Why Japanese Men Have Far Less Heart Disease

Coronary artery disease, the type that causes heart attacks and is generally known as heart disease, is the leading killer in the U.S., and men have much higher rates of it than women. Things are different elsewhere, so this article will tell you why Japanese men have far less heart disease than Americans.

Virtually every man is taught to fear heart disease, with good reason, and wants to do everything to prevent it.

Heart disease rates are much higher in the U.S. and the UK than many other places, such as Japan. Dr. Malcolm Kendrick posted the following stats, taken from the article “Cardiovascular Disease and Risk Factors in Asia”.1

% WHO SMOKE 35.4% 23% 17.2%
AVERAGE BP (SYSTOLIC) 130.5mmHg 131.2mmHg 123.3mmHg
CHOLESTEROL LEVEL 5.2mmol/l 5.4mmol/l 5.1mmol/l
RATE OF CHD/100,000/year 45.8 143.7 150.7

Dr. Kendrick wished to make a point about cholesterol, namely that it cannot be a risk factor. The point I wish to make is: can we learn from the Japanese experience and keep our heart disease risk low?

Japanese men smoke cigarettes at twice the rate of American men, have higher cholesterol and higher blood pressure, yet they have about 30% the rate of heart disease as in the U.S.

Note that their rate of diabetes is about 60% that of the U.S.; that’s important.

Here are some candidates for the lower male Japanese heart disease rate, along with what I believe are the best answers.


Maybe the Japanese have some kind of genetic protection against heart disease.

Unfortunately for that thesis, Japanese men who move to the U.S. have much higher rates of heart disease than Japanese men in Japan.2

The incidence rate was lowest in Japan where it was half that observed in Hawaii. The youngest men in the sample in Japan were at particularly low risk. The incidence among Japanese men in California was nearly 50 percent greater than that of Japanese in Hawaii. A striking increase in the incidence of myocardial infarction appears to have occurred in the Japanese who migrated to the United States; this increase is more pronounced in California than in Hawaii.

No, Japanese genes do not offer protection.

Fish consumption

The Japanese eat a lot more fish than Americans, and this is important, since omega-3 fatty acids, the type in which fish is abundant, are protective against heart disease.3

A study done in 2005 found that the more fish the Japanese ate, the higher was their consumption of omega-3 fats, and the lower was their rate of heart disease.4

The following chart shows the decline in heart disease risk with increasing omega-3 consumption.


At the highest quintile (fifth) of consumption, risk was ~70% less than the lowest quintile of consumption — and keep in mind that the risk in Japan is already low. The study also notes that the lowest quintile of fish consumption in Japan was equal to the third quintile in Western countries, meaning that for us Westerners, increasing our fish and/or omega-3 consumption could lower our heart disease risk greatly.


Sugar consumption is linked to heart disease, probably through its effects on insulin resistance. People who consume 2 or more sugar-sweetened drinks (SSBs) daily had a 35% greater risk of heart attack.5

In the U.S., the average person consumes 126 grams of sugar daily. That’s about 25 teaspoons.

The corresponding figure for Japan is 57 grams, or about 11 teaspoons. Less than half the amount as the U.S.

Trans Fat

Trans fats are the artificial fats created in the making of vegetable oil and margarine. They are strongly implicated in coronary heart disease. Risk in highest quintile of consumption vs lowest is 50% higher.6

Intake of trans fat in Japan is about 25% that of U.S. consumption.

Processed food of all kinds, but especially baked goods, are loaded with trans fat. Margarine is basically about 100% trans fat and should never be used. Vegetable oils — throw them out. Use coconut oil, olive oil, lard, and butter instead.

Vitamin D

Vitamin D deficiency is associated with heart disease, with a 62% higher rate in those who are deficient.7

Fish are high in vitamin D, and as we saw above, the Japanese eat a lot of fish.


Excessive iron is strongly associated with many diseases. As a rough and ready measure of iron status, we find that Japanese women are more than twice as likely to be anemic as American women.8

That tells us that both iron intake and iron levels are lower in Japan than in the U.S., and could be a big factor behind lower heart disease rates.


The U.S. obesity rate is 33%; in Japan, it’s 5%. As obesity is linked to heart disease, enough said.

Conclusion and steps to take

Men in Japan, despite smoking much more than American men, and despite higher cholesterol and blood pressure, have a rate of heart disease 70% lower than American men.

Among the reasons for this are high consumption of fish and omega-3 fats, more vitamin D, and less consumption of sugar, trans fats, and iron.

