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Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
Food as Medicine: The New Concept of
“Medical Rice”
Shaw Watanabe, MD, PhD1*; Azusa Hirakawa, BS1; Chiharu Nishijima, BS2; Ken'ichi
Ohtsubo, PhD3; Kozo Nakamura, PhD4; Shigeru Beppu, PhD5; Patcharee Tungtrakul,
PhD6; Sun Jian Quin, MD7; E-Siong Tee, MD8; Takuo Tsuno, PhD9; Hajime Ohigashi, PhD10
1Lifescience Promoting Association, Tokyo, Japan
2Kagawa Nutrition University, Sakado, Japan
3Niigata University, Niigata, Japan
4Department of Agriculture, Shinshu University, Matsumoto, Japan
5Forica Foods Co. Ltd., Niigata, Japan
6Institute of Food Research and Product Development, Kasetsart University, Bangkok,
Thailand
7Clinical Nutrition Center, Huadong Hospital, Fudan University, Shanghai, China
8Nutrition Society of Malaysia, Petaling Jaya, Malaysia
9Tsuno Rice Fine Chemical Co., Ltd., Wakayama, Japan
10Kyoto University and Human Health Foundation, Kyoto, Japan
*Corresponding author
Shaw Watanabe, MD, PhD
President
Life Science Promoting Association
25-3-1004, Daikyo-cho, Shinjuku-ku
Tokyo 160-0015, Japan
E-mail: watashaw@lifescience.or.jp
Article History
Received: July 14th, 2016
Accepted: July 20th, 2016
Published: July 22nd, 2016
Citation
Watanabe S, Hirakawa A, Nishijima
C, et al. Food as medicine: The new
concept of “medical rice”. Adv Food
Technol Nutr Sci Open J. 2016; 2(2):
38-50. doi: 10.17140/AFTNSOJ-2-129
Copyright
©2016 Watanabe S. This is an
open access article distributed un-
der the Creative Commons Attribu-
tion 4.0 International License (CC
BY 4.0), which permits unrestricted
use, distribution, and reproduction
in any medium, provided the origi-
nal work is properly cited.
Volume 2 : Issue 2
Article Ref. #: 1000AFTNSOJ2129
Review
Page 38
ABSTRACT
In many countries, rice contributes to health by supplying dietary energy, proteins and fat.
Many different species of rice have been developed in Japan and other rice producing countries.
Some varieties are expected to prevent various diseases, or to be used for dietary therapy. The
health effects of brown rice are empirically well known, and accumulating evidence about the
physiological and pharmacological activity of rice bran strongly supports the use of brown
rice in the dietary therapy. These could be categorized in the new concept, “medical rice”. For
example: medical rice for diabetes (glycemic index<55), medical rice for chronic kidney dis-
ease (CKD) (protein<1/20), medical rice for mental health (high gamma-aminobutylic acid or
γ-aminobutylic acid (GABA), gamma oryzanol (γ-oryzanol) and/or ferulic acid), and medical
rice for cancer prevention (high antioxidant capacity). Organic cultivation is necessary to avoid
toxic substances from fertilizers and insecticides. In response to the enormous increase of med-
ical costs in many countries, encouragement of healthy longevity by changes of dietary habits
is mandatory. Functional food labeling has started in 2015 in Japan, so the proper food labeling
of medical rice could help people who want to control and/or improve their health status.
KEYWORDS: Brown rice; Rice bran; Rice ingredients; Glycemic index; Low protein rice;
Gamma-aminobutylic acid or γ-aminobutylic acid (GABA); γ-oryzanol; Ferulic acid; Phytate.
ABBREVIATIONS: CKD: Chronic Kidney Disease; GABA: Gamma-aminobutylic acid or
γ-aminobutylic acid; γ-oryzanol: Gamma Oryzanol; LDL: Low-density lipoprotein; HbA1c:
Glycated hemoglobin; BMI: Body Mass Index; DRI: Dietary Reference Intake; MHLW: Min-
istry of Health, Labour and Welfare; EPA: Eicosapentaenoic acid; DHA: Docosahexaenoic
acid; FTLD: Frontotemporal lobar degeneration; RCT: Randomized Clinical Trials; HDL:
High-density lipoproteins; HPLC-UV: High-performance liquid chromatography-ultraviolet;
TD2: Type-2 diabetes; BRAVO: Branch Retinal Vein Occlusion; MDRD: Modication of Diet
in Renal Disease; WHO: World Health Organization; IGF-1: Insulin Like Growth Factor 1;
POMS: Prole of Mood States; TMD: Total Mood Disorders.
INTRODUCTION
Rice is the main staple food for approximately 70 percent of the world’s population, principally
living in ten areas of the Asia-Pacic region.1 In many countries, rice contributes to health
Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
Page 39
by supplying dietary energy, proteins and fat. It accounts for
more than 50% of the diet in Bangladesh, Myanmar, Lao PDR,
VietNam and Indonesia.2 In this regards, the nutritional aspects
of rice should be re-evaluated, especially the integrated compo-
sition of functional ingredients.
BROWN RICE AND HEALTH
Until the late 19th century, Japanese traditional meals were com-
posed of unpolished brown rice and barley as staple food, miso
(fermented soy) soup and side dishes cooked with vegetables,
soybean products, and various varieties of roots.3 In the Meiji
era (1868-1905), polished rice became popular, and beri-beri in-
creased to epidemic proportions until vitamin B1 was found in
rice bran. After the World War II, polished rice, meat, eggs, and
dairy products became the major food items composing main
and side dishes. Consequently, new dietary habits largely ac-
count for the high prevalence of the metabolic syndrome and
other lifestyle related chronic diseases.4
On the other hand, there is a traditional way of eating in
Japan. Macrobiotic is one of the school of dietary therapy found-
ed by Sagen Ishizaka, Kenzo Futaki, and Yukikazu Sakurazawa
(George Ohsawa).3 Whole grains and whole foods have been
emphasized as central to macrobiotic diet.5-7 Locally-produced
and organically grown, and minimally processed foods are also
recommended. Macrobiotic meals are practically plant-based:
seasonal vegetables, beans, and sea vegetables with brown rice
as staple food.8 Recently a variety of rice species have been har-
vested, and they are expected to contain various ingredients, in
addition to the ordinary nutrients.8,9
NUTRITIONAL ASPECTS OF BROWN RICE
According to our research, macrobiotic practitioners consume
more magnesium, iron, vitamin E, vitamins B and dietary bers,
although their energy intake is less than that for average Japa-
nese. Their body mass index (BMI), blood pressure and low-
density lipoprotein (LDL) cholesterol levels are often found to
be low, while glycated hemoglobin (HbA1c) remained within
normal levels. Even when analyzed in comparison with other
vegetarian dietary data, daily nutritional values were higher
in those who ate rice more frequently than noodles, and even
higher in brown rice than white rice.10 The macrobiotic dietary
habit of eating brown rice seemed to contribute to their healthy
state. The consumption of small sh, in the shape of whole food,
for macrobiotic practitioners supplemented vitamin B12, eicosa-
pentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Using sample meals, we investigated whether or not
macrobiotic meals (we say genmai-shoku) could fulll nutrition-
al requirement.11 In the radar charts displayed in Figure 1, central
circle (in blue) represent the dose of Dietary Reference Intake
(DRI) 2010 recommended by the Ministry of Health, Labour
and Welfare, (MHLW) Japan. The outer green lines represent
the relative intake doses from genmai-shoku (Figure 1). Sample
meals of genmai-shoku provided enough energy, fat and protein,
and several times more minerals and vitamins than required.
In addition to the functional effects of ingredients in
brown rice, the frequency of mastication inuences the brain
function. In Japan, fast foods with soft texture have recently be-
come popular for younger generation. The mastication frequen-
cy has been decreasing in proportion. The brown rice increases
the chewing number of times than a meat or sh dishes.12 Na-
tional Health and Nutrition Survey, Labour and Welfare (2010)
showed it was only 800 times per American meal compared to
the 30,000 times by genmai meal. Longer eating time acts to
prevent fast eating, which would be lead to obesity, and relaxes
stress.
So, brown rice could be called the “medical rice for
Figure 1: Kenji-shoku: Japanese traditional meal with brown rice and miso soup.
The macrobiotic meals (genmai-shoku in Japanese) could fulll the nutritional requirement by
making the sample meal. Center blue circle is a recommended dose of DRI 2010 by the Ministry
of Health, Labour and Welfare (MHLW). Outer green line is a relative intake dose by genmai-
shoku. The meal fullls the energy and protein, and several times more minerals and vitamins
than required.
Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
Page 40
health”. The effects of eating brown rice have been gaining at-
tention for preventing and treating not only beri-beri and consti-
pation, but also other chronic diseases. Organic rice can remove
arsenic and other toxic chemicals ingested from fertilizers and/
or insecticides.8
FUNCTIONAL INGREDIENTS IN RICE BRAN
Compared with white rice, whole brown rice, is rich in vitamins,
minerals, dietary bers and various functional chemicals (Tables
1A, 1B and 1C).9,13 About 8.52 million metric tons of brown rice
are produced every year in Japan. Rice bran makes about 10% of
unprocessed rice by weight, and contains 18-22% oil, of which
up to 5% of unsaponiable dark oil (Figure 2). Rice bran can be
used in a variety of applications such as food, animal feed and
fertilizer, but most of the rice bran is discarded at present.
