Daruma or Maruda are a classic symbol of luck and they are simply Japanese. But have you ever wondered how they came to be or even what they are?
These delightful charms are initially designed on Bodhidhama or the founder of Zen Buddhism, the Japanese sect of Buddhism. With regards to what the Maruda looks like, each artist can do as much or as little as they like.
The benefits of this are simple: if you can think of a character there is a Maruda for it. The example above is distinctly cat shaped, a purrfect example.
How do they work?
Maruda are usually bought without pupils and you need to paint them on yourself. You first paint one pupil while wishing for something and once it comes true, you paint the other.
This does mean that there are many accross Japan with only one eye as the wishes never came true.
Nevertheless the less, a lucky charm can certainly never hurt!
While living in Japan, it is inevitable that you will pick up some good and some bad habits- it’s just how it goes. One habit that I adore, and will miss, is Hatsumoude or visiting a shrine at the beginning of January.
Hatsumoude is held at most if not all shrines across Japan and each shrine offers a different benefit such as business success, transportation safety, academia etc.
The main shrine in Nabari city is Urufu Shrine, located in the Hirao district of Nabari. The main benefit of performing Hatsumode at this shrine is transportation safety (交通安全) and charms (お守り) can be bought (and were bought) for 500 JPY to help ensure your safety.
Upon arrival, I was greeted with a massive bonfire, which had the delightful job of keeping me warm while I waited for midnight to welcome in the new year. A tent was set up which offered sake, sweet sake and dried fish (all of which were delicious!).
Everyone was enjoying the fine heat and looking at our phones to see when the clock struck midnight. Suddenly many people seemed to quietly erupt with the phrase “あけおめ” or an informal happy new year. There was quite a queue to pray and thank the kami for the previous year and for help with the coming. Naturally, I took lots of photos, but they were terrible- so I had to visit another shrine.
積田神社 or Sekita Shrine
Sekita Shrine is an ancient shrine with a 1250 year-old history and it is dedicated to the Shinto Kami Kashimaookami (鹿島大神). It is said that in ancient times before the opening of the heavens and the earth, Kashimaookami was appointed by Tenso Tenjin and descended from the heavens to earth (or from Takamagahara).
Kashimaookami is particularly known for their protection of the Tohoku region (northern man-land Japan) and has been worshipped as a god of military arts and equal to the god of thunder (war). More modern depictions include the phrase “鹿島立ち” meaning to set off on a journey and as a god who will protect you on your journey- or a perfect kami to ask for protection when travelling back to the UK.
When entering a shrine, you are expected to purify yourself with hand washing (post to come) and when coming up to the shrine, make an offering of saisen (賽銭) or donations into the donation box or offertory box (賽銭箱- the kanji is a bit literal). Luck donation amounts are usually considered to be 5, 50 , or 500 JPY(the ‘best’ donation is 9 5 JPY coins- a good fate from beginning to end). But why 5 yen coins?
5 yen in Japanese is pronounced go-en (五円) and guess what this is the same as? If you guessed Pulmonary aspiration- 誤嚥 (swallowing the wrong way) go try to brilliant medical Japanese skills but I meant ご縁 or luck/ fortune.
After praying or asking a kami for a wish, it is traditional to get an Omikuji or fortune for the year ahead. Fortunes cost 100 JPY and it is either a ‘lucky dip’ or shaking a wooden contained until a wooden rod emerges with a number which corresponds to a fortune.
If your fortune is bad, you have the option of keeping it- it is an option- or tying it to a rope at a shrine to keep the bad fortune enshrined there instead.
Omikuji will give you a complete fortune and advise on matters from academic success, financial success, matters of the heart, travel, health etc- in much more detail than a horoscope (AN I did write “horror scope” but that would be a bit morbid now wouldn’t it).
Finally, I would like to wish you all a very happy new year from Nabari and Japan or in Japanese: 新年あけましておめでとうございます.
Thank you for reading and happy exploring in 2020!
If you are at all concerned with the well-being of a friend or family member, please ring 999 and ask for a “welfare check” to be performed. I have spent New Year’s Eve with a friend at A&E for physiological help and they are still here!
Japanese helpline numbers
Tell Japan (Suicide and general help)
English and Japanese
Foreign Residents’ Advisory Center
Health and Medical Information Center
Emergency Translation Services
Tokyo Employment Service Center for Foreigners
English or Chinese
Legal Counseling Center for Foreigners
English, Chinese , or Spanish
*English may be available in major cities
If any of these numbers are useful for you, please do use them. I hope that they will not be needed but better safe than sorry.
Thank you for reading and happy (and safe) exploring.
A guide to Parkinson’s disease and the costs in Japan
Parkinson’s disease is quite a common NCD in Japan with over 150,000 people who suffer from the disease in Japan. But what exactly is it?
Parkinson’s disease is a progressive nervous system disorder is caused by the loss of dopamine production in the part of the brain called the substantia nigra- part of the midbrain.
Parkinson’s disease is not a life shortening disease alone but many sufferes also develop dementia separately which can be life-shortening.
Parkinson’s is comprised of 5 stages and early symptoms of the disease include:
A tremor in a hand, leg, finger
Bradykinesia: sudden stiffness with often a ‘mask-like’ expression
Loss of balance
problem with swallowing
memory issues including dementia
Basic treatments for Parkinson include medications which when taken convert to dopamine and help the body cope with loss of production, a healthy and balanced diet. However, as the disease progresses, patients will often decline physically.
Loss of independence
Late stage Parkinson’s patients will likely require around the clock care as they become unable to complete simple household tasks such as cooking, cleaning or washing.
About 40% of stage 5 patents will have a form of dementia as well as more common symptoms such as loss of bladder control, frequent mood changes, respiratory problems, less responsiveness to dopaminergic medications (dopamine replacement medications), dysphasia (inability to understand language), dysarthria (the inability to speak) etc.
Some late stage patients have described it as being a “drooling vegetable” but each person with the disease is different- and each treatment plan is different.
Many universities in Japan are studying Parkinson’s disease and are running clinical trials including Kyoto University (who have transplanted iPS cells [induced Pluripotent Stem aka non-specific stem cells] to supplement dopamine-emitting neurons), and Tokyo Metropolitan University of medical science (looking at the effects of adiponectin [a protein produced by fat cells with many effects] on neurodegeneration).
The costs of PD in Japan is high. Curative care (treatment which looks towards a cure- even if not possible) is around 500 USD a month. Palliative PD care or PD care requiring a care home is significantly higher and estimates are hard to find in Japan.
With a monthly cost of around 500 USD and an annual cost of around 6000 USD, it is estimated that 90% of this cost is from PD medication- but this is mainly for earlier stages. For patients in later stages and for patients who have had PD for more than 10 years, the costs are between 550 and 600 USD a month. Costs do change with symptoms. If a patient requires pain medication, the costs are higher; if the medication is “wearing off”, the costs are higher.
One problem with PD costs in Japan is that there is very little research. One article I used (see further links page) doesn’t consider long term care home costs. But the costs are comparable to the cost of PD in the US, UK, or Germany.
Basic care home costs in Japan are around 40,000 JPY a month for basic care needs which is 446,000 JPY a year. This would be in addition to direct PD care costs. Please note, the care home cost is for a basic level of care only- PD would require a lot more care and thus expense.
In order to combat this costs, it is estimated but the JT that around 470,000 people left their jobs between 2007 and 2012 to help care for elderly relatives which does reduce costs but by how much is yet to be determined.
There are many articles and posts that look at the year just (or almost) gone and this article is no different. 2019 has been an extremely busy year for Japan and I have picked out the 12 main news stories of this year- but don’t worry it’ll be kept short.
There are many more important news stories that did occur across Japan, but the stories I have chosen are ones that seemed to make Japan stop and think- unfortunately hit-and-runs, executions and other “depressing” events are mostly ignored.
Was the last chance to visit the imperial palace in the Heisei era.
1324 Leo Palace Apartment buildings are heavily criticized for failing to meet minimum construction standards nationwide
Ichiro resigns from major league baseball. His career lasted for more than 28 years. He had 4367 hits in his career.
The forthcoming Imperial name “令和” was announced on live TV. The name is the first from a Japanese source
The crowning of a new emperor, following the abdication of the previous emperor. Reiwa begins.
President Trump crosses the North Korean border with the Supreme leader of North Korea Kim Jong-un
An arsonist attacked the Kyoto animation studio. 36 were killed in this attack
Toyota and Susuki announce a collaboration to speed up the development of autonomous technology
The rugby world cup starts in Japan. It ended in August with South Africa winning the title
Typhoon 19 hits Japan. It was the worst typhoon in recent Japanese history. The death toll stands at 74, with millions of dollars of damaged caused
The imperial parade celebrating the new emperor takes place in Tokyo. Thousands lined the streets in the hopes of seeing the new emperor and empress.
Japanese doctor Tetsu Nakamura was killed in Afghanistan. His body was returned to his family on the 9th of December and the funeral took place on the 11th.
It has been quite a year for Japan and other highlights include the end of the pager in Japan, the end of 7 pay, and the execution of Wei Wei, a Chinese national on the 27th of December.
But there are dates to look forward to in 2020 including:
Oshogatsu, new Years celebration and the shrine visit on the 1st of January
31st of January is the proposed Brexit day
23rd of February the J-league starts
26th of Match is the start of the Olympic torch relay
24th of July is the start of the Tokyo Olympics
What are you looking forward to in 2020, besides perfect vision?
This month the Tokyo Olympic Torch relay timetable had been released. The relay will go to all 47 prefectures, starting in Fukushima-cho on March 26th and Finish in Shinjuku, Tokyo on July 24th- an event which will last 121 days and see 858 villages, towns, cities, and wards.
Additionally, it will visit several world heritage sites throughout Japan including Mt. Fuji (富士山), and Himeji Castle (姫路城).
The following article is a list of where the torch will be day-by-day and I highly recommend planning an Olympic trip to at least feature part of this country-wide relay!
Please note, due to the length of some place names I have romanised the Japanese with the following rules:
If the place name starts with a direction, I have placed a hyphen between the direction and rest of the name
I have ignored the kanji “町” meaning town and the kanji “市” meaning city except in cases where the Prefecture shares a name with a city. I have translated “村” as village but this doesn’t need to be included.
For Tokyo wards, some include the ending “ku/(区)” and others do not.
Place names in bold are the prefectural capital.
Fukushima Prefecture （福島県）
Naraha, Hirono, Iwaki, Kawauchi Village, Tomioka, Okuma, Katsurao, Namie
Soma, Shinchi, Iitate, Kawamata, Fukushima City, Inawashiro, Kikatake
Chofu, Miyake Village, Kozushima Village, Niijima Village (Niijima and Shikinejima), Toshima Village, Oshima
Mikurajima Village, Hachijo, Aogashima Village, Ogasawa Village (Chichijima and Hahajima), Mitaka, Musashino
Suginami, Nakano, Nerima
Toshima, Itabashi, Kita, Adachi
Katsushika, Edogawa, Sumida, Arakawa
Taito, Bunkyo, Chiyoda, Chuo
Koto, Ota, Shunagawa
Meguro, Shibuya, Minato
There is no prefectural capital as Tokyo is the capital of Tokyo. Ward or “区” meaning special district in Japanese just translates to city in each official English translation. Every place from the 18th is a ward in Japanese. Finally, Chiyoda could be considered the “capital” of Tokyo if such a thing were to exist.
I hope that this information is useful in planning your Olympic trip to Japan.
Let’s look at diabetes in Japan in a bit more detail.
Diabetes Millitus is an extremely common non-commutable disease (NCD) that exists in every country- and Japan is no exception. In fact, diabetes has been on the rise in Japan and it is getting the recognition it deserves.
Diabetes in Japanese is 糖尿病 which is read as [too/nyou/byou] and is made up of 3 kanji: 糖- sugar,尿- urine, and 病- sickness so it is a decent translation.
There are a suspected 10 million people who suffer from diabetes in Japan but there are only 78.7% of men who receive treatment and 74.1% of women who receive treatment- but the difficulty is there are an additional 10 million who are at risk of becoming a diabetic. Additionally there are more than 300,000 people who regularly undergo dialysis.
There are 2 main types of diabetes which are simply called:
Type 1 is an immunodeficiency disorder (which means the body attacks its’ self) where the immune system is destroying pancreatic beta-cells that are responsible for producing insulin. People with type 1 diabetes need to inject insulin for survival.
Type 2 can be a few things but it is generally the body’s inability to cope. For example, the body either in unable to cope with the amount of insulin it produces (i.e. too little) or the insulin it does produce cannot properly interact with receptors on the cell membrane and take in sugar.
Other types can include gestational diabetes- diabetes during pregnancy, diabetes which is due to other conditions e.g. endocrine disorders, liver disease, drug or chemically induced etc.
Additionally, there is idiopathic diabetes is diabetes without a known cause. Idiopathic comes from 2 Greek words: ἴδιος (one’s own) and πάθος (suffering).
In Japan, a singular blood test is not enough to be diagnosed as a diabetic. One of the required symptoms of diabetes is chronic hypoglycemia or long-term high blood sugar (慢性低血糖).
After this symptom has been observed and a HbA1c test performed (which gives the average blood sugar level over a 3 month period), further tests are performed which are:
a fasting blood test. Diabetes is suspected if the result is greater than 126mg/ dl (which is greater than 27.0 mmol/l )
An oral glucose tolerance test (a 2h test) and if the result is greater than 200mg/ dl (or greater than 1.11 mmol/l)
The Japanese problem
With the westernization of Japan and the influence of the Japanese diet, in addition to reduced physical activity- Asia and Japan are going to be the epicenter of global diabetes.
Japan has sugar in everything and the Japanese diet is extremely carbohydrate heavy (rice) which encourages poor control and helps the development of type 2 diabetes. Additionally, the estimated cost for diabetic treatment is 400,000 JPY a year and even with the national health insurance discount, this is a whopping 120,000 JPY a year. While this is cheap for Americans in Japan, anyone from a country with a funded health system, this is an extraordinary expense.
Diabetes education and awareness
There are a few diabetes organisations in Japan that are actively working to promote health living and help people who have already been diagnosed with diabetes. However, there is still a lot more to be done. The main source for this information is the Japanese diabetes society (information in English and Japanese). Please check out the “further information” page for further links and reading.
Thank you for reading and happy exploring.
Final note, the following is a list of diabetes vocabulary and the Japanese translation.
Capital punishment or the death penalty exists in Japan and it is still used. This may come as a shock to people who are excited by the ‘strangeness’ of all things Japanese but it is a reality.
The world seems to be moving away from capital and corporal punishment and there is heavy debate about this- no matter the culture or religious background of the country.
Japan has received criticism, sometimes rightfully so, for many things. The most controversial is political motivation. Executions in 2018 were at a 10 year high at 18 and the reasoning for this simple: it may be hard to carry out executions in 2019 due to the abdication and crowning of the emperor, and a reluctance to carry out an execution when the Olympics are taking place.
Additionally, under Japanese law, commended prisoners are not classified as prisoners so the conditions they are kept in are not reported on. Japan has come under fire from Amnesty International on several occasions because of the way it treats prisoners.
