Thoughts on the Kempner Rice Diet

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Recently, Denise Minger wrote a thought provoking post “In Defense of Low Fat“. Denise is the author of a book called “Death by Food Pyramid” and came to fame writing a very thorough analysis of the China Study, which many people, (myself included) thought was far, far superior to the original analysis by the author T. Colin Campbell. I admire her open-mindedness and she has clearly put much work and thought into her latest post, too. Her humor also makes her writing quite special, and I encourage you to read it, even though it may be the longest blog post ever written. I quite agree with her main point that we cannot simply ignore evidence that contradicts us, but need to look closer. However, I do not agree with all her conclusions in her latest post, and the numerous comments made have not really addressed the key deficits of her arguments.

Denise describes the Rice Diet used by Kempner which consisted of rice, sugar and fruits and juice. This is extremely low in fat (<10%) as opposed to 20-30% of typical ‘low fat’ diets. Denise’s hypothesis is that at extremely low fat states, something ‘magic’ happens. Kempner was a clinician at Duke University in the 1930s who treated over 18,000 patients with this diet of refined carbs. And Denise states that it worked ‘ridiculously well’. There were 3 main groups of patients treated, as far as I can see – kidney disease, malignant hypertension and obesity/T2D.Minger1

So, this is taken as evidence that this extremely low fat diet works because it is extremely low in fat. That’s not accurate. We can say that the Rice Diet works, but we cannot infer that it works because it is low in fat. That is like saying that both antibiotics Amoxil and Azithromycin work for pneumonia because both start with the letter ‘A’. No, we can only say that it does work, but not why.

Further, we need to consider each disease separately. Why would low fat work for kidney disease at all? Why would the same mechanism cure kidney disease and high blood pressure and obesity all at the same time. Might not there be separate mechanisms? Let’s take a look.

Kidney Disease

Now, I’m a nephrologist (kidney specialist), so I’m not going to accept some hand-waving argument that low fat diets improve kidney disease. There are hundreds of different kinds of kidney disease. What kidney disease was Kempner treating? It was not diabetes or hypertension, but primary kidney disease or glomerulonephritis. Statistically speaking, we can assume that the majority of this was IgA nephritis – the most common type of inflammation in the kidney. Why would a low fat diet work here? There is no reason to think that it would.

However, a percentage of IgA nephritis is caused by dietary lectins (carbohydrate binding proteins) and reactions to other food antigens. Primary amongst these are gliaden and bovine serum albumin. Gliadin you probably know as the problem in gluten and celiac disease. There is a well described association between IgA nephritis and celiac disease. In other words, celiac disease and IgA nephritis often co-exist and are caused by a reaction to the dietary lectin, gliadin. The other major dietary problem in IgA nephritis is postulated to be bovine serum albumin, which you may have guessed is found in dairy products and cow’s milk.

In fact, there have been studies on and off using a so-called ‘elimination diet’ whereby all foods are eliminated with the gradual reintroduction of foods that are low in antigens (avoiding mostly wheat and dairy). In this study 11 of 12 patients improved. Not because it was low in fat (because it wasn’t), but because they removed dietary lectins and other antigens. The Kempner diet, with only rice and fruit and sugar was similarly a low antigen diet. So this may well have worked for IgA nephritis, but not because it was low in fat, but because it eliminated wheat (gliadin) and dairy (bovine serum albumin).

So, yes, the Kempner Rice Diet may have worked well in kidney disease – as shown in other elimination diet studies of this disease as well. But the mechanism is not the low fat.

Malignant Hypertension

The second major area that Kempner describes success is in the treatment of malignant hypertension. This is high blood pressure on Mark McGwire dose steroids. Remember that this was the 50s where there was just about no treatment for high blood pressure other than lying down in a dark room and thinking relaxing thoughts. Most of the drugs that we currently use for lowering blood pressure simply did not exist at that time. So high blood pressure was a really big problem, because there was essentially no treatment.

But the Rice Diet worked. But why? One of the things we have known for at least a half a century is that sodium restriction can lower blood pressure. To be sure, I don’t think there is any benefit to a low sodium diet in the person without high blood pressure. But that’s not the situation here. Here we have super super high blood pressure without any drugs to treat it. In the land of the blind, the one-eyed man is king. The Rice Diet has virtually zero sodium! If you kept on it, there’s a very good chance your blood pressure will go down – maybe even enough to save your life.

It doesn’t seem plausible to me to say that the Rice Diet worked because it was low in fat. It is much more likely that it worked because it was an extreme salt restriction diet. You could have also eaten an all olive oil diet and done well. Same goes for the claim that heart failure is treated. Yes, because it is a zero sodium diet.

Obesity

Here’s the big one. The Rice Diet was CARBOCALYPSE, as Denise describes with all refined carbs, yet people lost weight and reversed their type 2 diabetes. This shoots an arrow directly into the eye of the Low Carb Crazies, right?  Well, not quite.

So here’s the diet:Minger2

A patient takes an average of 250 to 350 gm. of rice (dry weight) daily; any kind of rice may be used provided no sodium, chloride, milk, etc. has been added during its processing. … All fruit juices and fruits are allowed, with the exception of nuts, dates, avocados and any dried or canned fruit or fruit derivatives to which substances other than white sugar have been added. Not more than one banana a day should be taken. White sugar and dextrose may be used ad libitum; on an average a patient takes about 100 grams daily, but, if necessary, as much as 500 grams daily should be used. Tomato and vegetable juices are not allowed.