Recently, much attention has been paid to rice bran, be-
cause of various pharmacological properties of its ingredients,
like anti-oxidation. A current study further claried the proper-
ties of many functional ingredients in rice bran.13,15 A current
study has further claried the properties of many functional in-
gredients in rice bran15 It is separated to gum, wax, dark oil and
scum by different boiling temperature for further extraction of a
number of chemicals (Figure 2). The biological activities of each
factor have been claried by many in vivo and in vitro experi-
ments. Human data by randomized clinical trials (RCT) are also
accumulating.16
(1) Lipophilic Ingredients
The nutritional benets of rice bran oil are well known.15-17
γ-oryzanol and tocotrienol are considered to be the active ingre-
dients in the oil.18 The pharmacological effects are: a decrease in
total and LDL cholesterol, an increase in high-density lipopro-
teins (HDL) cholesterol, a decrease in triacylglycerol and ApoB,
and the inhibition of platelet aggregation. γ-oryzanol is con-
tained in the non-saponiable fraction of rice bran. γ-oyzanol is
Table 1A: Nutrient composition of brown rice, milled rice and rice bran at
14% moisture content.14
Table 1B: Typical minor components found in Thai rice bran oil.
Thai Edible Oil Co. Ltd’s Lab, 2010-2011.
Figure 2: Ingredients in rice bran.
Brown rice is produced in amounts of about 8.52 million metric tons (MT) a year in Japan. This
means that 0.8 million MT of rice bran are produced annually, because rice bran makes 8 to 10% of
the brown rice. Rice bran is used in a variety of applications such as food, animal feed and fertilizer,
but most of the rice bran is discarded at present. Recently much attention has been paid to rice bran,
because it has been reported that the ingredients of rice bran show various interesting properties,
such as anti-oxidation and lowering of serum lipid levels.
Constituent
Rice part
Whole
Polished
Bran
Energy content (J)
1520-1610
1460-1560
1670-1990
Energy content (kcal)
363-385 349-373
399-476
Crude protein (g)
7.1-8.3 6.3-7.1
11.3-14.9
Crude fat (g)
1.6-2.8
0.3
15.0-19.7
Available carbohydrate (g)
73-87
77-89
34-62
Total dietary ber (g)
2.9-4.0 0.9-2.3
17-29
Water-insoluble ber (g)
2.0 0.5
15-27
Sugar (g)
1.4
0.2-0.5 0.8-5.5
Phytic acid (g)
0.4-0.9 0.1-0.2 3.0-7.4
Phenolic (g catechin)
0.01-0.02 0.01-0.02 0.01-0.02
Minor components Crude rice bran oil (%)
Rened rice bran oil (%)
Free fatty acids
6-10
0.04-0.08
Phytosterol
2.9 1.8
gamma-oryzanol
1.6-1.8 0.2-0.8
Total tochopherol
0.078
0.062
tocopherols 0.021 (27.3% of tocols)
0.020 (32.4% of tocols)
tocotrienols 0.057 (72.6% of tocols)
0.042 (67.6% of tocols)
Rice bran wax 2-3
0
Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
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Table 1C: Various nutrients and ingredients in rice per 100 g.
protein amino
acids
Protein (g)
5.7-6.8 2.8-3.7 1.8-2.4 2.4-2.6
Arg mg
445-534 201-285 149-194 185-208
Lys
228-253 100-137
65-77
85-93
His
139-164 92-137
41-53
53-59
Phe
269-329 130-175 95-124 111-125
Tyr
164-196 87-111
67-86
78-88
Ala
325-383 144-213 105-136 134-146
Gly
274-316 121-176 86-111 111-121
Pro
233-284 107-158 80-105 99-116
Glu
922-1130 413-603 321-423 400-443
Ser
297-354 137-198 104-135 129-141
Thr
220-240 100-148 171-219
85-93
Asp
518-611 236-335 171-219 213-233
Tryp
53-75 19-38 17-20
22-23
Cys
141-177
54-85 50-55
58-63
GABA
Phytic acid
GABA 3-7 4-6
<0.5
3-5
Phytic acid
1.18-1.21
1.3-2.0 0.8-1.3 0.4-0.5
Cooked rice
Major nutrients Whole brown rice Brown rice
Polished
rice
Pre-germinated
rice
Major nutrients
Water (g)
14-15 60-64 61-64
60-62
Energy (kcal)
353-357 150-204 145-154 156-160
Protein (g)
5.7-6.8 2.8-3.7 1.8-2.4 2.4-2.6
Fat (g)
3.2-3.3 1,2-1,7 0.2-0.3 0.8-1.0
FFA (g)
2.26-2.81 0.72-1.21 0.23-0.29
0.5-0.57
SFA (g)
0.58-0.71
0.2-0.3
0.09-0.11 0.16-0.17
UFA (g)
1.68-2.1 0.52-0.9 0.14-0.2 0.35-0.4
Carbohydrate (g)
74-76 32-35 34-35
34-35
maltose (g)
0.3
0.05 0.05 0.05
glucose (g)
0.2-0.3
0.05 0.05 0.05
Dietary ber (g)
2.2-3.1 2.1-2.5 0.3-0.6
1
Ash (g) Ash (g)
1.1-1.3 0.5-0.7 0.1-0.2
0.3
Minerals
Ca mg 8-9
1.2-1.7
3-4 4-5
P mg
290-300 120-150
22-24
63-69
Fe mg
0.9-1
0.5-0.6
0.1
0.2-0.3
K mg
220-250 100-140
16-20
53-63
Mg mg
110-120
51-68
2-3
