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Ancient Hawaiians were once one of the most powerful communities in the Pacific. Relatively isolated from foreign intervention, the early inhabitants of the islands enjoyed robust health and were in peak physical condition – it was a requirement of the rugged land and the rough seas, a side effect of living in a paradise of abundance and plenty. Yet, the colonization and subsequent annexation of the islands led to many cultural changes that eventually altered the traditional methods of farming, cooking and eating. Western industry introduced processed foods and used local farmlands to grow profitable crops like sugarcane, thereby squeezing out much of the traditional foodways. Fast forward fifty years to the present day, where 34.7 percent of native Hawaiians are obese, 19.7 percent suffer from heart disease and are twice as likely to be diagnosed with diabetes than white residents of the islands. It’s a far cry from Hawaii’s ancestral heritage.

The Hawaii Diet was created as a response to the high death rates and chronic lifestyle disease diagnoses among native Hawaiians. At its inception, the diet began as the Waianae Diet Program at the Waianae Coast comprehensive Health Center, as that region on the island of Oahu has the highest concentration of native Hawaiians and, thus, the highest concentration of Pacific Islanders in poor health.

Among the health professionals involved was Terry Shintani, M.D., J.D., M.P.H., a physician interested in nutrition and traditional diets.

Shintani was most intrigued by what he called “The Hawaiian Paradox.” In the early days of the Waianae Diet Program, officials saw startlingly rapid results – cholesterol levels falling 14.1 percent, the cessation of diabetes medication, and an average weight loss of 17 pounds in three weeks – while patients consumed more food and, specifically, more carbohydrates than before. These results were published in the American Journal of Clinical Nutrition, and the program was granted the highest national award for health promotion in a community by the Secretary of Health and Human Services. From this success, Dr. Shintani developed the Hawaii Diet.

Hawaii-Diet-CoverAt its most basic, the Hawaii Diet is a holistic health program that emphasizes whole-food nutrition and whole-person wellness. It integrates modern nutrition science with ancient wisdom and cultural practices, and is based upon traditional eating patterns. From this foundation, those participating in the Hawaii Diet are allowed to eat to satiety – the program is not a deprivation diet, but rather involves a diverse array of filling foods and is customizable to the needs of the individual.

So far, the Hawaii Diet isn’t unlike the Paleo diet in this respect; however, the food is where the two paths deviate.

The Hawaii Diet Pyramid emphasizes whole grains and “other staples” at the base of the structure, with 8-13 servings daily. Next are fruits and vegetables, with a 3-5 servings each, while non-dairy calcium foods and no-cholesterol protein- and iron-rich foods are recommended at 2-3 servings daily. At the top of the pyramid are non-fat dairy foods, low-fat fish, poultry and meat, and fats, oils and sweets, all considered to be “optional” foods not necessary for health.

The Hawaii Diet includes the Shintani Mass Index of Food (SMI), a system developed exclusively for the program that is similar to the glycemic index. The SMI examines the amount of weight of food per calorie, and in effect calculates the mass-to-energy ratio of various foods. The theory behind the SMI is that foods with a higher number – meaning, the greater the mass per calorie provided – can help with weight loss through increased fiber and bulk, and therefore increased satiety, with low caloric cost.

The Hawaii Diet is based upon a foundation of whole, unrefined, complex carbohydrates derived from whole grains and starchy tubers like sweet potato, or the traditional Hawaiian breadfruit or taro root. Fruits and vegetables receive liberal praise, but sources of complete protein are not emphasized; instead, Shintani writes that humans “don’t need a lot of protein to thrive” and that most Americans in fact consume too much.

In his discussion of protein, Shintani also touches on the ketogenic diet as one of the many popular diet trends that should be removed from its lofty pedestal. He writes: “On a ketogenic diet, however, the dieter is encouraged to eat ‘rich’ foods, such as meats, cheese, and sauces, along with some greens. This is one of the selling points of this diet. It is very inviting to people who are dying to find a diet that allows them to eat their favorite rich foods.”


Shintani himself practices a mostly vegan diet, and encouraged most of his high-risk patients in the Waianae Coast Comprehensive Health Center to begin their wellness journey in such a way.

In The Hawaii Diet, Shintani recommends moderate exercise, and emphasizes play as an important aspect of physical activity. He does not recommend vitamin or mineral supplements, but instead highlights the importance of whole-food nutrition. Shintani writes that “wholeness is the key to good health,” and this theme has as much to do with whole-person theories of wellness as it does supplements.

In fact, some of the most important takeaways from The Hawaii Diet have nothing to do with food, but instead concern the “subtle intangibles that surrounded the act of eating in ancient Hawaii,” according to Shintani. These include:

Eating together (aloha).

Eating in peace (mana).

Offering prayers of gratitude before eating (pono).

Eating local foods in season (lokahi).

Preparing food with love (aloha).

Eating with great appreciation of its source (kumu).

In these ways, the Hawaii Diet is most similar to Paleo – those practicing an ancestral pattern of eating understand that the food is only a small part of the equation, and that for real healing to occur there must be widespread change across an entire lifestyle. This means getting better sleep, managing stress, playing, being in community, engaging in smart exercise, connecting with the earth and expressing gratitude for our food’s miraculous origins.

These intangibles fuse together the spiritual and mental with the physical, and this is an important if underutilized aspect of any successful program: it’s not just about what you eat, but how you eat it and why.


Shintani, Terry. The Hawaii Diet. Pocket Books, New York, NY. 1999. Print.