To lower your risk of heart attack:

  1. Eat fish and/or supplement with fish oil. In Japan, the category with the lowest risk ate fish 8 times a week, or an average of 180 grams (more than a third of a pound) daily. That meant a consumption of omega-3 fats of 2.1 grams daily, or the equivalent of about 2 teaspoons of cod liver oil. That’s a lot, but I take one teaspoon of cod liver oil several times a week, and I’m now going to increase that to every day.
  2. Avoid sugar in all forms. No sodas, fruit juice, candy, donuts — you get the idea. Small amounts, such as teaspoon in a cup of coffee, probably won’t do much harm.
  3. 3. Avoid trans fats. That pretty much eliminates processed food, as well as margarine, mayonnaise, vegetable oils. Eat whole, unprocessed food.
  4. Get sunshine and/or supplement with vitamin D. I take 5,000 IU daily, less in summer when I get sun exposure. (That’s higher than mainstream medicine recommends, by the way.)
  5. Control your iron levels. Keep ferritin below 100.
  6. Stay lean. Don’t be overweight.

PS: Check out my book, Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.

Subscribe and get my free book on fat loss
  1.  Ueshima, Hirotsugu, et al. “Cardiovascular disease and risk factors in Asia a selected review.” Circulation 118.25 (2008): 2702-2709.
  2.  Robertson, Thomas L., et al. “Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: incidence of myocardial infarction and death from coronary heart disease.”The American journal of cardiology 39.2 (1977): 239-243.
  3.  Harris, William S. “The omega-3 index as a risk factor for coronary heart disease.” The American journal of clinical nutrition 87.6 (2008): 1997S-2002S.
  4.  Iso, Hiroyasu, et al. “Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese the Japan Public Health Center-Based (JPHC) Study Cohort I.” Circulation 113.2 (2006): 195-202.
  5.  Malik, Vasanti S., et al. “Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk.” Circulation 121.11 (2010): 1356-1364.
  6.  Willett, Walter C., et al. “Intake of trans fatty acids and risk of coronary heart disease among women.” The Lancet 341.8845 (1993): 581-585.
  7.  Wang, Thomas J., et al. “Vitamin D deficiency and risk of cardiovascular disease.” Circulation 117.4 (2008): 503-511.
  8.  Kusumi, Eiji, et al. “Prevalence of anemia among healthy women in 2 metropolitan areas of Japan.” International journal of hematology 84.3 (2006): 217-219.
Liked it? Take a second to support me on Patreon.

Leave a Comment:

Why Japanese Men Have Far Less Heart Disease | Technology and Longevity Feed says September 28, 2016

[…] Original Article: Why Japanese Men Have Far Less Heart Disease […]

Stuart Mather says September 28, 2016

I wonder if sugar itself is bad or it the time over which you consume it is the real culprit. Even pure glucose doesn’t even budge my own blood sugar as long as I don’t consume more than 8 grams of it in any 40 minute period. More and my blood sugar reliably spikes. All carbs convert to glucose eventually anyway. (and thereafter bodyfat if glycogen reserves are full).
The take home message seems to be don’t avoid sugar or any other carb up to the 300g /d RDA but space their consumption very evenly throughout the day. And the higher the GI of any particular sugar the more careful you have to be to space it’s consumption.
Whuch of course doesn’t suit the modern hectic lifestyle. And it’s hard to consume that delicious slice of cake over several hours after all. I personally would rather do so and reduce the inflammatory effect of my blood sugar EVER straying above baseline..
Fructose of course ( and especially modern fruit selectively bred for sweetness) has it’s own raft of problems unrelated to blood sugar. For instance I love bananas. But I’d never consume more than half a banana in any 30 minute period (stretch that commensurately if you are consuming other carbs).

    Arren Brandt says September 28, 2016

    I indulge in excessive sugar consumption twice or thrice a week but I Always make sure to do it when my liver is empty (fasted 18-24 hours before). Also make sure to time three cups coffee and some green tea in the hours afterwards and usually hitting weights /sprinting right before or a few hours later. Not sure if this helps but my looks are very good after cutting grain/breads consumption from 6-9 times weekly down to 2-4 times.

Herman Rutner says September 28, 2016

Interesting correlation of low heart rate versus heat disease. As you mentioned well conditioned athletes have the lowest heart rates, even below 40. Per Dr Weil magnesium supplements will lower the rate as do beta blockers down to about 40 at higher doses.My resting heart rate is 47 -55 rising only a few beats even when climbing stairs. As an 81 y with heart attack 12 years ago (3 stents for 2 partially blocked arteries, taking lisinopril and baby aspirin) and no problems since, I use light exercise consisting of daily walking for 1-2 miles and my own version of 2 simple universal whole body exercises, truly senior and doable by anyone with joint mobility, either standing or sitting in a chair. One of them also increases lung capacity and function, both critical in seniors, that can be monitored with an inexpensive peak flow meter. Neither requires any exercise equipment.