20-23
Zn mg
1.9-2.2 0.8-1.3 0.6-0.7 0.8-0.9
Cu mg
0.12-0.27
0.1-0.16
0.04-0.08 0.11-0.14
Mn mg
2.0-2.5 1.0-1.5
0.17-0.25
0.8-0.9
Se mg
2.5 2.5 2.5 2.5
Vitamins
vitamin B1 mg
0.32-0.46 0.11-0.22
0
0.11-0.12
vitamin B2 mg
0.02-0.03
0.005-0.01
0.005 0.005
vitamin B6 mg
0.36-0.41 0.17-0.32
0.007-0.008 0.054-0.094
niacin mg
5.3-5.9 2.1-3.4
0.008-0.1
0.4-0.8
αtocopherol mg
1.3-1.5 0.6-0.8
0
0.5-0.7
βtocopherol mg
0.1
0 0 0
γtocopherol mg
0.1-0.2
0 0 0
θtocopherol mg
0 0 0 0
Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
Page 42
bound to ferulic acid, and thus belongs to the family of ferulated
sterols. γ-oryzanol exists in 4 chemical forms with similar func-
tional activities: two are triterpene alcohol esters and the other
two are sterol esters (Figure 3).19,20 The solubility of γ-oryzanol
is only 0.06% in water, and 0.2% in 20% ethanol. The absorption
of γ-oryzanol may not be optimal after oral intake of brown rice.
The proportion of γ-oryzanol is 0.1% in rice bran, but it is pos-
sible to take 300 mg of γ-oryzanol by oral intake of brown rice.
Phenolic compounds are major antioxidant and radical
scavenging ingredients in rice. Nakamura et al19,20 developed a
method for the simultaneous determination of phenolic com-
pounds in rice by high-performance liquid chromatography-
ultraviolet (HPLC-UV). Eleven kinds of phenolic compounds
were identied in rice: ferulic acid, caffeic acid, sinapinic acid,
p-coumaric acid, vanillic acid, protocatechuic acid, syringic
acid, hydroxybenzoic acid, chlorogenic acid, 6’-O-feruloylsu-
crose and 6’-O-sinapoylsucrose (Table 2). In unpolished rice,
the three most abundant ones are: 6’-O-feruloylsucrose, 6’-O-
sinapoylsucrose, and ferulic acid.20 With their representative
concentrations of 1.09, 0.42 and 0.33 mg/100 g rice our, they
represent 84.0% by weight of the total amount of soluble pheno-
lic compounds (2.19 mg/100 g brown rice our). Polished rice
contains only 0.28 mg of phenolic compounds/100 g rice our.
Tocotrienol and tocopherol are lipid-soluble anti-
oxidants, which prevent cardiovascular diseases and cancer.21
Squalene, an isoprenoid compound structurally similar to beta-
carotene, is an intermediate metabolite in the synthesis of cho-
lesterol. In humans, about 60 percent of dietary squalene is ab-
sorbed.
(2) Water-Soluble Ingredients
Inositol and phytic acid are water-soluble ingredients like
GABA.22-28 Magnesium, calcium and other trace elements are
Figure 3: Gamma-oryzanol in unsaponiable fraction of rice bran: γ-Oryzanol: Anti-stress effects,
palliation of menopausal disorders and dysautonomia.
Gamma-Oryzanol being bound to a molecule known as Ferulic Acid; so it is essentially a term used
to refer to a collection of ferulated sterols. Major g-oryzanol has 4 types; two are triterpene alcohol
ester and the other two are sterol esters. The functional activity is not different.
Table 2: Contents of soluble phenolic compounds in rice (mg/100 g).
Unpolished Polished
ferulic acid
0.33 0.07
caffeic acid
0.02
0.025
sinapinic acid
0.02
0.005
p-coumaric acid
0.098 0.02
vanillic acid
0.072
0.032
protocatechuic acid
0.037
0.013
syringic acid
0.03 0.01
hydroxybenzoic acid
0.04
0.021
chlorogenic acid
0.033
0.028
6'-O-feruloylsucrose
1.089
0.026
6’-O-sinapoylsucrose
0.417
0.032
Total
2.186
0.282
Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
Page 43
also included in this fraction.
In 2008, Maeba et al26 reported an interesting clinical
observation about the preventive effect of inositol on metabolic
syndrome. Seventeen subjects with metabolic syndrome were
given inositol per os for 2 weeks (5 g a day for one week and 10
g a day thereafter). The authors observed a signicant decrease
in total cholesterol, LDL cholesterol, small dense LDL choles-
terol and apolipoprotein B (a marker of post-prandial hyperlip-
idemia). Waist circumference, high-sensitivity CRP and fasting
blood glucose level also improved. Interestingly, a signicant
decrease in blood glucose level was only observed among sub-
jects with metabolic syndrome. This may reect higher con-
centrations of serum plasminogen, which is a protective factor
against oxidative stress. The nding suggests that plasmalogen
is a key factor mediating the benecial effect of inositol on the
metabolic syndrome.
Myoinositol is a ring-shaped polyalcohol (Figure 4). It
has half the sweetness of sucrose. It is an element of the vita-
min B complex, although it is not a real vitamin. It is present
in human colostrum, and considered to be essential for babies’
growth. It is also effective for the prevention of metabolic syn-
drome. It has shown anti-fatty liver effect, anti-diabetic effect,
improvement of metabolic syndrome, effectiveness against pan-
ic disorders and obsessive-compulsive disorders, and inhibitory
effect on lung cancer in animal experiment.27 The intake of large
amounts of inositol (more than 10 g a day) could improve the
panic syndrome.28
Phytic acid is a phosphatized inositol, and has a strong
chelating effect, pH adjustment effect, and antioxidant action. It
is used for the prevention of discoloration and as a deodorant.
In vivo, it is expected to have various effects, for example: de-
toxication, anti-fatty liver effect, immuno-stimulatory action,
and anti-cancer effect by inhibition of the phosphoinositide (PI)
3-kinase system.
CONCEPT OF MEDICAL RICE
Many different kinds of rice have been developed in Japan and
other rice producing countries.9,29 Some varieties are expected
to prevent various diseases, or to be used for dietary therapy.30
For example, ‘super-hard’ high-amylose rice could be used for
diabetic patients,31 low-protein or low-gluterin rice for patients
with renal failure,32,33 GABA-rich large germ rice is expected to
improve mental health,34 and rice with high antioxidant proper-
ties would be effective for the prevention of cancer and other
diseases.35,36 Human data are accumulating, so we believe it is
time to introduce the concept of medical rice for disease preven-
tion and treatment (Table 3).
(1) Medical Rice for Diabetes
In 2012, a meta-analysis reported an association between white
rice intake and increased risk of type-2 diabetes (T2D), suggest-
ing the need to replace white rice by brown rice in the Japa-
nese diet.37 The effects of brown rice on visceral obesity and
endothelial function were shown in the Okinawa branch retinal
Table 3: Candidates of medical rice.
Figure 4: Inositol and phytic acid.
Inositol and phytic acid are water soluble ingredients like GABA. for mental health. Magnesium,
calcium and other trace elements are also present in the same fraction. Inositol is a member of
vitamin B complex, although it is not a real vitamin. It is rich in human colostrum, and considered
to be essential for baby’s growth. It has anti-fatty liver effect, anti-diabetic effect, improvement of
metabolic syndrome, effectiveness for panic disorder and obsessive-compulsive disorder. Intake
of large amount of inositol, more than 10 g a day, could improve the panic syndrome.
Medical rice for health Organic brown rice containing nutrients and functional ingredients
Medical rice for diabetes Superhard rice or rice powder with low GI, mostly less than 50
Medical rice for kidney disease Low protein rice containing less than 1/25 protein
Medical rice for mental health High GABA, and/or γ-oryzanol/ferulic acids
Medical rice for cancer prevention Brown rice with high antioxidant activity with functional ingredients
Open Journal http://dx.doi.org/10.17140/AFTNSOJ-2-129
Adv Food Technol Nutr Sci Open J
ISSN 2377-8350
ADVANCES IN FOOD TECHNOLOGY AND
NUTRITIONAL SCIENCES
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vein occlusion (BRAVO) study.38 Participants were between 30
and 60-years-old males with metabolic syndrome. Brown rice
reduced their post-prandial blood glucose level and insulin lev-
el. A decrease in body weight and an improvement of various
biochemical abnormalities were also observed. The benet of
brown rice and brown rice with legumes for glycemic and insu-
linemic control were also shown by Mulan et al.30
Recently, Ohtsubo et al39-41 succeeded in harvesting
special super-hard rice, which contained a high concentration of
resistant starch, due to long amylopectin chains. It showed good
effect on postprandial glucose level and insulin secretion (Figure
5). However, the taste is different from ordinary Japonica rice.
So, they next developed super-hard-rice powder after boiling.
Now, the powder of super-hard rice is available for a number of
new food items. For example, medical “Tomato Bread” is made
of super-hard rice powder, containing resistant starch, GABA
rich pre-germinated brown rice, tomato as a source of lycopene,
and gelatinized rice our for durable palatability. The size and
taste is comparable to wheat bread. Tasty rice noodle is also
made from this powder.31,40
(2) Medical Rice for Chronic Kidney Diseases (CKD) and Renal
Dysfunction.
