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:

Changing Protein Requirements

There has been a history of enthusiasm for protein in the nutrition world. A century ago, the protein recommendations were more than twice what we know them to be today. This enthusiasm peaked in the 1950s with the United Nations identifying protein deficiency as a serious, widespread, global problem. According to them, there was a worldwide protein gap that needed to be filled. This was certainly convenient for the U.S. dairy industry, who could then “dump” their postwar surplus of dried milk “in developing countries than to have to just bury it in the United States as was contemplated by the Department of Agriculture at one point.” But all of this led to the phenomena I cover in my video The Great Protein Fiasco.

It started in the 1930s with a disease of malnutrition called kwashiorkor, which was assumed to be caused by protein deficiency. The disease was famously discovered by Dr. Cicely Williams, who then spent the latter part of her life debunking the very condition she had first described. It turns out “there is no real evidence of dietary protein deficiency.” The actual “cause of kwashiorkor remains obscure,” but fecal transplant studies suggest changes in gut flora may be a causal factor. How could the field of nutrition have gotten it so spectacularly wrong? 

A famous editorial about the nutrition profession started with these words: “The dispassionate objectivity of scientists is a myth. No scientist is simply involved in the single-minded pursuit of truth, he [or she] is also engaged in the passionate pursuit of research grants and professional success. Nutritionists may wish to attack malnutrition, but they also wish to earn their living in ways they find congenial.”

“This inevitably encourages researchers to ‘make a case’ for the importance of their own portion of the field and ‘their nutrient,’” which in this case was protein.

Science did eventually prevail. There was a “massive recalculation of human protein requirements in the 1970s which ‘at the stroke of a pen’ closed the ‘protein gap’ and destroyed the theory of pandemic ‘protein malnutrition.’” Infant protein requirements went from a recommended 13 percent of daily calories down to 10 percent, 7 percent, and then down to 5 percent. To this day, however, there are still those obsessing about protein. For example, those promoting Paleolithic diets try to make the case for protein from an evolutionary perspective.

Okay, so what is the perfect food for human beings that has been fine-tuned over millions of years to contain the perfect amount of protein just for us?

Human breast milk.

“If high-quality protein was the ‘nutrient among nutrients’” that helped us build our big brains over the last few million years, “one would expect that importance to be resoundingly reflected in the composition of human breast milk,” especially because infancy is the time of our most rapid growth. But this is patently not the case. “In fact, human breast milk is one of the lowest-protein milks in the mammalian world…” Indeed, it may have the lowest protein concentration of any animal in the world, at less than 1 percent protein by weight. This is one of the reasons why feeding straight cow’s milk to babies can be so dangerous. And, although the protein content in human milk has been described as extremely low, it’s exactly where it needs to be—at the natural, normal level for the human species, fine-tuned over millions of years.

Adults require no more than 0.8 or 0.9 grams of protein per healthy kilogram of body weight per day, which is about your ideal weight in pounds multiplied by four and then divided by ten. So, someone whose ideal weight is 100 pounds may require up to 40 grams of protein a day. On average, they probably only need about 30 daily grams of protein, which is 0.66 grams per kilogram, but we round it up to 0.8 or 0.9 grams because everyone’s different and we want to capture most of the bell curve. 

People are actually more likely to suffer from protein excess than protein deficiency. “The adverse effects associated with long-term high protein/high meat intake” diets may include disorders of bone and calcium balance, disorders of kidney function, increased cancer risk, disorders of the liver, and worsening of coronary artery disease. Considering all of these potential disease risks, there is currently no reasonable scientific basis to recommend protein consumption above the current recommended daily allowance.


The “low” protein level in human breast milk (about 6 percent of calories) doesn’t mean adults only need that much. A 15-pound infant can suck up to 500 calories a day, but an adult who’s ten times heavier doesn’t typically consume ten times more food (5,000 calories). Although we weigh ten times more, we may only eat four or five times more. So, our food does need to be more concentrated in protein. Nevertheless, people tend to get way more than they need. See my video Do Vegetarians Get Enough Protein?.

Plant protein sources are preferable. See, for example:

But what about protein quality? Should we try to mix certain foods together at meals? See The Protein Combining Myth.

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:

Cancer-Causing Caramel Color

Caramel coloring may be the most widely consumed food coloring in the world.  Unfortunately, its manufacture can sometimes lead to the formation of a carcinogen called methylimidazole, which was identified as a cancer-causing chemical in 2007. For the purposes of its Proposition 65 labeling law, California set a daily limit at 29 micrograms a day. So, how much cancer might caramel-colored soft drinks be causing? We didn’t know…until now… My video Which has more Caramel Coloring Carcinogens: Coke or Pepsi? explores these questions and more.

Researchers tested 110 soft drink samples off store shelves in California and around the New York metropolitan area, including Connecticut and New Jersey. None of the carcinogen was found in Sprite, which is what you’d expect since Sprite isn’t caramel-colored brown. Among sodas that are, the highest levels were found in a Goya brand soda, while the lowest levels were in Coke products, which were about 20 times less than Pepsi products. Interestingly, California Pepsi was significantly less carcinogenic than New York Pepsi. “This supports the notion that [labeling laws like] Proposition 65…can incentivize manufacturers to reduce foodborne chemical risks…” To protect consumers around the rest of the country, federal regulations could be a valuable approach to reducing excess cancer risk—but how much cancer are we talking about?

Johns Hopkins researchers calculated the cancer burden, an estimate of the number of lifetime excess cancer cases associated with the consumption of the various beverages. So, at the average U.S. soda intake, with the average levels of carcinogens found, Pepsi may be causing thousands of cancer cases, especially non-California Pepsi products, which appear to be causing 20 times more cancer than Coke. Of course, there’s no need for any of them to have any these carcinogens at all “as caramel colorings serve only a cosmetic purpose [and] could be omitted from foods and beverages…” But we don’t have to wait for government regulation or corporate social responsibility; we can exercise personal responsibility and just stop drinking soda altogether.

Cutting out soda may reduce our risk of becoming obese and getting diabetes, getting fatty liver disease, suffering hip fractures, developing rheumatoid arthritis, developing chronic kidney disease, and maybe developing gout, as well.

In children, daily soda consumption may increase the odds of asthma five-fold and increase the risk of premature puberty in girls, raising the likelihood they start getting their periods before age 11 by as much as 47 percent.

If we look at the back of people’s eyes, we can measure the caliber of the arteries in their retina, and the narrower they are, the higher the risk of high blood pressure, diabetes, and heart disease. Researchers performed these kinds of measurements on thousands of 12-year-olds and asked them about their soda drinking habits. Their findings? Children who consume soft drinks daily have significantly narrower arteries. “The message to patients can no longer remain the simplistic mantra ‘eat less, exercise more.’” It matters what you eat. “[S]pecific dietary advice should be to significantly reduce the consumption of processed food and added sugar and to eat more whole foods.”


Prop 65 is lambasted by vested interests, but, as I mentioned, it may push manufacturers to make their products less carcinogenic. Other Prop 65 videos include:

For more background on caramel coloring, see my video Is Caramel Color Carcinogenic?.

There are other soda additives that are potentially toxic, too. See my three-part series on phosphates:

Other coloring agents are less than healthy. For more on this, see Artificial Food Colors and ADHD and Seeing Red No. 3: Coloring to Dye For.

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: