- construction and Development / The World Bank; 2006. Chapter 44. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11795/Co-published by Oxford University Press, New York.
- Phillips MCL, Deprez LM, Mortimer GMN, et al. Randomized Crossover Trial of a Modified Ketogenic Diet in Alzheimer’s Disease. Alzheimers Res Ther. 2021;13(1):51. doi:10.1186/s13195-021-00783-x
- Downer S, Harlan T. Food Is Medicine: Actions to Integrate Food and Nutrition Into Healthcare. BMJ 2020;369:m2482. doi:10.1136/bmj.m248
- Nazarenkov N, Seeger K, Beeken L, et al. Implementing Dietary Modifications and Assessing Nutritional Adequacy of Diets for Inflammatory Bowel Disease. Gastroenterol Hepatol (NY). 2019;15(3):133-144.
- Trapl ES, Smith S, Joshi K, et al. Dietary Impact of Produce Prescriptions for Patients With Hypertension. Prev Chronic Dis. 2018;15. doi:10.5888/pcd15.180301
- Haskey N, Gibson DL. An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. Nutrients. 2017;9(3):259. doi:10.3390/nu9030259
- Shen J, Zuo ZK, Mao AP. Effect of Probiotics on Inducing Remission and Maintaining Therapy in Ulcerative Colitis, Crohn’s Disease, and Pouchitis: Meta-Analysis of Randomized Controlled Trials. Inflamm Bowel Dis 2014;20:21–35. doi:10.1097/01.MIB.0000437495.30052.be.
- Marx W, Moseley G, Berk M, Jacka F. Nutritional Psychiatry: The Present State of the Evidence. Proc Nutr Soc. 2017;76(4):427-436. doi:10.1017/S0029665117002026.
- Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr. 2014;99(1):181-97. doi:10.3945/ ajcn.113.069880
- Opie RS, O’Neil A, Itsiopoulos C, Jacka FN. The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials. Public Health Nutr. 2015;18(11):2074-93. doi:10.1017/S1368980014002614
- Tangney, C. C., et al. “Vitamin B12, cognition, and brain MRI measures: a cross-sectional examination.” Neurology 77.13 (2011): 1276 1282.
- Adan RAH, van der Beek EM, Buitelaar JK, et al. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019;29(12):1321-1332. doi:10.1016/j.euroneuro.2019.10.011
- Enderami A, Zarghami M, Darvishi-Khezri H. The effects and potential mechanisms of folic acid on cognitive function: a comprehensive review. Neurol Sci. 2018;39(10):1667-1675. doi:10.1007/s10072-018-3473-4
About the author
Dr Sepe Sehati is an innovator and a passionate advocate and practitioner of both critical thinking and tactical cross-pollination of disciplines. Sepe holds a Doctorate in Bioengineering from the University of Oxford and is a Fellow of the Royal Society of Medicine. Sepe’s innovative approach to problem solving and strategising – fuelled through the application of diverse scientific fields, analytics, neuroscience, behavioural science and evidence-based principles, has led him to contribute to various high-profile initiatives, ranging from President Obama’s Transition Health Policy, to the UK Prime Minister’s sustainable development plan, to the late Dr Richard Rockefeller’s innovative healthcare models.