One of the benets of a low-protein diet is the preservation of the
kidney function.42 Distinct mechanisms could be identied: (1)
improvement of hyperphosphatemia and hyperkalemia, (2) de-
crease in urinary protein, (3) improvement of subjective symp-
toms, (4) prevention of complication, (5) good control even after
indication of hemodialysis for better survival.43
The protein in rice is stored in two different types of
compartment.44 The major proteins are prolamin and gluterin.
Prolamin is the alcohol soluble protein fraction remaining after
salt extraction of globulin. Glutelin is the dilute-acid or dilute-
alkaline soluble protein fraction after prolamin extraction. Most
of the prolamin was present at the periphery in whole rice grains,
implying that prolamin is removed by enzymatic digestion on
polished white rice.33
Low-protein rice is available in Japan in ve different
packages, depending on their different amount of protein. The
rice content varies between 150 g and 180 g to reach a total con-
tent of 160 kcal (2 E-unit).45 The lowest protein concentration is
0.1 g/pack, which is 1/25 of normal rice (Figures 6A and 6B).
The palatability period is usually 7 months, but some packages
have an extended storage period of 3.5 years for disaster situa-
tions.
Ideura46 conrmed the effects of a low-protein diet on
patients with chronic kidney diseases. At the threshold of renal
failure of 6 mg serum creatinine/dl, low protein diet had started.
With a content of 0.4-0.5 g/kg body weight, the median survival
Figure 5: Postprandial blood glucose and insulin level.
Super hard rice showed suppression of postprandial glucose level and insulin
secretion. Super hard rice or purple rice, and new technology, such as co-extru-
sion with red onion germination, make it possible to fortify bio-active rice bread.
Figure 6: (a) Aseptic Package of low protein rice and (b) nutritional components of low protein rice.
A: Low protein rice.
Low protein rice is available in packed state in Japan. There are ve different amount of protein rice. The rice content is 150 g to 180 g to fulll 160 kcal (2
serving unit of Diabetic Society). Lowest protein concentration is 0.1 g, which is 1/25 of normal rice. Palatability period is usually 7 months, but some has 3.5
year best-before period as storage pack for a disaster.
B: Low protein rice.
Nutritional aspect of low protein rice is characteristic. Energy source is preserved and protein concentration is well controlled. Low potassium and phosphate
concentration are additional benets for CKD patients. If the patients continue to eat meat, the control of K and P is very difcult.
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was 4 years.
With a content of 0.6 and 0.7 g/kg, no benecial effect
was observed compared with a control group (>0.8 g/kg body
weight). The optimal low-protein content was 0.3 g/kg body
weight. Low potasium and phosphate concentrations are addi-
tional benets for CKD patients.
Sun et al47 performed a preliminary study in Huadong
Hospital (Shanghai, China), examining the effect of 12-weeks
of low-protein rice as dietary therapy (0.6 g/kg body weight) for
CKD patients. Cooked rice was provided 3 packs/day contain-
ing 1.35 g proteins and 900 kcal energy.33 The meal plan was
checked by trained research dietitians, and dietary intake and
compliance were monitored through diet diaries.
Compared with baseline levels, the total dietary ener-
gy increased from 1606 kcal/d (27.9 kcal/kg bwt) to 1748 kcal
(30.8 kcal/kg bwt). Dietary daily vitamin B1 intake increased
from 0.34 mg to 0.78 mg, and vitamin B2 intake from 0.42 mg
to 1.08 mg. Serum albumin slightly increased from 44 g/L to
46 g/L. The total serum protein concentration increased from
74 g/L to 77 g/L. Meanwhile, changes in body weight, BMI,
and hemoglobin were not signicant. After 12 weeks, urinary
protein levels decreased from 0.4 g/d to 0.1 g/d. Urine albumin
decreased from 130.8 mg/24 h to 60.8 mg/day. Twenty-four uri-
nary protein, albumin excretion, and urinary albumin/creatinine
ratio decreased by 63.7%, 55.0% and 52.0%, respectively.
Low-protein rice was well accepted by Chinese CKD
patients. It is an important tool for CKD dietary therapy as it
increases energy and micronutrients intake and improves the nu-
tritional status. A long-term and large sample size RCT study
is planned in Thailand to conrm the protective effects of low-
protein rice on CKD progression.
The average Japanese citizen consumes 60 g protein a
day, and half comes from rice. By using low-protein rice, we can
reduce the protein intake by half. The amount of sh or chicken
on side dishes does not need to be strictly restricted. However, if
the main dish contains a large portion of beef like in the Ameri-
can diet, meat is the source of both protein and energy. In the
well-designed multicenter Modication of Diet in Renal Disease
(MDRD) study,48 the benet of a very low protein diet could
not been shown. We analyzed their data and found the reason
why MDRD study was failed.49 The energy intake was less than
70% of the protocol, probably due to the cut of meat from main
dish. So, energy deciency could plausibly have worsened the
disease.49
Medical rice for CKD should contain enough energy
source and low protein, as well as low potasium and phosphate.
