Ramen restaurant prevalence is associated with stroke mortality in Japan | Hacker News Reader

Ramen restaurant prevalence is associated with stroke mortality in Japan

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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...

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.

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...

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.

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

Some ramen joints in the states offer non pork broth ramen options. But I'm the states the options are predominantly pork

/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.

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.

Skip the tonkotsu and try another broth like miso?

Vegan ramen.

I don’t think Americans invented tonkotsu broth.

It doesn't seem like they tried to imply that given that they stated the diversity of broth options in Japan.

"Liquid bacon" seems quite disingenuous and cynical. It's thick broth that is, reportedly, full of collagen. That doesn't sound like liquid bacon to me.

Yes. Ramen in western cities is preying on the local perception that ramen is 'trendy' and therefor worthy of being expensive.

In Japan, ramen is more akin to burgers in America where sure you can go to a 'fancy' place and get a $15 burger, or you can go to the diner down the street and get a burger for $3. Ramen is the same, with plenty of fancy places if you want that type of meal, but the majority are small, quick, almost "fast food" type places with cheap food.

Noodles (soba, udon, ramen) are among the cheapest foods in Japan - commonly 8-10 USD.

I can only speak from my experience: Yes, it's cheap, but it's not the cheapest around. It tends to be in the 500-1000Y range depending on toppings. But that range also describes a great variety of restaurants in Japan: soba, teishoku, convenience store prepared meals - all are in the same range.

It's been 15 years since I lived in Japan, but IIRC it was on average among the cheapest foods there (as it is pretty much everywhere in Asia).

Low cost ingredients, easy/fast to make, possible to cook bulk "batch" in large pot etc.

It’s not easy to make. The broth is rich and takes a lot of time and skill.

I stand corrected. I probably then saw just the last steps and chef was using previously made broth.

I had some really great ramen recently in Tokyo. I would say the place was no fancier than... well... above Jimmy Johns under Olive Garden.

Downtown Tokyo, absolutely delicious ramen, $6 USD or so.

A $10 ramen is considered expensive in tokyo.

$6 is standard.

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?

You don't at the level of this study. It's useful to suggest this is something that might be explored in a better, more clinical, setting.

The news might pick up and run with this, which is unfortunate, but so long as you don't view this as anything more than a suggestion of a relationship, you should be fine.

> How do you prove that your results are legit in the age of reproduction crisis?

You... try to reproduce them. The "reproduction crisis" isn't a failure of the scientific method, it's just pointing out that we've picked all the low hanging fruit (i.e. highly significant results) in science while increasing the amount of science done by huge amounts. So there's a lot of junk. Possibly (hopefully! I love ramen) including this paper.

But nothing has changed with how you prove your results are legit: do a similar study in a different location trying to find the same effect.

I guess the only reliable way is to have an independent group reproduce it using different data and publish their result.

Whenever theres something interesting shown in natural sciences you quickly hear about replication efforts being able or unable to replicate the results. In most other sciences there doesn't seem to be much glory in replication

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.

I don't think you have to assume good faith at all in these situations.

If someone comes up with a correlation of X statistic with Y statistic in a fashion seemingly coming from nowhere, they either say why they started studying the correlation or show the correlation is incredibly strong.

I think that's pretty much what "extraordinary claims require extraordinary evidence" winds-up meaning.

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?

What is the connection between a correlation and an explanation? I see none. Zero. Nada.

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.

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.

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.

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/...

Potassium is hard on your kidneys, probably okay if you’re young but increasingly worse for you as you age...

I'd never heard of this so I tried to find anything that talls about potaassium causing kidney issues and I haven't been able to find any links between potassium consumption and kidney problems.

Mind linking

I can't stand the taste of 100% potassium salt. The Morton's 50/50 mix is just barely tolerable. It actually tastes better than regular salt when used to season avocados, though.

Why not limit your scope to just sodium and potassium? This guy tries all of the alkali metal salts! https://www.youtube.com/watch?v=RJh9yTIBY48

WebMD? Seriously? The science on salt is quite debated, actually: https://www.health.harvard.edu/blog/heart-failure-and-salt-t...

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...

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

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?

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.

Highly commercialized through pharma with no real avenues for accountability to what they claim.

I think things are going the opposite direction with salt.

That is one study, but studies that are not finding any link between health hazards and salt are starting to pile up.

https://www.scientificamerican.com/article/its-time-to-end-t...

Lots of doctors are even starting to tell people that they don't really have to worry about salt unless they have a hypertension problem.

Why the hell would you want your diet to be salt free? Sodium is essential to proper bodily functions. You're going to hurt yourself by over-limiting sodium and using potassium chloride.

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

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.

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.

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.

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?

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.

The science on sodium is far from settled

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

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.

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...

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?

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.

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.

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.

https://en.wikipedia.org/wiki/2013_horse_meat_scandal

Food fraud is potentially related to this correlation.

Well they do have a ton of saturated fat.

https://www.amazon.com/dp/B0095ZMPTU/ref=dp-kindle-redirect?...

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