The “macrobiotics friends association”: nurturing life amidst chronic disease in Vietnam

This article is part of the following series:

“I will never return to that Zone of Death! You too should try to follow this diet to nurture life.” Aunt Minh[i](Fieldwork notes, February 2018)

We first met Aunt Minh and Aunt Khai a few days after the Vietnamese Lunar New Year in early 2018 during our first field research trip to “Xóm sống vui” (“Happy life village”) in the rural southeastern part of Vietnam, approximately 60 kilometres from Hồ Chí Minh City. “Happy life village” is a name community members have given to themselves. Through social media and coverage in printed and online newspapers, this “Happy life village” has become fairly well-known outside of their province as a community following macrobiotic diets as a way to maintain health and cope with chronic diseases. 

Macrobiotics diets in Vietnam today comprise a way of eating based mainly on brown rice, whole grains, soy, beans, seaweed and vegetables. It might also include a small amount of fish and shrimp. The diet focuses on the balance of yin and yang elements of food and cookware, while also paying particular attention to consumption of seasonal and local products (see, for example, Stalker, 2009; Hong, 2017: 92-133). Macrobiotics, or “thực dưỡng” (translated as “nurturing by food”) is widely known as an alternative diet in Vietnam today. The diet was founded by a Japanese man named George Ohsawa (1893 – 1966), and was first introduced in the then Republic of Vietnam (South Vietnam) by Ohsawa himself during atrip to Huế in the 1960s.

While Vietnam is currently struggling with a double burden of both infectious as well as chronic diseases and hospitals in large cities are often inundated by the sheer number of patients seeking treatment, a growing number of people living with chronic illnesses have tried to find ways outside of biomedicine to cope with their health problems or to supplement biomedical treatment. The healthcare sector and treatment for illnesses in Vietnam have long been characterised by therapeutic pluralism as well as a diversityin beliefs and perceptions of illnesses (see, for example, Craig, 2000, 2002; Wahlberg, 2006; Pashigian, 2012; Le, 2020). Amid the rise of chronic illnesses in Vietnam, macrobiotics has re-emerged as a popular alternative diet and is believed by many to have multiple therapeutic benefits for patients living with chronic problems, including cancer[ii]. Although it didfall into relative obscurityafter 1975 due to extreme post-war hardships and severe food deprivation, macrobiotics has once again attracted followers and rapidly become popular since the first decade of the 21st century. It is noteworthy that the rapid increase in the number of people living with chronic illnesses such as diabetes, high blood pressure, kidney problems and different types of cancer in the country has parralelled the rise of macrobiotics as a popular alternative diet.

Aunt Minh

Aunt Minh was diagnosed with cervical cancer 20 years ago. To Aunt Minh, a diagnosis of cancer at the time was like a death sentence. Despite major advances in medical treatment, until recently the disease has been widely perceived in Vietnam as a fatal one with no cure. At a rather late stage, Aunt Minh started a treatment plan with radiation therapy at the Oncology Hospital in Hồ Chí Minh City. At the time, she did not have many resources at her disposal; “I did not have any money, not even 500 đồng!” as she recalled. Nonetheless,her family managed to borrow 20 million Vietnamese đồng (US$ 860) for her treatment.

Radiation therapy was unbearable for Aunt Minh. “The treatment was full of sufferings”, Aunt Minh shook her head. “I had never imagined that one day I would have to lie down like a woman giving birth so they could push a whole bunch of needles into my ‘female organ’. It was horrible”. It would take a few hours to commute to the hospital from her home village in Bình Dương province, so Aunt Minh and her daughter had to rent a small room near the Oncology Hospital, shared with other patients also undertaking treatment at the hospital. She would go to the hospital in the morning for radiation therapy, and in the afternoon, her daughter would see the doctor at her clinic to pick up medicine. Their money quickly diminished, but on top of that, Aunt Minh realised she had no hope. The doctor told her daughter they would try radiation therapy, but her chance of survival was very small. “I lost hope and faith in biomedical treatment. The doctor rejected me! (bác sĩ chê rồi)” Aunt Minh recollected, using the Vietnamese term “bác sĩ chê”, which is usually used to refer to terminal patients for whom doctors cannot do anything further to help.

