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:

Boosting Moods with Foods

In my video Plant-Based Diets for Improved Mood and Productivity, I discuss a recent systematic review and meta-analysis of dietary patterns and depression that concluded that a healthy diet pattern was “significantly associated with a reduced odds of depression.” However, out of the 21 studies the researchers were able to find in the medical literature, they were only able to find one randomized controlled trial, the study design that provides the highest level of evidence. It was the study I profiled in my Improving Mood Through Diet video, in which removing meat (including fish and poultry) and eggs improved several mood scores in just two weeks.

We’ve known those eating plant-based diets tend to have healthier mood states—less tension, anxiety, depression, anger, hostility, and fatigue—but we couldn’t tell if it was cause and effect until it was put to the test, which researchers finally did. What could account for such rapid results?

Eating a vegetarian diet gives you a better antioxidant status, which may help with depression, as I discussed in Antioxidants and Depression. Also, as I previously addressed in A Better Way to Boost Serotonin, consumption of even a single carbohydrate-rich meal can improve depression, tension, anger, confusion, sadness, fatigue, alertness, and calmness scores among patients with premenstrual syndrome. But what about long term?

Overweight men and women were randomized into two groups: one following a low-carb, high-fat diet and the other following a high-carb, low-fat diet for a year. By the end of the study, who had less depression, anxiety, anger, hostility, feelings of dejection, tension, fatigue, confusion, fewer mood disturbances, and better vigor? “The sustained improvements in mood in the LF [low-fat] group compared with the LC [low-carb] group are consistent with results from epidemiological studies showing that diets high in carbohydrate and low in fat and protein are associated with lower levels of anxiety and depression and have beneficial effects on psychological well-being.”

The overall amount of fat in the research subjects’ diet didn’t change significantly, though. But the type of fat did. Their arachidonic acid intake fell to zero. Arachidonic acid is an inflammatory omega-6 fatty acid that can adversely affect mental health via a “cascade of neuroinflammation”—that is, it may inflame your brain. High levels of arachidonic acid in the bloodstream have been associated with a greater likelihood of suicidal risk and major depressive episodes, for example. How can we stay away from the stuff? Americans are exposed to arachidonic acid primarily through chicken and eggs. So, when we remove eggs, chicken, and other meat we eliminate preformed arachidonic acid from our diet.

Although high-quality treatment studies examining diet’s impact on depression are scarce, there was the successful two-week trial discussed earlier and, even better, a twenty-two-week study. Overweight or diabetic employees of a major insurance corporation received either weekly group instruction on a whole food, plant-based diet or no diet instruction for five and one-half months. There was no portion size restriction, no calorie counting, no carb counting, and no change in exercise. No meals were provided, but the company cafeteria did start offering daily plant-based options such as lentil soup, minestrone, and bean burritos.

Participants ate no meat, eggs, dairy, oil, or junk, yet they reported greater diet satisfaction compared with the control group participants who had no diet restrictions. More participants in the plant-based intervention group reported improved digestion, increased energy, and better sleep than usual at week 22 compared with the control group. They also reported a significant improvement in physical functioning, general health, vitality, and mental health. The plant-based group beat out controls on nearly every measure.

There were also significant improvements in work productivity, thought to be due in large part to their improvements in health. What this study demonstrated is that a cholesterol-free diet is acceptable, not only in research settings but also in a typical corporate environment, improving quality of life and productivity at little cost. All we needed was a large, controlled trial for confirmation, but we didn’t have such a thing… until now.

A study of ten corporate sites across the country from San Diego, California, to Macon, Georgia, with the same set-up as before found that a plant-based nutrition program in a multi-center, corporate setting improves depression, anxiety, and productivity. Significant improvements were found in depression, anxiety, fatigue, emotional well-being, and daily functioning. “Lifestyle interventions have an increasingly apparent role in physical and mental health, and among the most effective of these is the use of plant-based diets.”


The pilot data on workplace interventions can be found in my videos Slimming the Gecko and Plant-Based Workplace Intervention.

Diet can help at home, too. See:

And, for background on the inflammatory fatty acid arachidonic acid, see my videos Inflammatory Remarks About Arachidonic Acid, Chicken, Eggs, and Inflammation, and Chicken’s Fate Is Sealed.

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: