Fig. 4

Putative effects of Japanese traditional diets on end point over midpoint in planetary and human boundaries. Plant-based, low-protein diets as the traditional washoku diet, the Okinawa diet, and the traditional Buddhist diet. Using domestically produced foods reduces the need for transport, preserves links to ancient life history and culture, and may boost agriculture and the food industry in Japan. However, excessive food restrictions can cause frailty in older adults due to inadequate protein intake or trigger hyperkalemia among individuals with end-stage kidney disease due to potassium loading. Therefore, traditional diets should be modified toward co-benefit of renal health and environment. Traditional Japanese diets and sustainable diets in Japan may reduce the carbon footprint and reduce the prevalence of lifestyle diseases as midpoints. As end points, these diets may benefit the global environment or help prevent the progression of end-stage kidney disease