Staying healthy in Japan

Health - August 5th, 1994

by Elyse Rogers

Each time I return to Japan I am surprised at how much has changed and yet how much has stayed the same. During this last trip I lived in a brand-new complex, Gotenyama Hills, that didn’t even exist when I was last in Tokyo. On the other hand, when I went shopping on the Azabu Juban (an area close to where we used to live), very little seemed to have changed. I recognized many of the store keepers, and the type of merchandise appeared identical. In medicine and health, it’s a similar situation. While talking with Dr. Koichi Fujii of the popular Tokyo Medical Surgical Clinic, we discussed many medical problems that were familiar ones when I was writing this column on a regular basis. On the other hand, I was pleased to see some “new” emphasis on nutrition and particularly on the limitation of fat in the diet.

JET LAG

Through the years, I’ve written about jet leg “cures” or preventive techniques that ran from special “carbo loading” diets prior to a trip, to specific vitamin therapy after. But a new hormone may hold the great­est promise of all. Seems a hormone called melatonin from the pineal gland is important to sexual function and the circadian rhythm (sleep/wake) cycles of ani­mals and humans. It works like this: the longer the hours of daylight, the less melatonin is produced, and the lower the levels of melatonin, the stronger the sex drive becomes. This is one reason, scientists now reckon, that animals mate in the spring when days are longer and the young have a better chance for sur­vival. In the human species the sex-drive/melatonin cycle has a much more subtle relationship, but the relationship of the melatonin cycle and the sleep cycle seems pertinent to the circadian rhythm and jet lag.

Normally the melatonin cycle and the sleep cycle ” are integrated, but in total darkness of several days (and perhaps due to other disturbances such as cross­ing the date line) the two rhythms can become out of sync. Scientists have found that the influence of light on the day-night cycle and melatonin production can be used to adjust a person’s sleep cycle and avoid jet lag when changing time zones. Exposing oneself to bright light (preferably outdoor sunshine, if possible) in early morning and late night, supposedly helps one to sleep better at night. Also, taking a 0.5 mg pill of melatonin during the day aids sleep, helps prevent insomnia and minimizes jet lag.

Since this is new data, there will be more studies conducted and it will probably be some time before your physician prescribes a melatonin capsule rather than a sedative or sleeping pill for jet lag. Some natu­ral food stores in the states now carry melatonin, I understand, and a friend who says it worked.

At this point, I’d suggest we wait for more scien­tific confirmation of melatonin’s effectiveness and safety before wolfing down pills. But if it does turn out to be all that we hope, we can look forward to the day when along with our passport and travelers checks we’ll pack melatonin before boarding our jetliner.

THE JAPANESE DIET

The Japanese diet has traditionally been one low in fat and calories, and one which has kept this nation healthy and long lived. Now according to govern­ment reports, the average Japanese is “eating fewer grains, more dairy products, more meat, far more fats and oils, and less salt” than he/she was 30 years ago. At least the salt reduction is good news, although most Japanese food is still much too high in salt or sodium compounds. The result of these new dietary habits is already showing up: Japanese urban children aged 8-14 have cholesterol levels that are higher than the same age children in America.

The message here is that Japanese, Americans and people of all nationalities need to clean up their diet act. Diets high in whole grains, vegetables, and fiber, and lower in dairy products, meats and all kinds of fat, are best. Fish is an excellent source of protein and is healthy, too, so is an ideal choice as a substitute for meat—and is readily available and delicious in Japan. Poultry is also good as it tends to be low in fat. Mostly, good-diet savvy depends on common sense and what most moms taught: cat your fruits and vegetables, and go easy on desserts and sweets. Yasai sushi anyone?

KONNYAKU AND OTHER JAPANESE FOODS

On the subject of diet, but with a different twist, I was delighted to read in The Japan Times that they are sponsoring a cooking class using konnyaku. As many of you probably know, konnyaku is the firmer-than-Jell-O substance that is so popular in many Japa­nese dishes. The neat thing about this ingredient is that it has little taste and almost no calorics. Konnyaku is traditionally used in nabemono, udon and sukiyaki. But there are many other uses, and for a creative cook it can add variety and texture to a meal. Konnyaku is actually a starch from the arum root (sometimes called devil’s tongue) and is easy to work with and adapt to not only Japanese dishes but Western fare as well.

