Satoru Yamada: Changing the World with "Locabo," a Gentle Carbohydrate Restriction

"Locabo" is a shortening of "low carbohydrate." Carbohydrates can be divided into sugars and dietary fiber. However, in places like the United States, the term "low carbohydrate" is a concept and name that includes extreme carbohydrate restriction. If you demand strict dietary restrictions, it becomes painful and impossible to continue. Therefore, we are spreading "gentle carbohydrate restriction" as "Locabo."

I also thought it would be easy to get used to if it were abbreviated to three characters, similar to "Metabo" (metabolic syndrome), where Locabo is effective, or "Locomo" (locomotive syndrome), where muscles and bones weaken. In any case, the condition is to gently restrict carbohydrates and enjoy your eating habits.

In the past, it was thought that people became obese because they ate too much, but in fact, that is not the case. We now know that excessive energy intake happens as a result, and the cause is excessive carbohydrate intake.

When you take in excessive carbohydrates, postprandial hyperglycemia (high blood sugar after eating) occurs. Then, to suppress that, a large amount of a hormone called insulin is released with a delay. This creates obesity by throwing energy into fat cells, while simultaneously causing a rapid drop in blood sugar.

This rapid drop in blood sugar creates a terrible sense of hunger. Then, an irresistible appetite emerges, and you keep eating. That's why overeating occurs and obesity is promoted. When obesity occurs, substances that make it easier for blood pressure to rise are also released from visceral fat, and the fats coming from there also lead to hyperlipidemia.

That's right. If you suppress postprandial hyperglycemia, you can suppress all the components of metabolic syndrome. Since carbohydrates are the only factor that creates postprandial hyperglycemia, we have learned that we can defeat metabolic syndrome by cutting back on them.

The reason it must be "gentle" is that even if it seems like doing it extremely would have a greater therapeutic effect, in reality, people become unable to continue and end up rebounding.

We are proposing "Locabo," a gentle carbohydrate restriction where you have between 20 and 40 grams of carbohydrates per meal for three meals, and separately allow up to 10 grams of treats per day, so that you can enjoy your meals.

For people who are overweight, it is a diet. However, among Japanese people, there are also thin people with diabetes, so for them, the goal is not to lose weight, but strictly to correct blood sugar levels. These people need to manage their blood sugar while building muscle, and Locabo makes that possible.

It is said that there are 10 million diabetic patients and 10 million in the high-risk group, but in fact, this is only looking at fasting blood samples. Originally, people of the Mongoloid race, such as the Japanese, tend to have blood sugar levels that rise easily after meals, so that is what should be investigated. If we do that, I believe there may be about 40 million people with blood sugar abnormalities.

Therefore, I believe that everyone should adopt a Locabo lifestyle once they reach their 30s.

In 2013, I established an organization called the "Eat, Enjoy, and Health Association." It has been six years since I began the steady activity of conveying the ideal of a healthy dietary lifestyle that is fun and makes people want to continue to various companies, including family restaurants and convenience stores.

Actually, we also believed for a long time that a calorie-restricted diet was correct and guided patients accordingly, but in fact, it really has no meaning.

Studies have reported that current calorie-restricted diets, whether they follow current guidelines or are even stricter, have resulted in weight gain.

That's why I wanted to somehow break the myth of calorie restriction. In the end, even if you feel like you're doing well by going hungry and enduring it all day, one day you'll think, "just for today," and eat until you're full, so you may end up with the same energy intake in the end.

I also had a time in the past when I was about 10 kilograms heavier than I am now. I tried calorie restriction and rebounded spectacularly. Since I encountered carbohydrate restriction, even though I eat until I'm full every day, I properly stay at the weight I had during my student days.

Exactly as you say. That is why we have the companies in the Eat, Enjoy, and Health Association develop low-carbohydrate breads, noodles, sweets, and so on. If we can create low-carbohydrate rice that is fluffy and chewy, it will be solved all at once.

In that sense, the "Salmon and Avocado Olive Oil Bowl" that Wakui-kun developed for the "Nihonbashi Locabo Festival" this time is wonderful. You used rice with slightly reduced carbohydrates and masked it well while suppressing carbohydrates with the fats and proteins of the salmon and avocado.

If we can restrict carbohydrates while enjoying Japan's rice culture, this should definitely become an export industry.

We have the support of Wakui-kun and everyone at the restaurants in Nihonbashi. It's truly gratifying to have not just one shop, but the entire Nihonbashi area—which is like the source of Japanese culture—participating.

Everyone is creating wonderful meals, starting with the "Salmon and Avocado Olive Oil Bowl" I mentioned earlier. What I asked the chefs in Nihonbashi was simply to serve delicious Locabo food. After all, if customers have a choice between something delicious and unhealthy and something delicious and healthy, they will surely choose the healthy one.

We had famous long-established shops representing Nihonbashi join us, such as Mr. Ninaga from "Funazushi," who is the head of the Nihonbashi Restaurant Association, "Shigenozushi," and the Japanese restaurant "Yukari." Furthermore, with the cooperation of "Ninben" and "Eitaro Sohonpo," we started the "Nihonbashi Locabo Festival" last year to broadcast Locabo from Nihonbashi.

I am very grateful. Yukichi Fukuzawa emphasized jitsugaku (science), but since papers and research are only theories, I think it is jitsugaku (science) itself when it takes shape for the first time with the help of the chefs in Nihonbashi and various companies.

Actually, Dr. Shibasaburo Kitasato also spoke of "wisdom and practice." Practice not supported by wisdom will eventually fade away. However, wisdom that cannot be practiced has no value. I am convinced that if theory and the food of the real world enter a relationship where they enhance each other, Locabo can be spread throughout the world.

There is still a view that "healthy food = unpalatable food" or that it is a "way of thinking that goes against tradition." In that context, if there is delicious Locabo while firmly protecting the traditions of Japanese cuisine in Nihonbashi, I believe it will spread to the world.

In the past, it was thought that if you didn't eat carbohydrates, you would lack the nutrient source called glycogen in your muscles; we were taught that way during our student days as well. However, we have learned that as long as you take in enough energy, you can properly store glycogen even if you restrict carbohydrates.

About three years ago, Mr. Nagatomo wrote in a magazine that he felt his athletic performance dropped when his blood sugar levels fluctuated wildly. Thinking that carbohydrate restriction would be effective, I contacted him through the publisher, and he showed interest and we met.

Then, when he actually adopted Locabo, the frequency of leg cramps decreased and recovery from injuries became faster. He felt that his condition truly improved and the quality of his muscles became overwhelmingly better, so he became devoted to Locabo.

That's right. I think it will truly spread if it becomes known that Locabo is not just a diet for sick people to become healthy, but something athletes are adopting to improve their performance.

In my third year as a doctor, Dr. Akira Shimada, currently a professor at Saitama Medical University, told me, "The greatest quality for a diabetes doctor is passion."

For example, in internal medicine such as cardiology, if the blood vessels are completely blocked, no matter how much passion the doctor has, they cannot save the patient. But for people with diabetes, even if they have terribly high blood sugar, if we have the passion to provide them with correct knowledge about health, the patient's life can change and improve dramatically. When he told me this, I was very moved and decided I wanted to aim to be a diabetes specialist.

Cardiovascular and kidney diseases often stem from diabetes, hyperlipidemia, or hypertension, and these should be suppressible if lifestyle habits can be firmly controlled. We call it primary prevention, and we can help many people there.

Among the causes of death for Japanese people, cancer, heart disease, stroke, and even pneumonia often stem from the aftereffects of stroke, so two-thirds are caused by so-called lifestyle-related diseases. These are things that can be saved by Locabo, and even being bedridden—actually, diabetes is related to osteoporosis and fractures, and it also greatly affects dementia.

In the past, I used to think about how to cause behavioral change in patients, but recently I've changed my way of thinking. I ask them to show me records of their eating habits and propose how much they can suppress carbohydrates while keeping their lifestyle habits as they are.

A lifestyle is built in a way that is most convenient for that person, so there are few people who can change it. I want to propose reducing carbohydrates while keeping the patient's lifestyle as much as possible.

And whereas before it was about "how to endure food," now it's just a word: "Well then, please go and eat at Oedo." This lifestyle guidance is the easiest. Patients who are Keio University alumni are very happy, saying, "Is it really okay to go to Oedo?" (laughs).

Dr. Kitasato returned to Japan from the Koch Institute in Berlin in 1892. However, despite being a graduate of the University of Tokyo, he had no job because he had refuted the papers of the University of Tokyo professors regarding the discovery of the beriberi bacteria.

At that time, Yukichi Fukuzawa, who received a request from Dr. Sensai Nagayo, helped establish the Institute for Study of Infectious Diseases, and Dr. Kitasato became the Director there. The following year, in 1893, when establishing the Tsukushigaoka Yojoen tuberculosis sanatorium, Yukichi Fukuzawa provided his own land for Dr. Kitasato. Then, the private Institute for Study of Infectious Diseases became national, and after Dr. Kitasato resigned from there, he built the Kitasato Institute on the site of the Tsukushigaoka Yojoen, and the successor to the Tsukushigaoka Yojoen is the Kitasato Institute Hospital.

In that way, the bond between Yukichi Fukuzawa and Dr. Kitasato was deep, and when the Keio School of Medicine was established in 1917, Dr. Kitasato became the Dean of the School of Medicine. Even now, there are more doctors at the Kitasato Institute Hospital from the Keio School of Medicine than from Kitasato University, so it feels like a small Keio, and it has a higher degree of freedom than Keio.

I spoke about "wisdom and practice" earlier, but there are three other words Dr. Kitasato left for us: "Pioneering," "Gratitude," and "Indomitable Spirit."

When I raised the flag of rebellion against the calorie-restricted diet—which is common sense despite lacking scientific evidence—and tried to introduce the carbohydrate-restricted diet that academic heavyweights had blindly criticized into our hospital, the Kitasato Institute recognized it as "pioneering." And I believe that raising the flag of rebellion against the calorie-restricted diet is precisely my "gratitude" toward those academic heavyweights.

In Kendo, there is a concept of "Shu" (protect), "Ha" (break), and "Ri" (separate). Blindly "protecting" the teacher's teachings is the attitude required in the early stages; once a certain level is reached, it is necessary to "break" the teacher's teachings, and finally, one "separates" completely from the teacher's teachings to create a new form oneself.

I consider myself to be at the "Ha" stage now, and I believe the "Ri" stage will be when I broadcast and advocate this gentle carbohydrate restriction to all of Japan and the world together with the people of Nihonbashi, centered on Wakui-kun. I believe it was truly because I was at the Kitasato Institute that I was able to tackle carbohydrate restriction head-on.