Johnny says September 28, 2016

Thanks PD! What are yiur thoughts on Vitamin K2 ? Japanese eat lots of natto which has the highest k2 content of any food. I read k2 activates MGP matrix proteins which make sure calcium is deposited in bones and not soft tissues like skin or arteries. K2 reversed!! Artery calcification on rats induced by warfarin. So k2 mayexplain part of it and also why japanese have nice skin

    P. D. Mangan says September 29, 2016

    Johnny – very good point. Vitamin K2 is important in prevention of both heart disease and cancer – but it hadn’t occurred to me that the Japanese eat a lot of it. BTW, Japanese consumption of lots of iodine from seafood has been suggested to play a part in the very low rate of breast cancer in Japan. Breast tissue is avid for iodine.

      Johnny says September 29, 2016

      Thanks for pointing out iodine for breast cancer!!! Did not now about this.
      Also, as this is a blog for men, I believe the relationship between zinc and prostate cancer is very important, good article here http://www.lifeextension.com/magazine/2015/5/new-studies-reveal-importance-of-zinc-in-maintaining-prostate-health/page-01

      It seems zinc for prostate cancer is like iodine for breast cancer. A post on this would be nice 😉

      A different Nick says September 29, 2016

      More evidence for vitamin K2: France is usually right behind Japan in terms of lowest rates of heart disease (the “French Paradox”). After natto, the best food sources of K2 are foie gras (goose liver pâté), fermented cheeses, and butter. (https://en.wikipedia.org/wiki/Vitamin_K2#Dietary_intake_sources)

      I’m starting to think the role of vitamin K2 in preventing heart disease by decalcifying arteries and heart tissue is very underrated.

        Johnny says September 29, 2016

        Yes an there are several studies on k2’s benefits in terms of heart disease. However, there is also the argument that once cholesterol plaque is formed, calcification in it is good ad it prevents the plaque from bursting which would lead to MI. Anyway it is definitely an area worth looking into. Also there is a video on youtube of fasting expert Fuhrman who claims fasting reversed atherosclerosis in patients

      Lex Corvus says October 1, 2016

      This is why it’s probably a good idea to combine fish oil with a rich source of K2, such as high-vitamin butter oil. Green Pasture sells the two in combination.

    Allan Folz says September 29, 2016

    I’m in favor of K2 as much as the next guy, but the natto thing in Japan always strikes me as wives-tale-ish. It falls into that category of story that’s “too good to check” which immediately sets-off my skepticism detector.

    By all accounts, natto is incredibly revolting to an untrained human palette. As such, I can’t help wondering how much, and how frequently does the median Japanese consume the stuff. Anyone know the real per-capita numbers? Anyone know anyone that’s been to Japan that can attest natto is a typical part of the normal diet?

      garymarHIT says September 29, 2016

      Natto is more frequently eaten in eastern Japan (Tokyo and north) than in western Japan; the supermarkets are chock full of it, in easy to use one serving packs, so obviously a lot of people are still eating it. Many dump it on their rice.

      It is foul to be sure. I hated and never touched it for 40 years, then turned around and learned to love it. Now I eat it every day.

        P. D. Mangan says September 30, 2016

        Don’t know why I didn’t think of this before, but from natto comes nattokinase, an anti-clotting compound which could be important in prevention of heart disease.

        Allan Folz says September 30, 2016

        Thanks for that reply. “Supermarkets chock full” settles the issue for me. I’m always saying that one will never encounter a more intense Darwinian environment than supermarket shelves.

        You also hit on another thing I’ve come to suspect.
        “I hated and never touched it for 40 years, then turned around and learned to love it. Now I eat it every day.”

        Strongly acquired tastes that morph into psychological addictions are from the bacteria that we’re ingesting ensuring that they’ll continue to be in a benign environment. I saw my kids become total addicts to yogurt and sauerkraut. Kimchi, pickled herring, and now natto, have that going for them too. I think it’s the bacteria.

        That has an interesting corollary as well. Folks that live off junk food, breakfast cereal, and so forth are inoculating their gut for bacteria that are going want more junk food, more cereal, and more etc.

          bigmyc says October 15, 2016

          I think that you are neglecting another force at work here, at least in the case of the natto turn around and that is the power of testimonial and personal conviction. In my case, I never liked Grape Nuts cereal until I believed that it was “good for me.” Then, I’d eat it for breakfast as often as I could. Now that I’ve long since dropped my cereal habit, there are numerous other items that I originally avoided which I now relish because of their perceived nutritional value. Coffee and team are great examples of this. Before I could appreciate their inherent value, they were merely acquired tastes that I care not to acquire…

          bigmyc says October 15, 2016

          It was meant to read, “coffee and tea.”

          You probably figured that out, though.

Ole says September 28, 2016

I think you should add green tea consumption to the list also. Apart from lowering iron levels, green tea cosumption is associated with lower risk of cardiovascular diseases:


PS. I think glycation and the formation of AGE is an overlooked issue, especially since we know that mean glucose level rises significantly with age.

