THE JAPANESE PARADOX
The Japanese suffered greatly before and during World War II. There were many food shortages, particularly of fats and animal foods. TB was common. Many Japanese lived almost entirely on rice during the war.

It was during the postwar years that the American researcher Ancel Keys wrote his famous Seven Countries Study in which he included groups from the Japanese districts of Tanushimaru and Ushibuka. He noted that the Japanese in these two regions had very low levels of serum cholesterol, consumed a diet extremely low in saturated fat and cholesterol and had low rates of coronary heart disease. It was primarily the Japanese data that allowed Keys and others to conclude that consumption of saturated fat and cholesterol caused heart disease.

Keys has been criticized for omitting from his study many areas of the world where consumption of animal foods is high and deaths from heart attack are low, including France. This is the so-called French paradox, one of many. But there is also a Japanese paradox. In 1989, Japanese scientists returned to the same two districts that Keys had studied. In “Lessons for Science from the Seven Countries Study,”15 they noted that per capita consumption of rice had declined while consumption of fats, oils, meats, poultry, dairy products and fruit had all increased. Between 1958 and 1989, protein intake rose from 11 percent of calories to about 15 percent and fat intake rose from a scanty 5 percent to over 20 percent. Mean cholesterol levels increased from 150 in 1958 to 188 in 1989. During the period, mean body mass gradually increased, with overweight rising from 8 percent to about 13 percent of the population. High blood pressure became more common while the percentage of smokers decreased from 69 percent in 1958 to 55 percent in 1989.

During the postwar period of improved nutrition the Japanese average height increased three inches and the age-adjusted death rate from all causes declined from 17.6 to 7.4 per 1000 per year. Although the rates of hypertension increased, stroke mortality declined markedly. Deaths from cancer also went down in spite of the increased use of animal foods.

The researchers also noted—and here is the paradox—that the rate of myocardial infarction (heart attack) and sudden death did not change during this period, in spite of the fact that the Japanese weighed more, had higher blood pressure and higher cholesterol, and ate more fat, more beef and more dairy.

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