Wow. You can eat 2400 calories of refined sugar and lose weight! Dr. Atkins – take that! A graphical comparison of equal calorie diets looks like the above. But is this a fair comparison? Do both sides eat 2400 calories per day?

Well, what was the average intake of rice? 250 gm. That is a bit more than 1 cup, or 850 calories or so. On average, they also take 100 grams of sugar. That would be 387 calories. We don’t know about fruit, but this was the 1950s before white peaches, before golden pineapples, and well before jumbo California strawberries are available year round. So we’ll guess that an average person on the Rice Diet would be taking a total about 1400 calories a day, virtually all carbohydrates.

How does this compare to the standard diet? Well, an average person would take 2400 calories, for example, and we will estimate 60% carbohydrates. That make it about 1400 calories of carbohydrates. This Rice Diet was not Carbocalypse at all! It was simply the same number of carbs but without any of the protein or fat. Protein also stimulates insulin, and it may also contribute to weight gain. So what we are comparing is 1400 calories of carbohydrates alone, or 1400 calories of carbs with another 1000 calories of fat/ protein. No surprise here, the 1400 calories of carbs alone wins.

The truth, of course, is that the Rice Diet is only one more example of the unrealistic monotonous diets that occasionally gain faddish supporters. The potatoe diet, optifast, slimfast, the grapefruit diet etc. If you only eat one thing, it quickly becomes monotonous and all pleasure is lost in eating. So you will eat only if absolutely necessary to avoid starvation because, well, it’s gross. Kempner would, on occasion, whip his patients to help compliance. The problem is that once you start eating normally, all the weight comes back.

I could make a diet called the Fung PigBlood Diet. Eat as much as you like! Eat day or night! Eat anytime, anywhere! First three whippings for no extra charge! As long as you eat only Pig’s Blood, I guarantee you’ll lose weight. Sure – you’ll do fine, because you won’t eat most of the time. Why? Cause it’s super-gross. Oh, wait, does that mean you’ll be fasting a lot? Sure will. I’ll start booking a ticket for the Nobel ceremonies next year. Obesity – cured by pig’s blood!

This is also, of course, why medical low-fat supporters such as Drs. Fuhrman, MacDougall and Barnard all do not allow unlimited sugar and rice. Because it doesn’t work in a mixed diet! These fellows aren’t stupid, you know. Most of these low-fat advocates also avoiding refined grains and sugars, just like the Low Carb and Paleo groups. Can’t we all just get along?

Same goes for all the data on lowered usage of insulin on the Rice Diet. Yes, because insulin requirements depend on both carbohydrates and protein. That fits perfectly with our understanding of how things work. Eat same refined carbohydrates but zero protein – Need less insulin. Less insulin – less weight gain.

Roy Swank and Multiple Sclerosis

After finishing with the Rice Diet, Denise brings up Roy Swank’s low-fat diet and MS. This is bizarre for 3 main reasons. The man collected 150 patients, put them on a low fat diet and described how many of these patients did well. That’s great for them. But that’s not great science.Minger3

First, there’s no comparison group. How many of those patients would have done well without the low fat diet? This is also seen in the placebo effect, the no-cebo effect and why, until recently people were still eating mummies as medicine. The same goes for leaching, blood letting, exorcisms, and other such superstitious practices (tiger penises, bear claws).  You need to compare one group to the other. Just as the Terry Wahls story is great, it is also not science and cannot be used to prove anything. Placebo controlled studies, for example, have shown placebo to have almost as much effect on subjective symptoms of asthma as real drug. Sham surgeries have the same effect as real surgery on meniscectomy for knee pain.

In fact, Benjamin Franklin, that famous fasting devotee, devised the first placebo controlled medical trial in order to debunk the myth of mesmerism or ‘animal magnetism’ whose proponents also claimed mystical healing powers. So, gathering a bunch of MS patients who did well is great, but it’s not great science and certainly proves nothing about low fat diets.

The second major point is that science means that this is a reproducible result. Has anybody else been able to replicate these findings? If not, then we generally would not accept them. If only one physician or researcher is able to show results, then those results are generally not accepted. The reason why?

Let’s review the despicable story of one Mr. Andy Wakefield, a former surgeon and medical researcher from Bath, England. He.wrote a 1998 paper published in the Lancet that alleged that there was a connection between MMR vaccines and autism. Brian Deere, a journalist dug into this story further and found a much deeper, more bile inducing story. Wakefield essentially made up the entire paper, because he had a vested interest ($$$) in proving this point.  This led to celebrities such as Jenny McCarthy taking up the no-vaccine cause and directly leading to several children’s deaths due to outbreaks of measles. Yes, kids died because the despicable Wakefield lied.

How was this found out? Well, this was in part because no other group could replicate the findings of the original paper. This is highly suspicious, and led to further investigations about the original paper which has since been retracted as well as its author.

Third, we mostly talk about diets in terms of affecting obesity and/or T2D. Whether it works or not for MS is mostly irrelevant to this discussion. Suppose I discover that a 100% fat diet is effective in a rare disorder affecting 1 person in the last 200 years worldwide. That’s great, but what relevance does it have to obesity of type 2 diabetes? Not very much. So maybe low fat diets are good for MS and maybe not. So what?

I’m going to end here with one more thought. I am always looking for studies that disprove my point of view of obesity/ T2D. That is the only way we learn. That is one of the reasons I read Denise Minger’s blog post with such interest. I don’t agree with its conclusions, but that’s OK. The point is to have open discussion and try to find our way to what matters in nutrition. For that, Denise, I would say thank you.

PS I will address the Pritikin Diet in another post, before this post threatens to be the world’s longest.

Update Oct 26, 2015

Several readers have contested the calorie count that I posted using different assumptions for amount of rice taken and fruit juices. I agree that it is certainly possible to get 2400 calories on the Rice Diet. However, the question is this. How many calories of carbohydrates were actually eaten for weight loss?

It appears that some of this depends upon why the Rice Diet was being used. For kidney disease and hypertension, calorie counts appear to average about 2200 calories/day. However, these were not patients that need weight loss.

In trying to figure out how many calories the weight loss people ate, a reader pointed out an interview with Dr. Don Rosati (Rice Diet Program Director) who picked up after Walter Kempner. For weight loss, it appears that unlimited rice and sugar was NOT the program, but instead was a severely calorie restricted diet of 800-1000 calories.

A patient, Jean Anspaugh wrote a book “Fat like us” in which she describes the Rice Diet as “spend(ing) all that money eating rice and fruit and starving to death”. Notice she did not say “I ate my fill of rice and fruit. So, perhaps the weight loss Rice Diet was not exactly the same as the kidney disease Rice Diet or the Malignant Hypertension Rice Diet.

Third, a piece written in JAMA 1974 by Dr. Eugene Stead, who became physician in chief at Duke University also mentions the Rice Diet as a great treatment of edema and hypertension. Notice there is no mention of obesity here.  However, he notes that “The rice diet was low in calories, protein and sodium chloride” (emphasis mine). A further interesting point was that many people who subsisted on this diet (and doing well) were eating less than 20g/day of protein – far below the recommended daily amount necessary and far, far, far below current intakes. I note this because I get a lot of grief about people who are worried about protein deficiency during fasting which is far overrated.

I realize that I have not reviewed all the studies, since, well, many of these papers are over 60 years old and I just can’t get them. However, there does seem to be a substantial amount written that indicated that the weight loss Rice Diet was not in fact, a 2400 calorie diet.

So, again, to compare the rice diet (800-1000 calories of refined carbs) to regular diet (2400 calories total with approx 1400 calories of refined carbs) you can see that there really is no mystery why the Rice Diet worked and why it died out.

 

2017-09-02T11:54:11+00:00 84 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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84 Comments on "Thoughts on the Kempner Rice Diet"

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erdoke
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There might be a plausible mechanism behind very low fat diets being able to reduce insulin resistance: http://high-fat-nutrition.blogspot.com/2015/10/protons-and-ultra-low-fat-once-more.html Dr. Jason Fung: I feel this author is trying to throw a bunch of biochemistry to distract us. His entire hypothesis is this: “So hypo insulinaemia with marked insulin sensitivity might well be the hallmarks of carbosis.” This is based on a single rat study of nicotinic acid to lower plasma FFAs – NOT lowering dietary fat. So nicotinic acid blocks insulin secretion. So what? Who is eating nicotinic acid? Is this guy really, honestly telling me that a 100% starch meal… Read more »
george
Guest
Well, here’s going to be an astonishing moment where I agree with Fung, erdoke. Of course if you eliminate fat, insulin resistance will improve. Let’s be honest: all foods provoke insulin to some degree. If refined carbs raise it by 10 (say), “whole carbs,” will raise it by 7, protein will raise it by 5, and fat will raise it by 1. It’s a slight increase, but it does increase. So if you eat cookies & your meter spikes to 200, say, replacing that with basmati rice will spike you less, maybe only 167, say. This over time will slowly… Read more »
BobM
Guest

If we consider the glycemic index to be a rough estimate of insulin spike, “whole” wheat bread is terrible. It has the same index as white bread:

http://www.health.harvard.edu/healthy-eating/glycemic_index_and_glycemic_load_for_100_foods

So much for “whole” grains being good for you.

Also, if you really want to get an eye-opener about “whole wheat”, read Wheat Belly. I’m convinced modern wheat is bad for me, and I’ve ceased to eat it.

Nate
Guest
A blood sugar of 160 mg/dl is better than one of 200 mg/dl. That is very good logic. Unfortunately, an average blood sugar of 104 mg/dl, which translates into an A1c of 5.5%, causes diabetic retinopathy in about 1 in 10 people according to one study. From the study, “The steepest increase in retinopathy prevalence occurs among individuals with A1C equal to or greater than 5.5% and FPG equal to or greater than 5.8 mmol/l [104 mg/dl].” Other studies have shown that average blood sugars between 140 to 150 mg/dl have shown significant damage to other organs. See: http://www.phlaunt.com/diabetes/14045678.php Using… Read more »
Bill
Guest
“What do you think happens if I feed you sugar? Insulin goes up. Way up. This has been demonstrated several millions of times.” Yes, for you and me this is true of course, but the question is what happens in people consistently eating close to 100% carbs. Peter’s argument (admittedly speculative) is that what we know about the ETC suggests a mechanism for metabolically healthy carbosis, based in extraordinarily high insulin sensitivity. You would acknowledge, wouldn’t you, that if insulin sensitivity is high enough even mega carbs could provoke only a very small insulin response? I’m not saying this is… Read more »
Mike T
Guest
Hey Jason just saw your reaction to Peter’s latest blog over at Hyperlipid. I wouldn’t be so dismissive, he is a a longtime practicer of the HFLC diet and ever since I ran across his blog, he has provided invaluable service in explaining biochemistry of cell metabolism, even though much goes over my head. His point is if these extremely LF diets work, there has to be a plausible biochemical mechanism behind it. He is not advocating it, nor does it sound like he is completely convinced by his own explanation. Dr. Jason Fung: Quite the contrary. I spent quite… Read more »
erdoke
Guest
Honestly, I don’t really care about very low fat diets, because I am convinced that for most people (including myself) it is much more difficult to follow than LCHF. Also, providing full nutrition seems more difficult and who is after that level of flatulance, anyway? My understanding from the the arguments over at Hyperlipid was that insulin secretion might physiologically be blocked when plasma FFA goes below a certain level. I think this is the part I need to re-read and look for supporting evidence in the scientific literature. In principal, I should also be one of the qualified people… Read more »
Rob
Guest
Dr Fung thanks for your two replies to Denise Minger’s v. interesting blog post. On salt and hypertension, I’m struggling to reconcile what you say here: “The Rice Diet has virtually zero sodium! If you kept on it, there’s a very good chance your blood pressure will go down – maybe even enough to save your life.” You continue: “It is much more likely that it worked because it was an extreme salt restriction diet. You could have also eaten an all olive oil diet and done well. Same goes for the claim that heart failure is treated. Yes, because… Read more »
Rob
Guest
Thanks for your speedy reply. My next post is indeed kind of a duplicate of this one. Do you have any advice for someone who suffers from hypertension mainly at specific times of the day? In my father’s case, he has quite normal or only mildly hypertensive blood pressure for much of the day, but he can have bad readings first thing in the morning, or during the night. My main assumption is that his high blood pressure at night may be a result of mild sleep apnoea – which we are treating with LCHF and occasional fasting weight loss… Read more »
Wenchypoo
Guest

Wouldn’t the “Rice Diet” be akin to the “Mickey D” diet, in that you’ll lose weight on both, but WHAT ELSE is going on behind the scenes (such as insulin resistance, BS issues, etc.)? The weight was lost because there was ZERO NUTRIMENT in the food. Fasting would’ve been much better–no body damage issues to deal with.

Sandy
Guest

Years ago I once did the original Rice Diet. It worked very well in the weight loss area. It was boring and I was never a fruit eater so was bored and stopped the diet before completing all the phases where you eventually add in veggies and protein. , and yes gained the weight back. But that can happen with any diet.. not sure what it did to mt BS

Ed
Guest

I read this blog to gain guidance and inspiration in my journey to cure my T2D and lose 40 pounds. Dr. Fung’s blog has taught me to be bold, questioning and patient. I Eat a LCHF diet on an intermittent fasting schedule, tweeting the details as I learn. Good luck to us all.

Nancy J
Guest
I have been trying to gather up the strength to read Ms. Minger’s blog post, but I’m not quite there yet. I mean truly, didn’t we all just come from there? And Durham is not being overrun by skinny people, and the dialysis centers are not closing even though the Rice Diet center has been there for decades. Thank you for pointing out the errors in logic of her argument. I’m a little surprised she made such mistakes. I’m not ruling out a Nobel Prize for you, but I’m glad it won’t be for the Fung Pig Blood Diet.
PhilT
Guest

Durham also has Dr Eric Westman and his low carbohydrate diet clinic.

marty kendall
Guest

I thought mine were the longest blog posts. 🙂

tl;dr

Denise Minger
Guest
Thanks for chiming in with your thoughts, Dr. Fung! The more voices that join this discussion, the better. 🙂 I actually largely agree with your comments when viewing these studies in isolation. We could find possible explanations for their results (with varying degrees of plausibility) that don’t hinge on fat intake, just as we could explain away a lot of low-carb studies in the same manner (spontaneous calorie reduction driving results, rather than carbohydrate reduction per se, etc.). What I find much more compelling — and the reason I still think these studies should be included in the repertoire of… Read more »
Wenchypoo
Guest

Will references to Justin Bieber be involved? 🙂

Christoph Dollis
Guest
Hi Denise, Can you please read this, possibly groundbreaking, aritcle: “Iron Fortification, Disease, and Obesity: An Update with Data Refinements,” paying attention to this passage: “Links to refined oils “Traditionally, many scientists and health gurus have pointed out that refined oils—like those from soy that are high in linoleic acid (LA)—a polyunsaturated omega-6 fatty acid—have been linked to obesity epidemic. We believe this fits perfectly into the exacerbation of micronutrient imbalances found in obesity. We found evidence that a diet high in refined oils might just make you absorb lots of iron, which in excess can promote oxidative stress in… Read more »
Christoph Dollis
Guest

Finally, Denis, as an afterthought, let me point that Kempner may have had greater success with non-iron-fortified rice than could be obtained in North America now with iron fortified rice.

Walter Bushell
Guest

Paul Jaminet’s perfect health diet recommends washing the “enrichment” off the rice. There was a lot of complaints about the increase in iron fortification, also, folic acid is not the optimal folate.