    P. D. Mangan says September 29, 2016

    Along with K2, there’s another one, green tea – yes, I agree.

The Man says September 28, 2016

I wish I lived nearer the sea, buying fish is simply atrocious here.
Can we be sure that taking fish oil sufficiently mimics fish consumption? I remember reading that fish (cod) protein had some beneficial too. Plus the difference of w3 fatty Acids in triglycerides vs phosphoglycerides..

    P. D. Mangan says September 29, 2016

    You’re right that we can’t be sure that the oil in fish is the only protective part, a point that the authors of the paper on fish consumption in Japan make. However, they chart both fish and omega-3 consumption by quintile vs heart disease rates, and omega-3 seems to be more predictive than fish consumption. The reason could be that some fish that are non-fatty don’t contain much omega-3 – tuna, perhaps. So as far as I can see, all signs point to fish oil as the protective ingredient.

      Nick says September 29, 2016

      I’ve been told that cooking ruins or has some detrimental effect on fish oils, and so grilled salmon, for example, is not all that better for you in O3’s than other fish. Raw or poached, OTOH, retains the O3’s. And so, if the Japanese eat a lot more raw fish than other people do….?

Question says September 29, 2016

I have an off-topic question, if it is OK to ask here:

How about orgasm frequency and muscle/strength gains?
I have read and heard a lot about this issue, but found it inconclusive.
Some say, for example, 7+ days of abstinence give them a boost in workout
motivation and ability to work out harder; frequent orgasms (say once per day),
some say, makes them tired and weaker.

I have a pal who goes to the gym, not only for exercising, but because he swears
the oggling and smelling of females in close proximity gives him a significant boost.

Is there objective data on that matter?

I know studies that demonstrate that male testosterone, for example, rises a lot momentarily
when men are exposed to:
-images of or real attractive females
-a big pile of cash
-social displays of dominant/aggressive/fighting behavior

I also noticed that, at least in the past, or maybe even today, in male-only gyms there are usually
sexy or even pornographic pictures on the walls – probably no coincidence?

What about the availability and exposure to porn, which has grown to unparalleled levels
since the mass availability of the internet?
Psychologists wanted to do a study about the effects of porn on males, and looked for
guys who do not use porn, at least not often – they screened almost 10,000 guys but
could not find anyone who qualified, anymore.

What about the nofap stuff? Is it a scam or has it a real basis?

    P. D. Mangan says September 29, 2016

    Porn is definitely detrimental, but whether so-called “no-fap” has benefits I don’t know, and same goes for your other questions about sex and weightlifting. To be sure, frequency of sex does influence T levels.

Cardiovascular Disease Rates In Us says September 29, 2016

[…] Why Japanese Men Have Far Less Heart Disease – 8 That tells us that both iron intake and iron levels are lower in Japan than in the U.S., and could be a big factor behind lower heart disease rates. The U.S. obesity rate is 33%; in Japan, it’s … […]

Dan says September 29, 2016

Our western diets are so unhealthy, most of the food we eat isn’t even food.

Cardiovascular Disease Stats Uk says October 2, 2016

[…] Why Japanese Men Have Far Less Heart Disease – Heart disease rates are much higher in the U.S. and the UK than many other places, such as Japan. Dr. Malcolm Kendrick posted the following stats, taken from the article … […]

Anthony Peters says October 2, 2016

I just read with Jared Diamond that Japanes stroke rate is 5 times the US rate. This is due to their high salt intake.

    P. D. Mangan says October 3, 2016

    The rate of stroke in Japan has been on a long-term decline, and, curiously, it coincides with their increased intake of fat and protein as well as rising cholesterol levels. One wrinkle here is that much of the stroke in Japan is hemorrhagic stroke, in which bleeding occurs in the brain. This is quite different from an ischemic stroke, in which a blood vessel becomes occluded and part of the brain tissue dies (an infarct). Hemorrhagic stroke is much less common in the US.

David says October 3, 2016

Hello, I have a little off-topic suggestion.

You wrote: “Vegetable oils — throw them out. Use coconut oil, olive oil, lard, and butter instead.”.
There are many oils on the market (olive,canola, sunflower, coconut, palm, nut…) to choose from. And oils do not have the same healthy/unhealthy characteristcs wether they are “raw” (as if served in a salad for example), or if they are heated for cooking.

Here in France people mostly use sunflower and olive oil. But it is common knowledge that not olive oils are equal.

I think it would be very interesting to have an article on “oil comparison” covering this topic helping us choosing the best oils.



    P. D. Mangan says October 3, 2016

    David, thanks, I agree, a good idea, and maybe I can get to that.

Chris says October 12, 2016

Any danger from the high vitamin A in cod liver oil?

    P. D. Mangan says October 12, 2016

    Not unless taken in high dose in my opinion.

Add Your Reply