Ideally no animal products of any kind are consumed, but Kushi recommends that the diet be adopted gradually, eating less and less animal products until the body ceases to demand any. Refined flour, sugar, dairy products and the meat of vertebrates are viewed as the most harmful, while fish meat is considered acceptable if the body demands it. Other than natural fruit, the only sweetener used in macrobiotic food is barley malt syrup.
A traditional Japanese miso soup is taken for breakfast. The ingredients for a macrobiotic main meal are always cooked together for an extended period of time in one pot, usually a pressure cooker. A fermented soy product (e.g. miso or tamari) is often mixed in after cooking.
Some dieters believe good health to result from eating macrobiotically, however opponents point to several deaths of people who were using the most severe form of the diet. No causal link between the deaths and the diet was actually proven, but it cannot be ruled out as a possible factor.