Actually I’d encourage all you cooks to be as cre­ative as possible with many of the fine Japanese foods that are available at your local stores. Our family has always loved salads and they can become a healthy, light main dish with a little imagination. One super salad ingredient we discovered in Japan is grated daikon. A salad that contains mixed greens, cucum­bers, tomatoes, mushrooms, bean sprouts (moyashi), carrots, celery, cabbage, daikon and almost any other fresh vegetable you can think of is a beautiful sight. With low-calorie dressing, which is now available in many parts of Tokyo, you can keep the fat content under control. (Remember, a tablespoon full of regu­lar dressing can contain 8 grams or more of fat which is a whopping part of a typically suggested 40-65 grams per day of fat.) If you don’t have light dressing, make your own by mixing a tablespoon or two of regular dressing with 1/4 or 1/2 cup of non-fat plain yogurt. With hot fresh bread or rolls on the side, a generous bowl of salad makes a wonderful evening meal. If a veggie-only salad doesn’t seem substantial enough for you or your family, add some cooked meat and cheese on top. Broiled chicken or fish cut into chunks is a delicious way to add low-fat heartiness and protein.

SMOKING IN JAPAN

In the States, smoking has become a very emotional issue. New information about the damage that sidestream smoke can do to those near to a smoker have made no-smoking areas the norm. Today many offices and even entire buildings are being designated as “smoke free.”

Since Japan has been a nation of heavy (male) smok­ers and there seemed to be no reduction in that trend in the last few years, I didn’t expect to see any wide­spread or harsh no-smoking policies in effect. But I was hoping to sec some evidence that smoking might be on the decline, and of more consideration for the non-smoker.

And such signs are abundant. For example, I re­member when the shinkansen first introduced non­smoking cars. Only one car (very often of a very long train) was designated as non-smoking. However, when we traveled by shinkansen this year, the number of non-smoking cars was often more than half the total.

I found some statistics about how smoking rates ‘Vary in different countries. You might find the chart (below) as interesting as I did:

Smokers

U.S.

Japan

New Zeal.

Australia

China

S. Korea

Cambodia

Male

28%

61%

28%

30%

61%

70%

90%

Female

24%

14%

27%

27%

7%

7%

3%

Some trends jump out from that simple chart: that developing nations have a higher incidence of male smoking than most developed nations. (Rates were higher years ago in the U.S. and Japan as well, and are now declining). Also, women apparently don’t jump on the smoking bandwagon until they become more emancipated. Too bad that more opportunity and free­dom for women means that they seize the opportu­nity to take up a habit that has proven so damaging to personal health.

Smoking continues to be the major cause of lung cancer which is a leading cause of death in both Japan and the U.S. Currently the three main causes of death in Japan are 1) cancer, 2) heart disease and 3) stroke. In the U.S., heart disease remains the number one killer with cancer and strokes following behind.

EXPATS AND MEDICAL SERVICES

Many old and new friends asked me about the state of medicine for foreigners in Japan. We are fortu­nate that we continue to have a willing and able supply of physicians for our expat com­munity. The Tokyo Medical Surgical Clinic remains a major resource, particularly for the large number of Americans and Brit­ish who live in the central Tokyo area. I spent a wonderful evening as a guest of Dr. and Mrs. Fujii, and had a chance to chat with fellow guests, Dr. Marshall and Dr. Sakai. Many of you know Drs. Fuji and Marshall who are two of the partners at To­kyo Medical/Surgical. Some of you may also know Dr. Sakai who used to head up Tokai University Hospital in Tokyo (Yoyogi area), and is now head of the entire department of Otolaryngology at Tokai University Hospital’s huge main complex in Atsugi.

There are many other fine resources that foreigners use and I’ve written about frequently in this column. To name a few: The International Clinic, Tokyo En­glish Life Line (TELL), Sanno Clinic; and many of the Tokyo hospitals such as Aiiku, Seibo, Keio University, St. Luke’s, Tokyo Sanitarium, etc. There are far more, of course, and I know many of you have your favorites.