In practice, the death penalty is only given to multiple murders or murders with additional unspeakable actions e.g. murder kidnapping etc. In addition to this, there are a further 9 factors which will affect the sentencing:
Degree of viciousness- was the person ‘put out of their misery’ or was it a messy affair?
Motive- revenge, money, love, just because?
How the crime was committed; especially the manner in which the victim was killed. (also looks into planning and additional factors)
Outcome of the crime; especially the number of victims.
Sentiments of the bereaved family members. (The most important one on the list).
Impact of the crime on Japanese society.
Defendant’s age (in Japan, the age of majority is 20). (18+ can be given a death sentence)
Defendant’s previous criminal record. (first time or long history)
Degree of remorse shown by the defendant. (does depend on the person and the crime)
This was something that I studied in detail during my time a NUFS and it has always stuck with me. In theory there are safeguards and at a sentencing level it does work. Additionally, the death sentence is rarely imposed and the Japanese BAR association want to:
… the JFBA hereby strongly protests the executions conducted today [02/08/2019], and reiterates its stance that the Government should immediately suspend all executions [moratorium], looking towards the total abolition of the death penalty system in Japan by 2020.
Yutaro Kikuchi, President (August 2, 2019) Japan Federation of Bar Associations
The JFBA posts in English, Japanese, and Chinese and it is a brilliant resource which does report on “unpopular” topics- if noting else, please do check out their ‘opinion’ posts.
Alas, the death sentence seems like a convenient option for the Japanese government to be seen to be doing something.
Public opinion is in favor of the death sentence and it is logical that the family of the victim seek the harshest punishment possible- whether this is always the correct choice is another conversation.
Fun fact: trial by jury was only introduced in 2009 in Japan (please re-read that statement. The line in ‘ a trial by your peers’ goes back to 1215 in UK law, to the foundation of the US (it’s the 7th amendment), was used in the ancient world (Greece and Rome) but it is only 10 old in Japan.
Most Japanese are in favor of the death sentence and even though there are campaigns against it, it does not seem likely to change any time soon.
Another fun fact: condemned prisoners sentenced before 2009 have been campaigning for a retrial and to be tried by their peers- most appeals for a retrial has been denied.
The Death chamber
The actual process of execution is carried out by hanging using the ‘long drop’ method to snap the neck.
The death warrant is signed by the minister of justice and once signed the condemned will be executed within 5 days. The problem with this system is that no-one is told. The prisoner is only told the morning of his execution that he as, at best, 15 hours left in this world.
Death chambers are located across Japan, but the 3 that are used the most are in Tokyo, Osaka, and Nagoya (which are the 1st, 3rd and 4th biggest cities ion Japan).
A clash of culture
Japan is an extremely Buddhist country and many laws reflect Buddhist teachings. The death sentence was initially introduced from China (along with a writing system, culture, law, philosophy etc) before being abolished until 1180.
Even though Buddhism teaching the scanty of life and the importance of preserving life, executions until the Meiji period (1873) were cruel and unusual and the meaning for this is said to be Confucianism- where your position in society must be protected and any perceived threat was dealt with. Think of the witch hunts- and you know how they got confessions, treated the accused and just what rights they (did not) have- this was how the condemned were treated in Japan.
In modern Japan, only murder gets a death sentence. But, is this still too much, or is it too little? What do you think?
A difficult topic to talk or write about but: an overview of palliative care in Japan
This is a difficult topic. This is a guide which should able to give you some guidance if you need it. This guide does NOT offer mental or spiritual advice, just an overview on palliative care.
You may be wondering why the warning- simple: dealing with either life shortening illnesses or end of life care is hard to experience. I have seen family members go through this and it is never easy. This guide should be helpful and it will include my opinions, and where to find help in Japan. If you do comment, please remember this is an extremely difficult topic- everyone has their own opinions and needs.
What is palliative care?
Palliative care helps individuals and families that are dealing with life-shortening illness and end of life care. Life shortening illnesses could be ALS, cancer, motor-neuron disease etc. End of life care is usually helping with pain management, emotional, physical, and spiritual support to those whose time is limited.
What you must remember is that everyone has different needs and wishes. Some end of life treatment plans may include hospice care, home care or hospital care. Additionally, palliative care seeks to neither hasten nor post-pone death. It simple seeks to improve the quality of life.
In developing countries at time of diagnosis 80% of cancer is incurable and the only thing left is palliative care- which is still a ‘new’ concept in may countries but millions of people are seeing the benefits of it.
The best resource I have found to show the benefits of this is a YouTube video. Please check out the ‘further resources’ page for the link.
Going to a hospice does not mean a place to die, for many it is a place to live before death. If you are in a position where palliative care is necessary- remember you are still alive and there are still bills to pay, things to do- life does not stop.
Hospice care takes these worries away from a person at a time when they’re usually extremely tired and don’t have much energy. For cancer patients, they can (and usually do) outlive their prognosis and are discharged from hospice care and in extremely rare circumstances return to a normal life (this is from a terminal prognosis).
For others, it is a place to help prepare one’s self and the family for the end.
Japanese hospice care
There are an estimated 300 hospice programs in Japan since the start of the program in the 1970’s.
Hospice care works with one basic principle: quantity rather than quality. For end-of-life treatment, emotional support and pain relief is at the heart of care. However, the hospice movement was a late movement in Japan. Many other countries had programs and support systems in place before Japan and in some respects Japan is catching up.
Therefore, end-of-life treatment in Japan primordially takes place in hospitals, and at home.
The Japanese hospice palliative care foundation looks to improve the image of palliative care in Japan as it is only seen as a place to die not as a place to live.
Home hospice care starts with a care plan with one member becoming the leader of a persons care. Doctors, nurses, people who supply medical equipment etc come together with the patient and family to talk about their goals of care, what they would like and what their family would like.
Home hospice treatment is supported by doctors and nurses trained in palliative care to ensure that (especially in Japan) terminal cancer patients have all the support they need. Home hospice care is becoming even more important in Japan due to 2 factors: an aging population and a short-fall of hospital beds.
Another reason for the rise of home hospice care is cost. For people under 70, a hospice can cost 469,000 JPY a month with a 70% reduction- this could be as little as 93,000 JPY a month- which is still, in my opinion, an unreasonable amount of money. For those over 70, hospice care costs 57,600 JPY a month- which is still expensive. Home care is cheaper- just a consultation fee, medical equipment fees and care support costs are needed.
However, home hospice care is not what most Japanese want. Many Japanese do not wish to be a burden on their families and would prefer to experience hospice care in a hospital setting. This is one of the things that the Japan Home Hospice Association is trying to combat.
There are brilliant resources in Japanese and English- the English resources are more limited. The key focus of this article was awareness and to give you a better understanding of what palliative care in and what your options are if you are researching it.
I have spoken to many people about food in Japan, whether is about breakfast, lunch, special food, shabu shabu (almost a winter broth) or even snacks and everyone I have spoke to said the same thing: watch the salt.
As this is the month of awareness, let’s take a look at the problems salt, along with other causes, may bring. Welcome to cardiac problems in Japan.
Firstly a definition. Cardiac problems will consider heart disease, heart attacks and cardiovascular disease as well. If this were to be published anywhere else I would have to think about each problem separately but not too many people would be interested in that, do let me know if I’m wrong on that front.
Starting off in a happy place, cardiac issues is one of if not the main causes of death in Japan, like many other highly developed nations. There are many causes for this, not just McDonald’s and fast food. The WHO have ranked 3 heart related conditions as the main causes of death in Japan which were: Ischaemic heart disease (aka Coronary Artery Disease), Aortic aneurysm, and other cardiovascular disease.
