
Ramen restaurant prevalence is associated with stroke mortality in Japan - rococode
https://nutritionj.biomedcentral.com/articles/10.1186/s12937-019-0482-y
======
HenriNext
Ramen is cheap, so there are more Ramen restaurants in poor areas, which have
lower life expectancy?

[https://www.huffingtonpost.com.au/2017/01/31/low-
socioeconom...](https://www.huffingtonpost.com.au/2017/01/31/low-
socioeconomic-status-affects-life-expectancy-more-than-obesi_a_21704449/)

~~~
motbob
But is ramen cheap at ramen restaurants in Japan?

I ask because I spent $17 on ramen in a large American city earlier this
month.

~~~
iso1337
Yes, they are cheap. Usually around 600-1200 yen or $6-12

many of them reduce labor costs by having a vending machine outside where you
get a token that indicates your order.

[https://livejapan.com/en/in-tokyo/in-pref-tokyo/in-
asakusa/a...](https://livejapan.com/en/in-tokyo/in-pref-tokyo/in-
asakusa/article-a0001973/)

The current ramen fad in America relies on super rich broth, basically liquid
bacon.

There are many styles of ramen in Japan, ranging from super simple broths to
the liquid bacon style.

~~~
op00to
How do I ask for the simple stuff? The liquid bacon gives me unfortunate
digestion symptoms that should not be named.

~~~
L_Rahman
/u/op00to: This is challenging because ramen is classified by a mix of base,
seasoning and thickness. Roughly bases can be: bones of chicken, pork, fish or
in rare instances beef. Often there is blend of these bases

Seasoning: sea salt (shio), soy sauce (shoyu) and miso

Thickness is a spectrum ending with: kotteri (thick) and assari (light)

Now, how to pick a light broth? This will be highly context dependent. Most
shops in Tokyo where I'm living right now are specialists so research will
show you upfront whether it's tonkotsu (heavy pork), chicken paitan (heavy
chicken), hakodate (light fish), tonkotsu-gyokai (blend of pork and fish).

If you're in Japan, I recommend the Ramen Beast app which has location based
recommendations, high quality reviews and lists for lighter ramen.

If you're in NY and looking for a lighter bowl: I can vouch for most of the
bowls at Nakamura, the yuzu shoyu at Mr. Taka, and all of the bowls at Yuji
Ramen.

~~~
elvinyung
Note that as you mentioned since most shops in Japan specialize in a specific
type of soup (i.e. the only differentiator is the tare and the toppings), it
might be more useful to familiarize oneself with the characteristics some of
the more common regional styles. For example, "Hakata-style" ramen generally
describes a creamy tonkotsu soup, "Kitakata-style" is generally a chintan with
shoyu tare and hand kneaded "temomi" noodles, Yokohama "iekei" generally tends
to be a paitan with shoyu tare, Sapporo ramen is generally a pork soup with
miso tare, etc.

This is not to say that e.g. Sapporo only has Sapporo-style ramen or Fukuoka
only has Hakata-style ramen, but the names describe where the style is
perceived to have originated from.

The water is slightly muddied (no pun intended...) by techniques like "double
soups", i.e. mixing multiple soups in the same bowl. In some cases a chintan
might be mixed with a paitan, etc.

------
sandoooo
How do we prove that they didn't just look at mortality in all diseases and
for all restaurants, and cherry-picked stroke-vs-ramen because it has the best
significance?

I am not accusing them of anything - I have no horse in this race. What I am
curious about is: how do you prove that you haven't p-hacked, if you are going
to do a study like this?

Sure, you can pre-register your methods, but presumably you can get the data
and do some data crunching on it way before you have to pre-register. How do
you prove that your results are legit in the age of reproduction crisis?

~~~
gryson
Good faith is required to accept any type of reporting. Otherwise, your
question can always be extended to "How do we know that they didn't just make
it all up?"

The researchers did not report conducting more comparisons and they did not
adjust for this in their analysis, so we have to assume that they are telling
the truth.

Of course, there's always the chance that they are being deceitful, so we have
to reserve some skepticism and take into consideration related studies before
forming any firm conclusions.

In this particular case, the correlations that they found have quite strong
effect sizes with p < .001. Figures 2 and 3 are quite striking. These results
are also supported by previous research. That doesn't mean the matter is
settled by any means. It's just another piece in the puzzle. But there is no
indication whatsoever that they are p-hacking or going on a fishing
expedition.

~~~
mattkrause
The correlation is so large that I find it literally incredible.

Could ramen restaurant prevalence really explain a quarter to a third of the
variance in mortality (which is what r=0.5 to 0.6 implies)? If so, the damn
things are an outright menace.

And why is it so different from fast food, which is equally unhealthy but
supposedly makes people live longer?

~~~
perl4ever
What is the connection between a _correlation_ and an _explanation_? I see
none. Zero. Nada.

~~~
mattkrause
It is pretty common to interpret r^2 as the fraction of variance in one
variable “explained by” the other. Here, ramen restaurant prevalence and
mortality are reported to be correlated at r=0.5 to r=0.6, so r^2=0.25 to 0.36

Obviously, “explained” here doesn’t indicate something conceptual or
causal—-it’s more like “accounted for”—-but the phrasing is probably too well
established to change now.

And that's sort of my point...It doesn't seem plausible to me that ramen would
be that deadly, so I suspect there's some other unmodelled factor that drives
both restaurant prevalence and mortality. For example, maybe ramen is more
popular in poorer/more rural areas, which have worse medical care/outcomes.

~~~
gryson
The authors discuss this in the paper's Discussion.

The prevalence of ramen restaurants is suggested as an indicator of general
food preferences in the regions studied. Regions that have a higher prevalence
of ramen restaurants also tend to have a higher salt intake in general. This
can be seen by the increased use of soy sauce and miso compared to other
regions in Japan (from personal experience, these regions are famous
throughout Japan for their high-salt diets).

So I'd say that the authors are very careful to clarify that they are not
implying any sort of causal relationship between ramen restaurants and stroke
mortality, and I don't think anyone reading the paper would assume that
either.

~~~
mattkrause
I did see that, and maybe Japanese regional cuisine varies a lot more than I'm
imagining. However, I'm still not convinced that something higher-level is
going on.

For example, I think you could find a similar correlation between (say) soul
food restaurants and diabetes prevalence in the US. Soul food tends to be
starchy and fatty itself; you could also make a similar argument that the
number of soul food restaurants is a proxy for food preferences in each
region.

However, soul food is especially popular in African-American communities.
There are genetic factors that predispose African-Americans to diabetes. Soul
food restaurants are probably more common in poorer areas. Diabetes is also
linked to poverty: partly through diet, but also through things like access to
preventative healthcare and management of pre-diabetes. Perhaps there still is
some residual effect of the restaurants themselves, but it would be much
weaker after adjusting for other factors.

------
xivzgrev
People are just waking up to dangers of sugar, but too much salt is also not
good, increasing blood pressure (see below link).

Potassium can offset much of the affects but it’s surprisingly difficult to
get even the US recommended amount every day.

I’ve started using potassium salt instead of sodium salt in my cooking, and it
feels great to kill two birds with one stone. Now I just need soy sauce and
others without sodium to make my kitchen (nearly) salt free.

[https://www.webmd.com/hypertension-high-blood-
pressure/news/...](https://www.webmd.com/hypertension-high-blood-
pressure/news/20110711/high-sodium-low-potassium-diet-linked-to-heart-risk)

~~~
jolux
WebMD? Seriously? The science on salt is quite debated, actually:
[https://www.health.harvard.edu/blog/heart-failure-and-
salt-t...](https://www.health.harvard.edu/blog/heart-failure-and-salt-the-
great-debate-2018121815563)

~~~
lvturner
For those of us who aren't medical practicioners - would you mind pointing
explaining a bit further on "WebMD? Seriously?" as I had no idea it wasn't
well regarded and am now curious as to why...

~~~
CardenB
WebMD has a profit driven interest to pick on health anxiety by exaggerating
symptoms

~~~
lvturner
Profiting through advertising, or is there darker connections?

Sorry, I'm genuinely not trying to be obtuse, but I'm just not quite sure on
how that would work - does exaggerating the symptoms cause people to spend
longer on the site? Or is it just to drive up search ranking? Or improve click
through?