Feeling hopeless and running out of money, Aunt Minh and her daughter decided to quit treatment at the Oncology Hospital and returned home. As it happened, a few people in her neighbourhood had been following macrobiotics diets for some time. Two neighbours visited Aunt Minh, bringing her a book on healing illness with macrobiotics. They reassured her many times that she must follow the diet strictly, and then her illness would definitely go away.

Có bệnh thì vái tứ phương” (“a sick person has to kowtow in all four directions”); at this point in her story, Aunt Minh cited this popular Vietnamese proverb, meaning one who suffers from illness must try to do whatever she or he can to treat a health problem. She decided to try this new method. For the first 25 days she only ate brown rice and sesame salt. In the following 3 months she added home-grown green vegetables to her macrobiotic diet. Aunt Minh said she would only consume vegetables she grew herself, since she could not trust that vegetables bought from the market were safe and free of chemicals. 

After the first 3 months, Aunt Minh underwent a period perceived as “detoxification” by macrobiotics followers. For 7 days, she kept on vomitting continuously. “Whenever I opened my eyes, I wanted to throw up”, Aunt Minh recited. “My body felt so weak. I was just lying flat on my bed like a plankof timber. I could not even sit up on the bed”.

However, when the 7 days had passed, Aunt Minh suddenly felt so light (nhẹ nhàng), as if her body had got rid of a huge burden. She felt much healthier and could return to farm work. Her health condition has remained stable ever since. 20 years have passed but Aunt Minh never returned to the Oncology Hospital. It is the “Zone of Death” in her mind and her words, while a macrobiotics diet is life-giving. It has given her life back. 

For 20 years, Aunt Minh has followed a strict regime – she only has brown rice, tamari sauce she makes by herself from fermented soy bean, home-grown vegetables and fruits taken from her orchard. She only eats what she believes to be clean and safe food, and completely avoids sugar, MSG, chemicals and animal meat. Moreover, her daily routine also comprises of meditation practice, light exercise, reading macrobiotics books and praying sessions in temples or at home in front of her altar. 

Since Aunt Minh has never undergone any health check-ups, no one can say for sure whether her cancer is cured or not. However, there is one thing she knows for sure – she feels healthy and happy now. In her 70s, Aunt Minh is very energetic and active, and always talks loudly. We followed her all day round in her orchard and on the rice field where she worked or in her kitchen where she cooked, because she kept on working most of the time and rarely rested. “Macrobiotics is a blessing in my life” Aunt Minh shared. “I am now grateful to my cancer. Thanks to this disease I have come to know macrobiotics. So I am actually blessed to have cancer”.

Aunt Khai

Aunt Khai lost both her parents at a very young age. She lived with her sisters until they got married; since then she has been all by herself. Being an orphan since her childhood, she was impoverished and has lived a very difficult life. Although Aunt Khai once started elementary school, she had to stop schooling a few months into the first grade when her village was bombed during the Vietnam War. As a consequence, Aunt Khai could not read or write. Due to war and poverty, she was not able to return to school, making a living by working as a seasonal worker on rubber farms in her province. 

Growing up as an orphan, Aunt Khai often felt pity for herself. She was sad that she was poor, illiterate and lonely. She was therefore very shy and did not have many friends. Aunt Khai never got married either. Now in her 60s, she lives by herself in a simple house not far away from Aunt Minh’s that her niece and nephew had built for her. 

Long years of hard labour, poverty and sadness had taken its toll on Aunt Khai’s health. Her health had been poor for many years. She was suffering from multiple chronic problems such as insomnia, depression, cirrhosis, kidney problems, osteoarthritis and back pain. “You see, my body was like a ‘warehouse’ of diseases!” Aunt Khai jokingly said. “Everyday I was tortured by all kinds of illness and the future seemed to me very ambiguous”. 

