Fermented Food in Japan

If you know anything about heart disease epidemiology, you know that Japan has the lowest rate of heart disease in the world. The usual explanation is high fish consumption. But other countries, such as Norway, also eat a lot of fish but don’t have low heart disease rates.

My visits to Japan suggest to me that Japanese eat far more fermented foods than people in other countries, including Norwegians. If heart disease is due to infection, then it’s clear that the immune stimulation provided by fermented foods helps fight infection. My umami hypothesis — that we like umami, sour, and complex flavors to encourage bacteria consumption, which we need to be healthy — began with a trip to Japan in 2008, when I noticed, in a food court, many types of miso for sale. Back in Berkeley, I started making miso soup. I was stunned how well it worked. All you needed was miso. No other flavorings. It was so easy and good I ate it every day. It was my first bit of evidence that fermented foods are different and better than other foods.

Here are some fermented foods that are easy to get in Japan:

1. Miso soup. Most Japanese eat this daily. In a few countries, such as France, many people eat yogurt daily. Koreans eat kimchi daily. In most countries, as far as I know, it’s hard to find a fermented food (apart from cheese and alcoholic drinks) that’s eaten daily by most people. Miso is also used to flavor fish.

2. Japanese pickles. The best pickles in the world. Some are pickled as long as as two years, developing noticeable alcohol. Other countries have pickles, of course, but as far as I know the only pickle restaurants are in Japan. Moreover there are pickle shops in big Japanese cities. The only other pickle shops I’ve seen are in New York City.

3. Pickled apricots (umeboshi). At a food court you have a choice of acidity, anywhere from 5% (slightly sour) to 25% (extremely sour).

4. Vinegar drinks. Tokyo 7-Elevens sell a black vinegar drink. Vinegar and water. In food courts you can buy special vinegars for this purpose. I’ve never seen vinegar drinks for sale anywhere else.

5. Natto.

6. Yogurt. The Japanese yogurts I’ve tried were sweetened but weren’t as sweet as the yogurts sold in Beijing.

7. Yakult. The fermented milk drink. It’s sold in such small packages it’s pretty clear it must appeal to people who think it improves their health. It doesn’t boost energy, quench thirst, or taste especially good. The manufacturer says it is good for health and that one bottle per day is all you need.

8. Beer and wine.

Because soy sauce is used in small amounts, it doesn’t count. At a Tokyo restaurant I met a nurse who said she thought you should eat fermented foods every day to be healthy. She said perhaps a third of Japanese believe this.

I’ve never seen high Japanese consumption of fermented foods noticed by epidemiologists. Individual fermented foods (such as miso), yes; the whole category, no. You can see how hard it would be to combine across foods: how much miso equals how much Yakult? Yet I’m sure fermented food consumption is extremely healthy.

12 Responses to “Fermented Food in Japan”

  1. Vic Says:

    I don’t think sake or vinegar contain live bacteria, do they?

  2. seth Says:

    Unless vinegar has been pasteurized (and as far as I know this is rare) it contains live bacteria. Sake, on the other hand, is usually pasteurized. I can’t see why bacteria need to be alive to stimulate the immune system; bacterial fragments should have the same effect.

  3. q Says:

    when i visited japan i found a lot of pickle shops and tofu shops in kyoto — a lot more than in tokyo or osaka.

    the pickle shops you’ve seen in nyc are places like gus’s and pickle guys, right?

  4. Caleb Says:

    I’m a big proponent of fermented foods and encourage my patients to get more of them, but it’s worth keeping in mind there are likely trade offs. When over-consumed fermented foods probably irritating the lining of the digestive tract.

    East Asians have notably higher rates of stomach and intestinal cancer. My gut feeling is that this comes from having acidic vinegary food so frequently that the digestive tract doesn’t get a chance to recover. I’ve had to go off vinegar when I found my body had an allergic inflammatory reaction to it.

    It would be very interesting to see if people only need fermented foods several times a week to get the immune stimulating benefits, while not being as hard on the lining of the digestive tract (though now that I’ve focused my thoughts, I suspect this may specifically be a vinegar thing; that stuff is strong, stronger than anything our tribal ancestors would have evolved to handle daily)

  5. pam meier Says:

    In Gary Taube´s book “Good Calories, Bad Calories” I remember that one possible explanation for the low rate of heart attacks is the fact Japanese doctors will rather diagnose a strike, as it is believed to be a more honorable death.

  6. mongolian Says:

    If fermented foods are critically important for health, wouldn’t more societies have evolved to include it in their traditional diets? If the umami hypothesis is correct and humans are predisposed toward complex flavors due to the bacteria in them, then don’t we see more fermented foods in diets around the world? Why is it concentrated only in Japan?

  7. seth Says:

    Pam Meier, by a “strike” you mean a stroke?

    mongolian, traditional diets include plenty of fermented foods, in many different cultures. Fermented foods aren’t only in Japan, they are just eaten there more than elsewhere. I can think of several possible reasons: 1. Modern foods, such as mcdonald’s hamburgers and Coke, are less compatible with the Japanese diet than other diets. So they have been slower to displace the traditional diet. 2. Japanese food, being relatively mild, left a big desire for complex flavors that fermented foods fill. Other cuisines, with more complex flavors in their main foods, don’t have that problem. 3. The Japanese are more food-conscious than other cultures, so they value complex flavors more. Certainly the French are relatively food conscious and also have a lot of fermented food.

  8. thehova Says:

    “My gut feeling is that this comes from having acidic vinegary food so frequently that the digestive tract doesn’t get a chance to recover.”

    heh, I love the pun.

  9. thehova Says:

    Seth is definitely correct when it comes to the Japanese and French passion for food. Most Americans take a much more pragmatic approach.

    I do think a lot of it comes form the fact that the French and Japanese generally eat less. When you eat less, your more selective about what you eat.

  10. Tom Moertel Says:

    mongolian, I think we can safely assume that fermented foods were part of almost any primitive society’s diet. Lacking refrigeration and modern chemical preservatives, most stored foods would have been subject to fermentation. And, back when food was scarce, almost any surplus would have been stored for later consumption. (Back in the day, discarding the leftovers wasn’t a good survival strategy.)

  11. pam meier Says:

    Seth, yes, I meant “stroke” …

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