Bryan
Guest

I love devil’s advocacy! Great work Denise

deirdra
Guest

I thought you were kidding about Kempner whipping his patients to help compliance … until I clicked the link. There must be something about excessive grain eating that induced Kempner, Kellogg and Graham to mesmerize cult-like followers.

michael
Guest

Denise –

Is there really a growing blame against low fat for the rise in disease?

It’s typically sugar and refined carbs that people are finger’ing. And I think you would agree – that if we all live in the “macronutrient swampland” – sugar is probably the real villain over saturated fat.

And most of us want to live in the macronutrient swampland – because that’s where pizza and donuts are.

Will
Guest
Ditto to what Michael said. We all seem to agree that being in the swampland (the land of pizza and donuts) causes many chronic diseases. So the question is which magical land is the easiest place to escape to? Seems like a very personal choice to me. As far as potential mechanisms for why a very low fat diet might improve insulin sensitivity: Perhaps the body senses that it is *starving* for fat and starts to use all of its available fat. This would include the visceral fat, the fat in the liver and other organs controlling metabolism and insulin… Read more »
Sanjay
Guest
Denise, the evidence base for carbosis appears to be very weak. And anecdotally, being Indian I have seen first hand just how awful low fat/vegan approaches are in my own country and with my family in their attempts to control diabetes. I’ve looked at the Barnard studies, the Vegan Ma Pi – and it seems like people are just becoming pre-diabetic in those studies. They’re not actually normalizing their blood sugars. All the conditions are insane too – Kempner whipping people, and Vegan Ma Pi had them held in a hospital to feed them the macrobiotic diet. And for what?… Read more »
WBryanH
Guest

Sanjay, where you say “McDougall himself says fasting blood sugars of 250/350 are OK. He was investigated for malpractice over this.” Do you have link(s) for these? Btw, I’ve followed grain-free LCHF for over 8 years and it’s basically normalized my BGs, I’m quite satisfied with it, and can’t ever imagine going to my previous grain-eating high-carb ways.

Oliver
Guest

WBryanH, Dr. McDougall says it here at about the 45 minute mark: https://youtu.be/iosoXlr3ZVI?t=45m

What’s more interesting is that he’d send his “incurable” patients to TrueNorth, a fasting clinic, where they’d be cured. Practically from the beginning here: https://youtu.be/c3SSL30-kQk

WBryanH
Guest
Oliver, thank you for these two links. About McD’s blood sugar comments, “letting them run to 250, 350,” yes that’s shocking and, to me, criminal. I’d like to learn the details why the head doctors couldn’t initiate some action against him after his comments and if they correlated with his patients reports. As for the fasting clinic, I regularly fast for at least 18–24 hours, and more rarely 36–72 hours. Invariably I feel better at the end of it and the fast does “reboot” my metabolism as Dr Goldhamer puts it. When a my BGs start to stay stubbornly above… Read more »
STG
Guest
Wow!! Kinda of scary! I wonder what Denise would say about that video? When I was a vegetarian eating a high carb, grain heavy, low fat diet my BG was elevated and I developed thyroid problems and other health issues. I switched to a variable fat/lower carb diet and I feel much better. I don’t do health by the number or anymore but that is a different topic. In any case, even if low fat gave me longevity, I would not resume eating that way. I love watching Anthony Bourdain because it reinforces the fact that humans can eat a… Read more »
Eric
Guest

The point that many of these quote unquote high carb diets (Think kata ins or Asian high rice diets) are in fact low fat low protein low calorie diets that result in shorter stunted growth THINK undernourished and or malnourished.

Tall healthy meat eaters seem the norm and runty carb eaters seem the consequences of meat restricted diets. Fish beef eggs seem to promote health while sugar and corn oil soy oil etcetera seem to do the opposite. Eric

MikeT
Guest

The exception being the Inuit who are also quite small, most likely a similar adaption to the harsh environment, scarcity of calories.

Leaf Eating Carnivore
Guest
Leaf Eating Carnivore
Re: the Inuit: short, not small. Proportionally shorter arms and legs on barrel torsos, adapted for heat retention, not malnutrited. Don’t get enough to eat in the Arctic? You die in short order. So they live in places where there is a relative abundance of fish and/or game, and not elsewhere. And until recently, the populations were stable, determined by the carrying capacity of the land. Their diets are as fatty as possible – dietary fat keeps you warm. Burn those calories like a furnace in the cold. They didn’t start getting fat and epidemically diabetic until they started eating… Read more »
Heather Twist
Guest
Look at cultures worldwide. The book “What I eat” gives you a quick rundown. The tallest human beings are the ones that eat ruminant meat or dairy. Mostly the places with cows drink the milk and eat meat less often. You can see this even in the tribal peoples of Africa … their entire calorie intake may be quite low, but they are often quite tall. Fish eaters tend to be short, even when they eat plenty of protein. I think it may have to do with growth factors. Milk is designed to make calves grow fast. Anyway, many Asians… Read more »
Dr.Garry Lee
Guest

Americans refuse to eat black pudding which is loved all over Europe and is made of Pigs blood and oatmeal. It’s gorgeous and I reckon you could nearly live on it alone.
Terrific article Jason. My son Tom who’s a physician is a big fan of yours

Dr. Jason Fung: Chinese cuisine also eats congealed pigs blood. My wife and in-laws love it and order it all the time, but I think it is gross. LOL. That’s why I pick on pig’s blood.

John C
Guest

I fully endorse Dr Gary Lee’s enthusiasm for black pudding. Try it with scallops or just sliced with a salad. But like anything “consume in moderation” as the French say.

Dr Loftsson
Guest

I agree, but here in the northern Europe (Iceland) we use sheep innards instead 🙂 One of our traditional foods that it still popular amongst our kids, although my country has the questionable honor of the fattest teenagers in Europe.
Btw, thanks Jason Fung for your work!

Alexandra
Guest

I love this analysis! So precise and detailed. Very nice.

JW
Guest

The thought of it sliced in a salad makes me queasy 🙁 Fried with eggs is delicious, fried long enough so that it has a crust.

Ann Patterson
Guest

Thank you! Love your posts.

Gudmundur Johannsson
Guest

Good post.
One thing though. What about glucagon?
Couldn’t it be possible that the LCHF and HCLF diets work because they only stimulate the release of one hormone, insulin or glucagon, instead of both like the standard diet does?

BobM
Guest
For me, while I’ve always enjoyed Ms. Minger’s posts, I will never go back to eating low fat. I used to count calories and fat and enter everything in a computer; I kept my fat to less than 10% of calories. A typical day would be hot cereal (no milk or protein) for breakfast, pasta for lunch, brown rice and beans and salsa for dinner, and then snacks of rice cakes. I would have protein supplements (low fat of course) at times. At that time, I was biking probably 60+ miles per week, walking a ton, playing tennis, lifting weights,… Read more »
John C
Guest
My experience is the same as BobM’s. My wife weighed all my food and I recorded it obsessively whilst on the low fat diet. I lost weight but it was hard work and I was hungry. Now I’ve been on low carb / high fat for over a year, only eat breakfast when it comes free with a hotel reservation and fast on alternate days two or three times most weeks. I eat anything I like, but in sensible amounts (less carb, more fat, not too much or too little protein). I feel stronger and more alert and am never… Read more »
Nate
Guest

It’s nice to read that others have developed a life style similar to mine after being on a LCHF diet. Of course, mob consistency can be good or bad. So be careful out there!

John C
Guest

Joseph Heller put it nicely in Catch-22

Dobbs: ‘Look Yossarian, suppose, I mean just suppose everyone thought the same way you do.’

Yossarian: ‘Then I’d be a damn fool to think any different. ‘

(But of course that applies to low-fat too)

Ivor Cummins
Guest

Excellent as usual Jason; it’s a hairy place indeed at the precarious LF end of the Carb:Fat Wellness Parabola – I’m staying right where I am on the old curve – I’ve got a life to live !!

Nate
Guest

What I like about this post and the comments is how sophisticated the discussions about healthy diets and metabolism are getting. Of course, these discussions are supported by scientific trials. I’m dreaming about the Feds requiring all universities that take federal funds for research to dedicate 50% of their medical/pharmaceutical research funds to make the statement, “Food should be your medicine and medicine should be your food” come true.

deb griffith
Guest

Dr. Fung, I like how she states that 18% of the 68 on the diet were able to reduce their insulin. WOW! Really? Only 18%!

Denise Minger
Guest

Deb Griffith — not sure where you’re getting those numbers from; 58% reduced their insulin, including 25% who were able to discontinue it entirely.

Denise Minger
Guest
Reading your calorie breakdown again and re-reading the paper I linked to in my post, I’d have to disagree with your calculations: – Average rice intake was “250 – 350 grams”; so a true average is probably closer to 300g. That’s 1.6 cups of dry rice, or over 1100 calories. – You left out fruit juice, which was consumed at 0.7 – 1 liter per day. If that’s apple juice or orange juice, that’s about 400 calories. – Add in 100g of sugar (387 calories) and a few hundred fruit calories to be conservative (let’s say 300) and now the… Read more »
BobM
Guest

Which, by the way, I find truly disturbing (paywalling these). I tried to look into where my blood testing company got its values (for “high”) for a blood test, and the citation it used was paywalled. So, how can I determine whether the values are correct?

Noel Frascatore
Guest

The white rice I eat, from Dollar Tree Store, West Seneca, NY; is only 45 calories per 1/4 dry cup serving. I eat 600-800 calories per day. This consists of consuming 1 & 1/4 cup of this white rice per day, that’s 225 calories, the rest of my Rice Diet protocol is sugar and fruit or fruit juices.

Isabela
Guest
There is a children’s story in my country of origin: a king had 3 daughters and he asked them how much they loved him. The first said “like she loved sugar” and was praised. The second said “like honey” and she was praised too. But the third said “like salt in my food” and she was shunned. Come wedding of the third daughter, where the king went not knowing it is his daughter’s wedding, she instructed the cooks to remove all salt from king’s table and replace with sugar and honey. The king FOUND ALL THE FOOD DISGUSTING and finally… Read more »
BobM
Guest
By the way, the sodium aspect of this discussion is fraught with problems. While it’s true that sodium restriction has been shown in some trials to reduce blood pressure, it’s not clear it’s the sodium restriction doing that. Go here and read the two articles on salt by Gary Taubes: http://garytaubes.com/ If you’re eating fruit, that could increase potassium, which could lower blood pressure. If you’re reducing calories, that could improve insulin levels, which could lower blood pressure. Of course, sodium reduction could also do the same, as could the combination of these. Or something you’re not taking into account… Read more »
BobM
Guest
To illustrate how complex this issue is: “The Problem of Low Sodium Intake When people consume relatively lower amounts of sodium, blood pressure may fall to a small degree, although in some people reducing sodium intake can actually increase blood pressure. In those seeing their blood pressure lowered with reduced sodium consumption, decreases might be only as much as 1-4 mmHg on average (on a scale where up to 120 mmHg is considered normal). Regardless of possible effects on blood pressure though, individuals consuming less sodium than around 3 grams per day actually experience greater risk of heart attacks, stroke,… Read more »
Joao Gabriel
Guest
Most of the arguments presented by Dr Fung are fallacious and tainted by cognitive dissonance. Sorry to say that, Dr Fung. The worst of them is the one presented to explain the success of the Rice Diet to treat hypertension. He goes on to say: “But the Rice Diet worked. But why? One of the things we have known for at least a half a century is that sodium restriction can lower blood pressure […] Here we have super super high blood pressure without any drugs to treat it. […] The Rice Diet has virtually zero sodium! If you kept… Read more »
Sky King
Guest

You’re “looking smart”, Joao! Keep proton(ing) on!

tony
Guest

If the Kempner Rice Diet was so great, why did Duke discontinue it in 2002?

Why did the fabulous Rice Diet program – run independently from Duke after it was discontinued – closed for business in the fall of 2013?

Why does low fat guru, Dr. McDougall, grudgingly admits that this diet is for the “nearly dead?” Do we need to be “nearly dead” to obtain benefits from this diet?

Christoph Dollis
Guest

Tony, please see my comment below: the Kempner Rice Diet may have worked pre-iron fortification, but worked much less well or been counteproductive post-iron fortification.

Walter Bushell
Guest

Only the nearly dead will follow the diet? Belike.

Christoph Dollis
Guest
Note that Kemper’s work was pre iron fortification. This is a confounder that you should have a look at, Dr. Fung. There are various paradoxes regarding diet and differential health outcomes around the world. The French, for example, eat far more wheat than North Americans, with a lot less obesity. But, they don’t add iron to it. Iron overload is well established as being associated with obesity and diabetes and inflammation generally. This inflammation can attack the hypothalamus and make overeating harder to combat. Note also that the French eat a lot of cheese, wine, and dark chocolate, all of… Read more »
Reader
Guest
One of they mysteries of Pritikin is, Why didn’t he convince the medical community? Bad science seems to have been part of the story. Here’s an exerpt from a letter by Pritikin to JAMA, 1984: ————— To the Editor.—  Since 1976, JAMA has consistently reported the Pritikin Program unfairly….The so-called Pritikin diet used in the study was neither the Regression diet used at my centers and in all my research since 1974 nor the Maintenance diet described in my books meant for asymptomatic patients….Hutchison’s subjects consumed twice the fat and three times the cholesterol permitted on my more lenient Maintenance… Read more »
Ali
Guest
It saddens me that you have rubbished Dr. Wakefield in this post. He was a kind man who helped many people. Anyone who thinks outside the box or is a perceived threat to the status quo is a target for dirt-digging and discreditation, as I am sure you are well aware. If you are only getting one side of the story from a biased source, the story can be vastly different to what may be the actual truth…… He was never convicted of any wrongdoing in a court of law, and like yourself, has many grateful supporters…… Dr. Jason Fung:… Read more »
Rob
Guest
Sorry if this is a duplicate post – had some trouble posting. Dr Fung, could you clarify your current position on salt for me? I’m interested on behalf of my hypertensive father. In the post here, you write, “The Rice Diet has virtually zero sodium! If you kept on it, there’s a very good chance your blood pressure will go down – maybe even enough to save your life…It doesn’t seem plausible to me to say that the Rice Diet worked because it was low in fat. It is much more likely that it worked because it was an extreme… Read more »
Albert
Guest

Also of note is what sumo wrestlers eat to get big: lots and lots of rice!!

Zen MC
Guest

I love the rice diet used commonly to defeat the “strawpaleo” diet that’s ,all meat and very low or zero carb.

jeanne
Guest

I lost 30 pounds and kept it off by eating fruit all day then either rice or potatoes or pasta at night and I feel better now at age 47 then I did when I was in high school. I don’t know the scientific explanation, but I do know that I can eat all I want and not gain the weight back. I get my blood tested once per year and my doctor is shocked that my numbers are so good for my age.

Judy
Guest

To Jeanne–Your comment is fascinating. Did you limit yourself exclusively to fruits and starches? No sugar? No salt? No fat? No veggies? What type of fruits? Whole fruit or smoothies? I’m inspired! Many thanks.

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[…] Some argue that the blood pressure lowering effects may not even be directly linked to eating a low-fat diet. The rice diet, for example, was extremely low in sodium. […]

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[…] Some argue that the blood pressure lowering effects may not even be directly linked to eating a low-fat diet. The rice diet, for example, was extremely low in sodium. […]

Darlene
Guest

Very informative post. Thank you. Will be checking back.

