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:

The Purported Benefits of Eating Fish

In the landmark Global Burden of Disease study, researchers compiled the top 20 causes of death and disability. Number one on the list was high blood pressure, two and three was smoke, and the fourth leading cause of loss of life and health was not eating enough fruit. Lack of exercise was number 10, followed by too much sodium, not enough nuts and seeds, not enough whole grains, and then not enough vegetables. Number 18 on the top 20 list was not getting enough long-chain omega-3 fatty acids like DHA and EPA found in seafood, due to their purported protective effect against heart disease. As I discuss in my video Is Fish “Brain Food” for Older Adults?, even years ago when the study was published, researchers were already questioning the benefits of these fish fats, as more and more randomized controlled trials put them to the test and they failed, culminating in the meta-analysis I profiled in my video Is Fish Oil Just Snake Oil? that appeared to put the issue to rest.

Consumption of fish and fish oil wasn’t only hyped for cardiovascular protection, though. Omega-3s have also been touted to treat depression. However, after taking into account all the negative results that went unpublished, there appears to be no benefit for major depression or for preventing suicide, as I explored in my video Fish Consumption and Suicide.

What about omega-3s for the prevention of cognitive decline or dementia? The available randomized controlled trials show no benefit for cognitive function with omega-3 supplementation in studies lasting from 6 to 40 months among healthy older adults.

It may sometimes even make things worse. “Higher current fish consumption predicted worse performance on several cognitive speed constructs. Greater fish consumption in childhood predicted slower perceptual speed and simple/choice reaction time.” This may be due to neurotoxic contaminants, such as mercury, in seafood. We’ve known that the developing brain is particularly sensitive to the damaging effects of mercury, but maybe the aging brain is as well.

This would explain results that have shown higher omega-3 levels to be associated with high levels of cognitive impairment and dementia. More EPA (eicosapentanoic acid) was found in the cognitively impaired, and more DHA (docosahexanoic acid) was found in the demented, presumably because of pollutants like mercury and polychlorinated biphenyls (PCBs) in seafood that have been related to cognitive impairment and Alzheimer’s disease.

The same cognitive “functions disrupted in adults, namely attention, fine-motor function and verbal memory, are similar to some of those previously reported in children with prenatal exposures,” that is, exposed in the womb. And, the adults exposed to mercury through fish consumption didn’t have only subtle EEG brain wave changes, but “observable deficits in neurobehavioral performance measures,” such as poorer performance on tests of fine motor speed and dexterity, as well as concentration, for example. “Some aspects of verbal learning and memory were also disrupted by mercury exposure,” and the greater the mercury levels, the worse they did.

That study, however, was done downstream of a gold mining operation, which uses a process that uses lots of mercury. Other such studies were done on people eating fish next to chemical plants or toxic spills, or eating whale meat. What about a more mainstream population? An “elite group of well-educated participants”—most were corporate executives like CEOs and CFOs––all living in Florida and wealthy enough to afford so much seafood that at least 43 percent exceeded the U.S. Environmental Protection Agency’s safety limit for mercury were studied. Researchers found that excessive seafood intake, which they defined as more than three to four servings per month of large-mouth fish like tuna, snapper, and bass, elevates mercury levels and causes cognitive dysfunction, resulting in about a 5 percent drop in cognitive performance. This may not seem like much, but it’s “a decrement that no one, let alone a health-conscious and achievement-oriented person, is likely to welcome.”

“It is worth noting the irony in the situation; that is, the fact that corporate executives who chose to overconsume seafood for health reasons sustained a drop in their executive functions. Yet, if a 4.8% drop in executive function due to excessive seafood intake occurs in highly functioning, healthy adults with ample cognitive reserve, the major concern for further study is whether similar [mercury] level elevations in individuals already suffering from cognitive decline might result in substantially greater declines,” particularly with cognitive decline, dementia, and seafood consumption on the rise.


Fruit deficiency is the number-one dietary risk factor? For more, see Inhibiting Platelet Aggregation with Berries.

But what about th Inuit? See Omega-3s and the Eskimo Fish Tale.

For more on the shift of the evidence on fish and heart disease, see my Is Fish Oil Just Snake Oil? video.

The greatest danger of mercury exposure may be for children, as I discuss in Mercury vs. Omega-3s for Brain Development and How Long to Detox from Fish Before Pregnancy?.

Other videos on the effect of fish contaminants and health among adults include Fish and Diabetes and Fish Consumption and Suicide.

Mercury is not the only neurotoxic contaminant of seafood, though. See Diet and Amyotrophic Lateral Sclerosis (ALS) and ALS (Lou Gehrig’s Disease): Fishing for Answers.

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 Many Servings of Fruits and Vegetables to Improve Mood?

“Thousands of papers have been published on the important topic of what determines people’s subjective well-being and psychological health,” but what about the potential influence of the different kinds of foods people eat? I explore this in my video Which Foods Increase Happiness?.

“The rising prevalence of mental ill health is causing considerable societal burden. Inexpensive and effective strategies are therefore required to improve the psychological well-being of the population….A growing body of literature suggests that dietary intake may have the potential to influence psychological well-being.” Dietary intake of what? Well, given the strong evidence base for the health benefits of fruits and vegetables, researchers started there.

Cross-sectional studies from all over the world support this relationship between happiness and intake of fruits and vegetables. Those eating fruits and vegetables each day have “a higher likelihood…of being classified as ‘very happy,’” suggesting “a strong and positive correlation between fruit and vegetable consumption and happiness” and perhaps feelings of optimism, too.

The largest such study was done in Great Britain, where “a dose-response relationship was found between daily servings of [fruits and vegetables] and both life satisfaction and happiness,” meaning more fruits and veggies meant more happiness. People who got up to seven or eight servings a day “reported the highest life satisfaction and happiness,” and these associations remained significant even after controlling for factors such as income, illness, exercise, smoking, and body weight, suggesting fruit and vegetable consumption didn’t just act as a marker for other healthy behaviors.

But how could eating plants improve happiness on their own? Well, many fruits and veggies contain higher levels of vitamin C, which is “an important co-factor in the production of dopamine,” the zest-for-life neurotransmitter. And, the antioxidants in fruits and vegetables reduce inflammation, which may lead “to higher levels of eudaemonic well-being.”

Eudaemonic? What’s that? “Aristotle’s notion of eudaemoniadescribed the highest of all human goods as the realization of one’s true potential,” which was the aim of a study: Researchers wanted to know whether eating fruits and vegetables was “associated with other markers of well-being beyond happiness and life satisfaction.” So, they tested whether consuming fruits and veggies was associated with “greater eudaemonic well-being—a state of flourishing characterized by feelings of engagement, meaning, and purpose in life.”

The researchers followed a sample of about 400 young adults for 13 days, and, indeed, the young adults who ate more fruits and veggies “reported higher average eudaemonic well-being, more intense feelings of curiosity, and greater creativity.” This could be followed on a day-by-day basis: greater well-being on the days they ate healthier. “These findings suggest that [fruit and vegetable] intake is related to other aspects of human flourishing, beyond just feeling happy.”

Not so fast, though. Instead of eating good food leading to a good mood, maybe the good mood led to eating good food. Experimentally, if you put people in a good mood, they rate healthy foods, like apples, higher than indulgent foods, like candy bars. Given a choice between M&M’s and grapes, individuals in a positive mood were more likely to choose the grapes. The results of these studies “lend support to a growing body of research that suggests that positive mood facilitates resistance to temptation.” Who needs comfort foods when you’re already comforted? It’s like which came first, the stricken or the egg? Yes, eating eggs may increase our likelihood of chronic disease, but maybe chronic disease also increases our likelihood of eating unhealthy foods. Which came first, the mood or the food?

If only there were a study that, instead of looking at well-being and diet on the same day, looked to see if there’s a correlation between what you eat today and how you feel tomorrow.

There is. In the study, researchers found the same “strong relationships between daily positive [mood] and fruit and vegetable consumption.” Additionally, “[l]agged analyses showed that fruit and vegetable consumption predicted improvements in positive [mood] the next day, not vice versa…On days when people ate more fruits and vegetables, they reported feeling calmer, happier and more energetic than they normally do…[and] also felt more positive the next day.” So, eating fruits and vegetables really “may promote emotional well-being.” Single bouts of exercise can elevate one’s mood, so why not the same with healthy food?

How many fruits and vegetables? Seems we “need to consume approximately 7.2 daily servings of fruit or 8.2 servings of vegetables to notice a meaningful change” in mood.


For more on this topic, I invite you to watch Plant-Based Diets for Improved Mood & Productivity.

I mentioned in passing the benefits of exercise for boosting mood, and here is more on maximizing movement:

Sadly, there are 20 times more studies published on health and depression than there are on health and happiness. There is growing interest in the so-called positive psychology movement, though. See my video Are Happier People Actually Healthier? for more.

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: