Women's health in Japan: although Japanese women have the highest life expectancy in the world, they still need nutraceuticals.

In order to understand the Japanese approach to women's health, it is important to first consider a single consistent statistic: Japanese women have the highest life expectancy of any country in the world--nearly 86 years in 2007--and that life expectancy is increasing slowly year-by-year. To the extent that Japanese women are able to maintain their health as they age, there is less incentive to intervene and potentially disrupt the health balance that already appears to exist.

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Important Qualitative & Quantitative Health Factors

There are many reasons typically cited for the relatively long life expectancy of Japanese women, even in comparison with Japanese men who live on average seven years less than women (although still among the longest in the world). The reasons include:

Low Tobacco Usage: The 2003 national nutrition survey in Japan indicated that only 11% of adult women were considered tobacco users (defined as more than 100 cigarettes smoked in the past six months); over 85% claimed not to smoke at all. By comparison, nearly 47% of Japanese men were considered tobacco users. This difference in tobacco usage is the mostly likely explanation for the major difference in trachea and lung cancer deaths between men and women--44,000 men and 16,000 women in 2004, for example.

Reasonable Exercise: Over 25% of adult Japanese women claim to engage in regular exercise, defined as at least twice per week, and at least 30 minutes per occasion. This is exercise specifically planned as exercise, and does not include the exercise associated with daily commuting and/or grocery shopping not using a private motor vehicle, for example.

Low Incidence of Overweight & Obesity: For Japanese women their prevalence of overweight and obesity (defined as a BMI of at least 25) peaks at 30% in the 60 to 69 age range. However, less than 10% of women ages 20 to 39 are considered overweight (and in fact nearly 20% in this age group are considered "underweight," with a BMI of less than 18.5). The relative slimness of women up to age 40 is pretty significant, especially compared to most other developed countries in the world.

Stress Responses: Japanese women consider their primary sources of stress to be child care and children's education in their earlier years, and senior care in their later years. For Japanese men, they regard work responsibilities as the primary source of stress in their lives. Suicide in Japan is a serious issue, with over 30,000 deaths per year. Women represent only 8000 of the 30,000 total, however, suggesting that men and women handle their stress differently.

The women of northern Okinawa are often claimed to be the longest-lived sub-population in Japan. Their daily lives reflect a combination of the health factors listed previously, plus the added benefits of regular socialization with neighbors and friends and a healthy, low calorie daily diet that includes adequate fruits and vegetables. In short, they represent an ideal study group for longevity understanding.

Women's Health Government Policy Initiatives

It might be tempting for the government agencies in Japan to approach women's health issues on an "if it isn't broke, don't fix it" basis. There are, however, specific issues that have surfaced and are being addressed by the Ministry of Health, Labor, and Welfare (MHLW). Examples of recent government policy involvement include the following:

Heart Conditions: More Japanese women die each year from heart and cerebrovascular disease than men. Heart failure deaths are nearly 50% higher for women than men, for example, in part because more men die younger from preventable diseases, such as lung (tobacco usage), stomach (salt and pickled foods) and liver (alcohol) cancers. Supporting data from the national nutrition surveys quantifies the information by sex and age groups for blood pressure, blood cholesterols and triglycerides, blood glucose, obesity, etc. The Japanese government has begun to focus serious attention on the Metabolic Syndrome risk factors, which can lead to diabetes and eventually its complicating factors such as heart disease. Deaths specifically from diabetes in Japan are roughly the same for men and women. But these rates are actually higher than would be expected for a relatively non-obese general population.

Calcium Consumption: Annual nutrition data consistently indicate that young Japanese women in particular are not consuming enough calcium. The MHLW established a specific category under their FOSHU (Foods for Specified Health Uses) regulations several years ago to allow calcium functional ingredients (such as calcium citrate malate) for bone health. MHLW has more recently developed a "Reduction of Disease Risk Claim" category for calcium that specifically allows a claim that "This food product is rich in calcium. Daily exercise and a healthy daily diet rich in calcium helps maintain the bones of young women. It may also reduce the risk of osteoporosis when they advance in age." The standard amount of calcium that may reduce the risk of the disease is set at 300 to 700 mg.

Folic Acid Consumption: A similar type of disease risk reduction claim has been authorized for folic acid, specifically "This product is rich in folic acid. A healthy daily diet rich in folic acid may reduce the risk of women having babies with neural tube defects." The standard amount of folic acid that may reduce the risk of the disease is set at 400 to 1000 mcg.

Emerging Women's Health Opportunities: 'Cosmeceuticals'

There has been a long tradition in the Japanese marketplace of claiming a product benefit for "general health and beauty." This unexciting "non-claim" was allowed before the current FOSHU era, at a time when MHLW did not allow any health claims to be used on- or off-label for non-drug foods and beverages.

There is currently growing commercial activity for nutraceutical ingredients targeting skin care in Japan in support of a demonstrated interest in "cosmeceutical" products (not yet an official defined term in Japan), mostly from women. Japanese companies are developing scientific support for ingredients and products, and are working with MHLW on the eventual approvals for potential health claims. A review of company abstracts from the ifia Japan 2007 food ingredients and additives show guide indicates the types of approaches that are currently being marketed in Japan.

* "Beauty effect on skin" via collagen

* Skin "whitening effectiveness" via black soybean hull extract

* "Enhance the beauty" via deep sea water

* Soy isoflavones for "cosmeceutical use"

* "Skin beautifying effect" from Cistanche tubulosa

A specific category for "Beauty" ingredients was also summarized in the ifia show guide. It included: hyaluron, ceramide, placenta, collagen, nucleic acid, pueraria, aloe and pomegranate. These more general "beauty" claims will eventually be converted to specific health-related claims as the science is developed and the subsequent regulatory acceptance is established. The ifia Japan show activity is a clear indication that interest in the category is growing, and confirms that reputable Japanese ingredient companies are developing science in support of potential MHLW-supported health claims for use in foods and beverages. It could be a useful development to monitor for non-Japanese applications as well.

Note: Important public sources of information for this article are Japan Health Food and Nutrition Food Association reports, "Statistical Abstracts on Health and Welfare in Japan, 2005", ifia Japan 2007 Show Guide, and National Nutrition Surveys in Japan for 2003 and 2004.

Ron Bailey is president of California Functional Foods and has been an independent consultant for over 20 years, focusing primarily on the transfer of food technology between the U.S. and Japan. He can be reached at 165 Almond Street, Ashland, OR 97520; 541-488-3184; E-mail: [e-mail].