When she was running out of hope, she met Aunt Minh, who had already started on her macrobiotics diet. Aunt Minh told her that macrobiotics could cure all her diseases and taught Aunt Khai how to prepare macrobiotic foods. They soon became best friends. However, starting a macrobiotics diet has never been easy for beginners. Aunt Minh advised Aunt Khai that in order to cure her problems, she needed to begin with the “Number 7” regime of the diet, the strictest regimen in macrobiotics which only allows consumption of brown rice with sesame and salt. At first, brown rice was hard and chewing rice well in one’s mouth until it turns into a liquid, as advised, was boring and time-consuming. During the first few weeks, Aunt Khai had to struggle with her own cravings for white rice, meat and fish, the regular food she had been used to. At times she thought of giving up, but when her spirit was flagging, she was encouraged by Aunt Minh and other villagers in her neighbourhood who also successfully improved their health by following this diet. 

After her first month on the diet, she realised her symptoms had improved. Gradually, her health recovered, day by day, week by week. Her pain and discomfort caused by osteoarthritis, gastrointestinal pains and kidney problems disappeared even without her realising. In spite of the hard efforts required to start and stick with such an austere diet, it turned out that the macrobiotics diet had been extremely rewarding and life-transforming, a sentiment Aunt Khai repeatedly affirmed during our discussions. 

As her discomfort gradually went away, Aunt Khai’s mood brightened and her mind also cleared up. Believing she now had mastered macrobiotics and could heal herself, Aunt Khai became increasingly happy, self-confident and optimistic about the future. From having been a very quiet and timid person, she could now open up and had become more talkative and lively too. Aunt Khai and her village friends have planted vegetables and make tamari sauce from fermented soy bean as the main supply for their daily macrobiotics meals. Since following the diet, she has a new circle of friends whom she has called her “macrobiotics friends association” – comprising Aunt Minh, Aunt Ba, Aunt Bảy and many other people in the neighbourhood who also practise macrobiotics. “We are like sisters” Aunt Khai merrily explained. She now believes that macrobiotics has transformed her and provided her with a chance to start life anew. Moreover, macrobiotics has given this lonely woman a supportive social network of fellow followers, whom she now calls her new family. 

However, preparing macrobiotics foods and complying with a strict diet are not enough. The other ladies advised Aunt Khai that in order to truly understand the philosophy and teachings on what macrobiotics really is, she needs to read books written by founder George Ohsawa. One day, Nam, the person who first introduced and promoted macrobiotics in the village, stopped by her house to give her a few books by Ohsawa. Nam actually did not know that Aunt Khai was illiterate. Receiving the books from Nam, Aunt Khai was frustrated because she really wanted to read the text written by Ohsawa himself, but she could not. 

Toàn, a neighbour who is also a long-term follower of macrobiotics, gave her some paper and a few pencils, telling her “Stop being depressed. You can learn how to read and write”. Encouraged by Toàn and other friends in the village, Aunt Khai was determined to learn. She often invited village children to come play in her house, so they could show her how to read and write. During the day when she worked on the farm, while other ladies were having a break, she found a stick and tried to learn by writing on the ground. 

Aunt Khai firmly believes that owing to macrobiotics, her mind became very clear. She could learn quickly and after some time was able to read macrobiotics books. Furthermore, Aunt Khai soon displayed her literary talent, as she could even compose many poems on macrobiotics. She was also invited as a speaker to share her experiences and poems at macrobiotics events in her province and in Hồ Chí Minh City.From someone who was illiterate, depressed and sick, as she often described herself before following macrobiotics, Aunt Khai now self-confidently said she could “lecture” (giảng) the public and provide advice to others. As someone whose health benefited greatly from macrobiotics, she believes it is her obligation to help others who are sick and are suffering from illness by introducing them to the diet. 

Today Aunt Khai often repeats her slogan for a macrobiotic lifestyle “Ăn ít biết đủ”, which literally translates as “Eat little and know when is enough”. However, this philosophy does not only apply to diet and consumption of food, according to Aunt Khai. It is her attitude towards life – living a simple, humble life that does not depend on materiality. She should be content with whatever she has and happy with her current situation. “A macrobiotics person should not be greedy. We do not eat much. We consume everything in moderation and know little is often better”, she said. 