~~~
ashildr
Dramatized, controverse stories bring more “interaction” and are more readily
shared on social media. So they bring more pageviews and ad revenue.

This is why news and social media are the shit dispensaries they are today.

------
pjbk
Now whenever I read articles of this type of statistical research, my mind
immediately recalls Tyler Vigen's website and book...
[http://tylervigen.com/spurious-correlations](http://tylervigen.com/spurious-
correlations)

------
whiddershins
When I saw ramen shops in Tokyo they seemed to cater to people working long
hours, or who were in a hurry, and were interested in eating standing up.

------
mark_l_watson
So, the higher carbohydrate and salt content in restaurant style Ramen
increases the chance of stroke.

I make Ramen at home about twice a week and double the vegetables and halve
the noodles in Ramen recipes. After reading this article, I am going to try to
reduce sodium also.

------
tus88
Weird they think ramen is the only food with regional variation. And lots of
stressed salarymen in Tokyo eating ramen but Tokyo is down the bottom. It's
really this north-western part of Honshu.

Total guess, but when I was in Hirosaki once (red area), I went to this little
restaurant on advice of an innkeeper, and they gave me this plate of green
leaf and other tempura. It was huge and oily and they expected me to eat it by
myself. I remember thinking at the time...this can't be good for my health.

------
m3nu
Not surprising. In the China Study they also found a positive correlation
between consumption of wheat flour and heart disease. (Some places in China
eat mostly rice, others more wheat.)

Any new guesses on the mechanism?

Related: [https://deniseminger.com/2010/09/02/the-china-study-wheat-
an...](https://deniseminger.com/2010/09/02/the-china-study-wheat-and-heart-
disease-oh-my/)

~~~
howlin
It's more likely the salt than the wheat. From the article:

| The traditional Japanese diet was thought to increase stroke risk because of
the heavy use of seasonings such as miso, salt, and soy sauce.

~~~
tcoff91
The science on sodium is far from settled

~~~
ncmncm
Amazingly. It's not like it's hard or expensive to study.

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afo3
Hokkaido seems like it is a major problem for this study: it ranks low on
stroke mortality and high on ramen consumption and is well known as a land
that loves ramen and other rich foods. Perhaps they eat more seafood and that
somehow offsets the risk or have some other advantage but it is interesting
the authors don’t even mention it given how glaring it is the largest
prefecture and one of the easiest to spot on the map for a foreigner.

------
arthurofbabylon
I’m reluctant to draw conclusions around nutrition based on this correlation,
because ramen is so regional. (When I’m in the Japanese mountains, there’s no
ramen - just udon and soba.)

I understand a huge portion of Japan’s ramen is in Tokyo. There are many human
health factors with an outsize presence/lack-of-presence in Tokyo - like
alcohol consumption, noise, overwork...

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porknubbins
I’d be surprised if people are eating ramen so much it affects long term
disease rates noticeably just because there are more restaurants. I also think
Japanese could eat tonkotsu ramen a few times a week and still get less
saturated fat than most Western diet eaters. Maybe salt could cause some acute
condition though?

~~~
gryson
The authors state (the obvious) in the discussion: the correlation is likely
not caused by ramen itself. Rather, the prevalence of ramen restaurants is an
indicator of general food preferences in a particular region. The regions in
question are known to have high salt diets.

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nemonemo
If you see the results, you can also find negative correlation between stroke
and the density of the western restaurants (french/italian or fast foods).
What conclusions can you draw out of that? I'd probably just think this is
just an interesting study that can't say anything with the results alone.

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jelliclesfarm
It’s noodles with meat, high sodium and high fat. It’s bad if it’s had every
single day.

Just like burgers and fries.

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ryacko
[https://en.wikipedia.org/wiki/2013_horse_meat_scandal](https://en.wikipedia.org/wiki/2013_horse_meat_scandal)

Food fraud is potentially related to this correlation.

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purplezooey
Well they do have a ton of saturated fat.

~~~
base698
[https://www.amazon.com/dp/B0095ZMPTU/ref=dp-kindle-
redirect?...](https://www.amazon.com/dp/B0095ZMPTU/ref=dp-kindle-
redirect?_encoding=UTF8&btkr=1)

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