(3) Medical Rice for Mental Health
As the society is aging, the number of people with impaired cog-
nitive function becomes serious problem in the world. In Japan
the number of people with dementia is estimated to be 2 mil-
lion, and World Health Organization (WHO) estimates that 47.5
million people have dementia, with 7.7 million new cases every
year worldwide.50
Large-germ brown rice and pre-germinated brown
rice contain functional ingredients to prevent dementia, such as
GABA, γ-oryzanol, in addition to nutritional elements such as
vitamins, minerals, and dietary bers.51,52 GABA and γ-oryzanol
are involved in the metabolism of hypothalamic catecholamines.
γ-Oryzanol is known to have anti-stress effects, to pal-
liate menopausal disorders and dysautonomia. Other effects
have recently been reported , for example: improvement of hy-
pertension, curative effect of Alzheimer’s disease, amelioration
in muscular fatigue.53,54 Antioxidant effect, radical eliminating
action, ultraviolet absorptive action, anti-inammatory effect,
antidiabetic effect, anti-allergic effect, increase of insulin like
growth factor 1 (IGF-1) and antibacterial action are also report-
ed, but the main hope is an improvement of cognitive function.52
GABA is also a candidate for mental health. Large-
germ rice and pre-germinated brown rice (GBR) contain a high
amount of GABA.54 Pre-germinated brown rice was developed
for easy cooking, keeping the many nutritional and functional
ingredients, such as dietary ber, vitamins and minerals, GABA,
γ-oryzanol, acyl-sterol glycoside, etc. GBR contained not only
GABA, but also ferulic acid.
The effect of ferulic acid mixed with Angelica archan-
gelica extract on cognitive functions and behavioral and psycho-
logical symptoms of dementia have been examined by Kimura
et al52 (Figure 7) and many symptoms were shown to improve
(Table 4).
Pregnant women often become unstable in mood. In an
intervention study, 41 pregnant women were randomized to take
germinated rice or white rice for 14 days.54 A psychological test
prole of mood states (POMS) was done before and after the
study, and salivary amylase was measured as a stress marker.
POMS test measures 6 dimensions of mood, and depression,
Figure 7: Mental health: Control of behavioral and psychological symptoms
of dementia (BPSD).
Treatment with ferulic acid extract led to reduced NPI scores in 19 (95.0%)
out of 20 patients and to signicantly decreased NPI scoresoverall
(p<0.001).55
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anger-hostility, fatigue score signicantly improved by brown
rice eating, and total mood disorders (TMD) was nearly half of
that of white rice (Figure 8).
Mothers who in took pre-germinated rice is shown by
black column and those who ate white rice is shown by white
column. Depression, anger-hostility, fatigure score signicantly
improved by brown rice eating, and TMD was nearly half of that
of white rice.
In addition to their mental effects, the giant-germ rice
and GBR are also useful for diabetic and hypertensive patients.
In a randomized-controlled trial comparing two packs of GBR
rice with white rice, 24 healthy volunteers (10 males and 14 fe-
males, aged from 27 to 47) were studied for the effect on blood
pressure. The GBR group displayed a signicant reduction in
systolic blood pressure after 12 h of GBR intake, particularly
marked after 6 minutes of physical load with an ergometer. It
was also shown that the blood glucose levels and the incremental
area under the curve (IAUC) were lower after taking GBR. The
IAUC was 1448 mg/min/dl in GABA rich group, whereas it was
1601 mg.min/dl in white rice group.
These results demonstrate that this special pre-germi-
nated brown rice (GABA+ferulic acid) may be effective in sub-
jects with mild hypertension and diabetes mellitus, in addition to
the mental health.
Other components of rice bran (steryl glucosides [PSG]
for example) were found to be effective for coping against stress.
So, medical rice for mental health is at least dened to contain
high GABA and γ-Oryzanol or ferulic acid.57
(4) Medical Rice for Cancer Prevention
In various animal experiments, Muto et al58-60 showed that fer-
mented rice bran (FBRA) strongly prevented the incidence of
colon, breast, head and neck, esophageal, and pancreatic cancers
almost half. The antioxidant activity of rice bran could be con-
sidered to be a major factor.
The effects of many phytonutrients are expected to
work well beyond free radical protection. Of late, an antioxidant
test known as Oxidation Radical Absorbance Capacity (ORAC)
has become popular61-63 Other similar assays, such as DPPH,
TRAP, TEAC etc. are available to specify the antioxidant capac-
ity of food ingredients.
This is why consumers are often confused by different
values as there is no readily available comparison method among
the values obtained by different assay systems. It is proposed
that the antioxidant capacity of complex supplements should
be expressed in terms of standardized antioxidant units (AOU),
pondering the antioxidant values obtained in aforementioned as-
say system.64 Japanese intake of AOU per day is estimated more
than 10000 AOU unit throughout a year.65
Beyond the standard antioxidant vitamins, such as vita-
min C and E, we should consider antioxidants found in brightly
pigmented whole fruits and vegetables, mostly due to anthocya-
nins and proanthocyanins.64 We measured antioxidant activities
Table 4: Changes in neuropsychiatric inventory score.
Figure 8: Mother’s stress measured by POMS: Changes in POMS scores before and after
dietary intervention by GABA rich rice.
Pregnant women often becomes unstable in mood. Is this intervention study, 41 pregnant
women were randomized to take germinated rice or white rice for 14 days. As the psyco-
logical test, POMS test was done before and after the study, and salivary amylase was
measured as a stress marker. POMS test measures the 6 axises of mood, such as tension-
anxiety, depression, anger-hostility, vigor, fatigue, and confusion. High score of all six, except
for vigor, suggests the unfavorable mood, and high score of vigor suggests favorable mood.
Higher TMD score (Total Mood Disturbance) suggests in bad mood.56
Baseline Follow-up p value*
NPI total score 28.3±9.6 17.7±9.7 <0.001
Delusions 2.2±2.7 1.3±2.1 <0.05
Hallucinations 2.8±3.4 1.1±2.1 <0.02
Agitation/aggression 4.6±3.2 2.5±1.9 <0.001
Depression/dysphoria 1.7±2.9 1.2±2.0 NS
Anxiety 1.9±2.3 1.5±2.0 <0.04
Euphoria 0.2±0.9 0.2±0.9 NS
Apathy/indifference 5.9±2.4 3.3±1.9 <0.001
Disinhibition 1.9±3.1 1.8±2.9 NS
Irritability/lability 4.0±3.2 2.3±2.0 <0.005
Aberrant behavior 3.4 2.6 <0.05
4 weeks after Feru-guard® treatment in 20 patients with frontotemporal lobar degen-
eration or dementia with Lewy bodies.
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of various rice varieties, and found that only brown rice showed
antioxidant activity (Table 5). Black rice showed the highest
anti-oxidant activity. Both brown rice and black rice retained the
high anti-oxidant activity even after cooking.66 Polished rice did
not show antioxidant activity at all. The presence of antioxidant
activity in daily meals should prevent carcinogenesis and dis-
eases caused by free radicals.
CONCLUSION
The health effects of brown rice are empirically well known,
and accumulating evidence about the physiological and phar-
macological activity of rice bran strongly supports the use of
brown rice in meals, although this is not popular in Japan and
other countries. However, in response to the enormous increase
of medical costs, the Japanese government starts to encourage
healthy longevity measures by changes of dietary habits. Func-
tional food labeling has started in 2015, so the proper food label-
ing of medical rice could help people who want to control and/
or improve their health status.44 An example of food label for
‘Medical Rice for Health’ is shown in the gure (Figure 9).
A word in the lower part of the mark could be changed according
to the purpose.
ACKNOWLEDGEMENTS
The authors deeply appreciate the participants in the East Asia
Conference of Standardization of Rice Function, which was held
in Kyoto from December 10 to 12, 2014. All authors attended
the conference and contributed to make the entity of medical
rice, providing their original data.
Figure 9: Food labeling of medical rice and licensed medical rice for health.
This rice is organic brown rice, containing enough vitamins and minerals with high antioxidant ability, without any
detectable herbicide or toxic heavy metals.
Table 5: Antioxidantactivity of various rice and cooked rice.
These rice with high antioxidant activity could be categorized in the medical rice for cancer prevention.
ORAC_W (AOU P) ORAC_L (AOU C) Total
Raw brown rice
13 4 17
Raw brown rice
15 4 19
Raw brown rice
11 5 15
Cooked brown rice by pressure pan
5 3
8
Cooked brown rice by pressure pan
6 1
7
Cooked brown rice by pressure pan
6 1
7
Cooked brown rice without pressure
6 1
7
Cooked brown rice without pressure
5 1
6
Cooked brown rice without pressure
7 2
9
Pregerminated rice
1
<0.5
1.5
Pregerminated rice
2
<0.5
2.5
Cooked polished rice “kinme”
<0.5 <0.5 <0.5
Cooked polished rice “kinme”
<0.5 <0.5 <0.5
Cooked polished rice “kinme”
<0.5 <0.5 <0.5
cooked polished white rice
<0.5 <0.5 <0.5
cooked polished white rice
<0.5 <0.5 <0.5
cooked polished white rice
<0.5 <0.5 <0.5
AOU-F: Antioxidant unit by avonoids; AOU-C: Antioxidant unit like carotenoids.
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The authors also thank the nancial support of Human Health
Foundation, Toyo Rice Cooperation, Tsuno Rice Fine Chemicals
Co, Ltd. Fancl Cooperation, Genmai-koso Co. Ltd, and Forica
Food Co. Ltd. to open this conference. A part of this work was
presented at the 9th Asia Pacic Conference on Clinical Nutri-
tion, which was held in Kuala Lumpur, Malaysia in 2015. They
also thank to Dr. Philippe Calain for his contribution to complete
this manuscript.
CONFLICTS OF INTEREST
The authors do not have any conicts of interest regarding this
paper to any company.
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