Rene
Guest
I think there is a misunderstanding in this article. The rice diet measurements as indicated in this article are incorrect. Per the rice diet – it’s 3/4 cup cooked rice for each meal (lunch and dinner). Which is just under 120 grams per serving and 150 calories per serving. The rice diet was intended to be fairly bland and sugar is NOT allowed, that is another misunderstanding in this article. The only “sugar” that would count would be the sugar in the actual fruit/fruit juices consumed. Depending on the fruits/fruit juice chosen – an average fruit is between 90-125 calories,… Read more »
Jonathan Carp, MD
Guest

You make note of Dr. Fuhrman as being in the low fat camp but his general diet guidelines allow up to 40% of calories from nuts, seeds, and avocado’s.

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[…] wie oder warum Ultra-Low-Fett-Mahlzeiten Gesundheit nicht verbessern sehr gut verstanden. und einige glauben, , um die Auswirkungen von Blutdruck zu senken kann nicht direkt mit einer fettarmen Diät verbunden […]

Peter W. Dunn
Guest

“Just as the Terry Wahls story is great, it is also not science and cannot be used to prove anything. ”

It was a low blow to put Dr Wahls in this paragraph. First, she is a medical professor. Second, her diet was the result of careful scientific research. Third, the Wahls Protocol was already in clinical trials well before you wrote this line.

Joe W.
Guest

Kudos Dr. Fung and Denise for your research, thoughts and respectful discussions. It’s refreshing to read your cordial and adult commentary. It’s been very helpful.
Thanks so much!

GrahamC
Guest
Dr Kempner no doubt used the low sodium rice diet ( 135 mg/day ) on the basis of sodium restriction being able to reduce blood pressure based on his knowledge of metabolism. If you look at Dr Kempner’s biography, you would have seen he was a very accomplished physician, who also was in Otto Warburg’s laboratory for 3 years so his knowledge of metabolism would have been first class for the era. http://hyper.ahajournals.org/content/64/4/684.long However, this Cochrane review http://www.cochrane.org/CD004022/HTN_effects-of-low-salt-diet-on-blood-pressure-hormones-and-lipids-in-people-with-normal-blood-pressure-and-in-people-with-elevated-blood-pressure says that the data supports 3.5% reduction in blood pressure in white people with hypertension. That’s not going to reverse anyone’s malignant… Read more »
GrahamC
Guest
McDougall funded a 1 year study of the Swank diet ($750,000) with 60 participants. He reports that at the end of the study, no MRI changes were seen between the control and study groups. However, the study group on < 15% fat lost on average 19lbs whereas the control group on 40% fat gained 1.9lbs. The study group also improved lipids which is not surprising, and fatigue also improved. More likely than not, the number of participants was too small, and the study duration too short for a chronic relapsing disease like MS. Co-morbidities such as hypertension, hyperlipidemia, and diabetes… Read more »
GrahamC
Guest

I was interested to read your explanation that the rice diet was basically a low antigen diet. However, looking on uptodate I see this mentioned only in a short paragraph. http://www.uptodate.com/contents/treatment-and-prognosis-of-iga-nephropathy#H29 And they report that the effect has not been reproduced. A gluten free diet also did not help. Coppo R, Roccatello D, Amore A, et al. Effects of a gluten-free diet in primary IgA nephropathy. Clin Nephrol 1990; 33:72.

So, I’m not sure why you would promote one unproven theory over another.

taty lauwers
Guest
I am a fan of Denise Minger and of dr Fung, but I am puzzled with Denise’s analysis on the rice diet article (that I read thorougly, with great pleasure as usual, I love her spirit). My msg is based on my everyday observations (20-year work as a nutritionist covering all diets for my clients, from low fat vegan to ketogenic, I am like a “diet broker”). It contradicts what we see in everyday life. I am surprised noone mentions that we have quite variable biochemistries – see metabolic typing by Wollcott. I used common sense in my practice: I… Read more »
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[…] Thoughts on the Kempner Rice Diet – Intensive Dietary … – Recently, Denise Minger wrote a thought provoking post “In Defense of Low Fat“. Denise is the author of a book called “Death by Food Pyramid” and came to fame … […]

K Knepp
Guest

I think the calorie and rice amounts as well as 100 grams of sugar ab lib are a little off. The original rice diet had no added sugar. The sugars/carbs were from the rice, rice equivalents, and fruits and juices. Rice and rice equivalents were more like 3/4 cup cooked in plain water twice a day. Breakfast was only fruit and no-sugar drinks; lunch and dinner was rice or rice equivalent and allowed fruit. And it was all about no sodium. No spices-something about the blandness of the food suppressing hunger.

Peet Hagenbeck
Guest

Have a look at Dr John McDougall’s website for the medical reasons why the rice diet works. If you revert to old eating habits, you will soon be ill again. My BP has gone down from 175/95 to 130/79 after 4 days on the rice diet. When I finish, I will start following McDougall’s starch solution diet.

Johnny
Guest
Jason seems to do a good job at exposing the difficulties of deep medical research. He also proposes some possibilites on how the rice diet effectively treated many of glomuleronephritis but a number of time he hits below the belt. No need to drag Wakefield into the discussion. No need to lump Kempners work into the grab bag of fad diets. Kemper was a professional and not a diet populist. There are plenty of arguments for doing blind and controlled studies many of which are in my opinion use humans as guinea pigs. Kempner was in the business of saving… Read more »
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