Reversing Massive Obesity With Diet

Dr. Walter Kempner introduced the first comprehensive dietary program to treat chronic kidney disease and, in doing so, also revolutionized the treatment of other disorders, including obesity. Kempner was Professor Emeritus of Medicine at Duke, where he came up with the so-called rice diet, which basically consisted of rice, sugar, fruit, and fruit juices, was extremely low in sodium and fat, and included no animal fat, no cholesterol, and no animal protein. The sugar was added as a source of calories so people wouldn’t lose too much weight. But some people need to lose weight, so he started treating obese patients with a lower calorie version of the diet, which I discuss in my Can Morbid Obesity Be Reversed Through Diet? video.

He published an analysis of 106 patients who each lost at least 100 pounds. Why 106? Kempner simply picked the last 100 people who lost more than 100 pounds, and, by the time he finished reviewing their charts, 6 more had joined the so-called century club. Average weight loss among them was 141 pounds. “This study demonstrates that massively obese persons can achieve marked weight reduction, even normalization of weight, without hospitalization, surgery, or pharmacologic intervention…[O]ne important fact to be gained from this study is that, despite the misconception to the contrary, massive obesity is not an uncorrectable malady. Weight loss can be achieved, massive obesity can be corrected, and it can be done without drastic intervention.”

Well, Kempner’s rice diet is pretty drastic, so definitely don’t try this at home. In fact, the rice diet is dangerous. It’s so restrictive that it may cause serious electrolyte imbalances, unless the patient is carefully medically supervised with frequent blood and urine lab testing. Dangerous? Says who? Said the world’s number-one advocate for the rice diet: Dr. Kempner himself.

The best, safe approximation of the diet, meaning low in sodium and without fat, protein, or cholesterol from animals, would be a vitamin B12-fortified diet centered around whole, unprocessed plant foods. However, even a medically supervised rice diet could be considered un-drastic compared to procedures like getting one’s internal organs stapled or rearranged, wiring someone’s jaws shut, or even undergoing brain surgery.

Attempts have been made to destroy the parts of the brain associated with the sensation of hunger, by irradiation or going in through the skull and burning them out. “It shows how ineffective most simpler forms of treatment are that anyone should think it reasonable to produce irreversible intracranial lesions in very obese patients.” The surgeons defended these procedures, however, explaining that their “justification in attempting the operation is, of course, the very poor results of conventional therapy in gross obesity, and the dark prognosis, mental and physical, of the uncorrected condition.” In reply, a critic countered, “Such strong feelings [about how dark the prognosis is] run the risk of being conveyed to the patient, to the effect of masking the operative dangers and steam-rolling the patient’s approval.” The surgeon replied, “If any ‘steamrolling’ is taking place, it comes rather from obese patients who sometimes threaten suicide unless they are accepted for experimental surgical treatment.”

As of 2013, the American Medical Association officially declared obesity a disease, by identifying the enormous humanitarian impact of obesity as requiring the medical care and attention of other diseases. Yet the way we treat diseases these days involves drugs and surgery. Anti-obesity drugs have been pulled from the market again and again after they started killing people—an unrelenting fall of the pharmacological treatment of obesity.

The same has happened with obesity surgeries. The procedure Kempner wrote about was discontinued because of the complication of causing irreversible cirrhosis of the liver. Current procedures include various reconfigurations of the digestive tract. Complications of surgery appear to occur in about 20 percent of patients, and nearly one in ten of which may be death. In one of the largest studies, 1.9 percent of patients died within a month of the surgery. “Even if surgery proves sustainably effective, the need to rely on the rearrangement of [our] anatomy as an alternative to better use of feet and forks [that is, diet and exercise] seems a societal travesty.”


For more on Kempner and his rice diet, see my videos:

Learn more on the surgical approach in Reversing Diabetes with Surgery and Stomach Stapling Kids.

And, for more on weight, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Reverse Type 2 Diabetes

 

Diabetes reversal, not just treatment, should be a goal in the management of type 2 diabetes. Type 2 diabetes can be reversed not only with an extremely low calorie diet, but it can  also be reversed with an extremely healthy diet. Could it be because an extremely healthy diet is also low in calories? This is the topic of my video Diabetes Reversal: Is It the Calories or the Food 

Study subjects lost as much weight on a green, leafy vegetable-packed plant-based diet as those who were on a semi-starvation diet based on liquid meal replacements. So, does it matter what we’re eating as long as we’re eating few enough calories to lose 15 pounds a month?

Even if diabetes reversal is just about calorie restriction, instead of subsisting off largely sugar, powdered milk, corn syrup, and oil (common ingredients in some liquid diet drinks) on the plant-based diet at least one can real food—in fact, as many low-cal veggies as desired. So, even if it only works because it’s just another type of calorie-restricted diet, it’s certainly a healthier version. But, even participants in the study who did not lose weight—or even gained weight eating enormous quantities of whole healthy plant foods—appeared to improve their diabetes. Thus, the beneficial effects of this kind of diet appear to extend beyond weight loss.