However, there have been 42,300 fewer CHD deaths because of medical and surgical treatments from 1980- 2012.
Major health trends
To start with let’s take a look at some general health trends which have contribute towards higher levels of heart disease in Japan. Firstly, Japan has become increasingly Westernized and has been since the 1960’s. While this has had many advantages culturally, economically, socially etc, there has been a negative impact on health.
The major trends that have been seen in Japan are a rise in the number of smokers within Japan, a noticeable difference in BMI- levels are much higher (in 1980, the average BMI for men was 22.5 kg/m^2 and by 2000 this has risen to 23.4kg/m^2); a rise in the number of diagnosed diabetics; an increase in blood pressure.
Side note: blood pressure. Blood pressure has 2 values: a systolic value (the top number) and a diastolic value (the bottom number). The WHO recommends that one’s BP should be 120/80 mm Hg- which is the ‘perfect’ value. High blood pressure is any reading that at rest is over 130/80 mm Hg.
Japan’s blood pressure is worrying- the average systolic blood pressure is 135 mm Hg (which is high) and the mean diastolic reading is 85 mm Hg. This average 135/85 mm Hg puts you into the Hypertension stage 1 category or High blood pressure stage 1 group.
Major factor: salt
One resource I used during my research was the Cardiovascular Risk Assessment Chart by Dietary Factors in Japan (which is a brilliant resource- linked in further information) and the major risk assessment was salt.
Salt is essential to life as we cannot naturally product it but we need it in moderation only. In the UK, it is recommended to have no more than 6 grams of salt a day- the recommended daily limit in Japan is 1.5 grams of salt (which explains why Japan has a lower level of CDV (cardiovascular disease). However, daily recommended limits are not always possible.
Average daily salt intake (from a sample size of 9115 people) was 14.0±5.2 g. This means that the lowest average daily intake was 8.2g. The risk assessment categorizes people into 2 groups based on salt intake high (men and women that consumed more than and including 8g and 7g of salt respectively) and low (those who consumed less than this).
This risk assessment showed that after 29 years, there had been 1070 deaths attributed to CVD. From the 2 salt intake groups, there were 57 deaths from the low salt intake group and 1,013 deaths from the high salt intake group (while there were other factors which contributed to their deaths- numbers are telling).
What factors have contributed towards Japan’s low CVD death rate?
Strangely enough, the Japanese diet has helped (and hindered) CVD in Japan. The main things which can reduce risk is consuming omega 3 (eating fish or rarely via supplements), avoiding sugar (hard to do in Japan), avoid trans fats (again difficult to do), ensure adequate vitamin D intake (either dietary, by being in sunlight or supplements) and controlling iron.
Not surprisingly, the Japanese consume a lot of fish- but the amount the Japanese consume has dropped. In 2016, the Japan Times reported that the average fish consumption as a mean 27.3 Kg a year- which is still a massive amount.
Additionally, the Japanese diet of high levels of fish, fruit, vegetables and (ideally) low salt consumption are the perfect heart diet. However with higher salt consumption and what can only be described as a fast food diet (low vegetables, fruit and fish), CVD is extremely likely and possible.
Soy based products (tofu) are also extremely helpful in reducing CVD risk and its’ benefits have been noted in men and women but especially in post-menopausal women.
CVD is regional in Japan and it has mostly been reduced except in major urban areas (Tokyo and Osaka). In major urban areas, there are higher levels of stress, less time to cook (so more processed food), less time for exercise etc so there are higher levels of CVD.
Further reading- The Japanese heart foundation (JHF)
There is certainly more information on this topic- in English (more research papers than advice) and in Japanese. The best resource I have found was the JHF or Japanese heart foundation (BHF or AHF anyone?).
The JHF have information on diet, research, AED and first aid training and so much more. Please do check it out- there are enough info-graphics that if you have a good scientific mind, you should be okay.