After their experiences with illness, Aunt Khai and Aunt Minh both felt empowered and in their words, “enlightened” (khai sáng) by macrobiotics. Aunt Khai is a tiny woman who looks a bit thin and frail and was somehow shy at first. Nevertheless, she quickly warmed up and started telling stories for hours about macrobiotics once she got to know us. “I suffered a lot before, but now my life is delightful and carefree (sướng). Living alone, I used to be so scared of ghosts. But now I am no longer scared of anything, owing to macrobiotics”.

Macrobiotic living

Although there is no scientific consensus that macrobiotics diet can be a cure for any diseases, as noted in our introduction, macrobiotics has nonetheless attracted a significant number of followers in Vietnam over the past years, particularly among people living with chronic illnesses. Macrobiotics might not have healed Aunt Khai, Aunt Minh and many others from their diseases, but when they suffered and felt hopeless, as we have seen, it certainly opened a way for them to cope and live on with their chronic illnesses. 

If followed correctly, the diet is essentially a plant-based diet that focuses on consuming whole grains and vegetables that are free from chemicals. But on top of that, macrobiotics as practised in this “macrobiotics friends association” is a way of life inextricably intertwined with ethical values, moral intepretations and religious belief. For many it is a spiritual journey of self-cultivation and purification through self-discipline and awareness, a moral endeavour to return to nature, to traditional values and to one’s roots. It helps followers change their lifestyle, mindset, perspective, and raise awareness about foods and the environment. They learn to eat responsibly and proactively control whatever they take into their body as much as materialistic greed and desires. 

Aunt Khai, Aunt Minh and others choose macrobiotics to live happily and even achieve life fulfilment in the face of chronic diseases because the diet nurtures not only their body but also their soul, or in their own words, “macrobiotics is nurturing life” (thực dưỡng là dưỡng sinh). They often emphasize that macrobiotics is a return (sự trở về). “It is a return to the natural order, to our origins, to the way we should be”. Far beyond food and nutrition, macrobiotics is lived and told as a moral project that changes life. 

When we bid farewell to Aunt Minh, Aunt Khai, Aunt Ba, Aunt Bảy and a few other villagers to return to the city after our first visit, which would be followed by many return trips from 2018 to 2019, Aunt Minh quickly sat down at her desk and wrote something down on a piece of paper. When she handed it to us, we realised it was a poem she hadcomposed for us:

“(Life) only needs purity and peace; what is poor or rich for?

 (Life) only needs purity and peace; all sufferings will be gone

 Control ourselves for purity and peace of mind

 We will overcome an ocean of sufferings and return to our old home.

              Wishing you both a safe trip.

               The 8th day of the Lunar New Year, 2018

               Happy life village” 

Dr. Le Hoang Anh Thu is an Assistant Professor of College of Asia Pacific Studies, Ritsumeikan Asia Pacific University (Japan). Dr. Le got her PhD in Anthropology at the Australian National University. Her research interests include ageing, elderly women, Buddhist practice, and religious philanthropy.

Dr. Le Hoang Ngoc Yen is a Lecturer at College of Asia Pacific, the Australian National University. Her research interests include infectious diseases e.g. leprosy and living with chronic conditions in Vietnam.

Chronic living: ethnographic explorations of daily lives swayed by (multiple) medical conditions” is a series being published alongside the Chronic Living conference, as part of the VITAL project. The series is edited by Ayo Wahlberg, Jieun Lee, Anna Mann, Arseli Dokumaci, Natasja Kingod, Marie Kofod Svensson and Laura Heinsen.


[i]All individual and place names are pseudonyms. 

[ii]Recently (particularly in late 2019 and early 2020) a heated debate erupted on Vietnamese media and social media platforms around whether macrobiotics is a “miraculous” remedy for different kinds of illness. These social debates have highlighted potentially severe risks of the diet, particularly among people who lived with a range of chronic and acute diseases seeking a cure in macrobiotics. Critics point out that macrobiotics might cause serious nutritional deprivation among people who practise this diet to the extreme by eating only brown rice and sesame salt for extended periods of time. Medical professionals have strongly advised against following an extreme diet as a therapy for chronic illnesses. 


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