The successful treatment of type 2 diabetes with a plant-based diet goes back to the 1930s, providing “incontestable evidence” that a diet centered around vegetables, fruits, grains, and beans was more effective in controlling diabetes than any other dietary treatment. In a randomized controlled trial, insulin needs were cut in half and a quarter of the subjects ended up off insulin altogether. But, again, this was a low-calorie diet. Walter Kempner at Duke University School of Medicine reported similar results 20 years later with his rice and fruit diet studies, showing for the first time documented reversal of diabetic retinopathy in a quarter of his patients, something never even thought possible. One patient, for example, was a 60-year-old diabetic woman already blind in one eye and who could only see contours of large objects with the other. Five years later, while on the diet, instead of her vision getting worse, it got better. She “could make out faces and read signs and large newspaper print,” and got off insulin, had normal blood sugars, and had a 100-point drop in her cholesterol. Another patient went from only being able to read big headlines to being able to read newsprint four months later. What was behind these remarkable reversals? Was it because the diet was extremely low-fat or because there was no animal protein or animal fat? Or, was it because the diet was so restrictive and monotonous that the patients lost weight and improved their diabetes that way?

To tease this out, we needed a study where researchers switched people to a healthy diet, but forced them to eat so much they didn’t lose any weight. Then, we could see if a plant-based diet has unique benefits independent of all the weight loss. For that, we had to wait another 20 years until a study in the 1970s. In it, diets were designed to be weight-maintaining. Participants were weighed every day, and, if they started losing weight, the researchers made them eat more food—in fact, so much food that some of the participants had trouble eating it all, but they eventually adapted. Thus, there were no significant alterations in body weight despite restrictions of meat, dairy, eggs and processed junk, and there were enough whole plant foods—whole grains, beans, vegetables, and fruit—to provide 65 grams of fiber a day, four times what the Standard American Diet provides.

The control diet they used was the conventional diabetic diet, which actually had nearly twice the fiber content of the Standard American Diet, so it was probably healthier than what they had been used to eating. So, how did the even healthier diet group do? With zero weight loss, did the dietary intervention still help? The study compared the number of units of insulin with which subjects had to inject themselves daily before and after going on the plant-based diet. Overall, despite no change in weight, insulin requirements were cut about 60 percent, and half of the diabetics  were able to get off insulin altogether. Was this after five years, or after seven months, as had been the case in the other studies discussed above? No.

It was after 16 days.

To be clear, we’re talking about diabetics who had had diabetes as long as 20 years, injecting 20 units of insulin a day, getting off insulin altogether in as few as 13 days, thanks to less than two weeks on a plant-based diet. Patient 15, for example, had injected 32 units of insulin while on the control diet, and then, 18 days later, none. Lower blood sugars on 32 units less insulin.

That’s the power of plants.

As a bonus, their cholesterol dropped like a rock to under 150 on average in 16 days, making them nearly heart attack proof as well. Just as “moderate changes in diet usually result in only modest reductions” in cholesterol, asking people with diabetes to make moderate changes often achieves equally moderate results, which is one possible reason why most end up on oral drugs, injections, or both. Everything in moderation may be a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, moderate amputations. Moderation in all things is not necessarily a good thing.

The more we, as physicians, ask from our patients, the more we—and they—get. The old adage, “shoot for the moon,” seems to apply. It “may be more effective than limiting patients to small steps that may sound more manageable but are not sufficient to actually prevent disease progression.”


Although I have dozens of videos about diabetes, I think Diabetes Reversal: Is It the Calories or the Food may be the single most powerful one I‘ve made. Please share this life-changing, life-saving video with anyone you know who has type 2 diabetes or is at risk for the dreaded disease. As far as I’m concerned, it should be required viewing for every healthcare practitioner. I wish I had seen it when I was a medical student!

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This is the final installment of a three-part series. If you missed the first two, check out Reversing Diabetes with Surgery and Reversing Diabetes with Food.

For more on the remarkable work of Dr. Kempner, see:

For more related videos, give one of these a try!

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Choosing to Have a Normal Blood Pressure

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many “low”-salt diets can be considered high-salt diets. That’s why it’s critical to understand what the concept of “normal” is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a “normal” salt intake can lead to a “normal” blood pressure, which can help us to die from all the “normal” causes, like heart attacks and strokes.

Doctors used to be taught that a “normal” systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone’s blood pressure creeps up as we get older. And if that’s normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake—ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we’d be protected. Of course, to test that theory you’d have to find a population in modern times that doesn’t use salt, eat processed food, or go out to eat. For that, you’d have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that’s like saying they have a diet deficient in Twinkies. They’re the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn’t drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we’d do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake—that is, a normal-for-the-human-species salt intake—and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn’t been invented yet.

His diet wasn’t just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner’s rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year—causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood PressureShaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won’t everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with DietHow to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can’t get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you’re exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through Diet?.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: