Walter Kempner

What Walter says, topic by topic

Proteínas

In a 1975 paper on 106 patients with severe obesity treated at Duke, Kempner and his colleagues described the starting rice/reduction diet as low in calories, salt, protein and fat, and essentially free of cholesterol¹. Vegetables were usually added after at least a month, and lean poultry or meat only later still¹.

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Nuts, seeds and avocado

In his 1948 paper on the rice diet for high blood pressure, Kempner let patients on the strict diet have any fruit or fruit juice, with a few named exceptions: nuts, dates and avocados were left out, as was dried or canned fruit with anything besides white sugar added².

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Salt

Sodium in the same 1975 program was kept extremely low, under 60 mg a day at the start and below 100 mg a day at every stage, with fluids reduced as well to avoid water intoxication¹. Patients’ adherence was checked by measuring sodium or chloride in 24-hour urine twice a week, since the expected values on the diet are known¹.

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Sugar

Sugar was a deliberate part of the rice diet, not a slip. The 1948 paper allowed white sugar and dextrose without limit; patients averaged about 100 g a day, and he wrote that up to 500 g a day should be given when needed to supply calories². In a 1949 report he described a heart failure patient who ate a pound of rice and a pound of dextrose daily and put on weight even as his edema went down³.

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Starches

The paper describes the diet as a lower calorie version, an estimated 400 to 800 kcal a day, of the rice diet Kempner had first used in the 1940s for kidney failure and severe high blood pressure and later for diabetes⁴. In its first phase 90 to 95% of calories came from carbohydrate, eaten as rice and fruit¹.

Patients lost 63.9 kg on average and 43 of the 106 reached normal weight⁴. The authors reported falls in blood pressure, blood sugar, triglycerides and uric acid alongside the weight loss, while serum cholesterol did not change significantly⁴.

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Fasting

In 1954 Kempner compared his diet with complete fasting, which the German physician Volhard had used for acute kidney inflammation. By his figures, a person on an ordinary diet with 125 g of protein excretes about 20 g of nitrogen a day, a fasting person about 8 g, and a patient after roughly three months on the rice diet about 4 g; he concluded the rice diet lowered nitrogen output more than fasting did and, unlike a fast, could be kept up for months or years⁵.

His comparison table set starvation against the rice diet: in starvation hemoglobin, serum calcium, plasma protein and blood sugar fell and nitrogen balance turned negative, while on the rice diet these held steady and patients stayed in nitrogen balance⁵. In the 1975 obesity paper he and his colleagues presented the rice/reduction program as a way to correct massive obesity without prolonged fasting, surgery or drugs⁴.

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Supplements

The 1975 paper states that patients on the rice/reduction diet took a multivitamin every day to prevent any possible deficiency¹.

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Fruit

In a 1950 talk in Paris, Kempner summed up the rice diet, then used for more than 1,500 heart and kidney patients, as rice, sugar, fruit and fruit juice and nothing else⁶. His 1948 paper allowed all fresh fruit and juices except nuts, dates, avocados and fruit products with additives, limited bananas to one a day, and gave most of the day’s fluid as 700 to 1,000 ml of fruit juice, usually with no plain water².

Fruit was not untouchable, though. When sodium had to go even lower, he wrote in 1954, all fruit and juice could be removed, leaving a stricter version made of white rice, tea and white sugar alone⁵.

What all the experts say about fruit

Vegetables and greens

Vegetables were not part of the strict rice diet: the 1948 paper did not allow tomato or vegetable juices². They came back as additions once patients improved; in the 1975 obesity program vegetables were usually the first food added, after at least a month¹. A 1949 case report describes a woman whose blood pressure held at its improved level for two years after a daily potato, a little meat and about 250 g of vegetables had been added back³.

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Whole grains, bread and flour

Rice was the only grain on Kempner’s diet. In 1948 he set the usual amount at 250 to 350 g of dry rice a day, said any kind of rice would do if nothing such as salt or milk had been added during processing, and had it boiled or steamed in plain water or fruit juice with no salt, milk or fat².

In 1954 he explained why other cereals were no substitute: by the US food tables, 300 g of oatmeal carries more than 22 g of fat against under 1 g in the same weight of white rice, so even swapping one grain for another could undo the diet’s very low fat content⁵.

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Meat

In his 1950 Paris talk Kempner reported animal experiments in which rats with experimentally induced high blood pressure, given the same amount of salt, survived 17 days on an all-meat diet against 57 days on rice; with salt cut further, survival was 28 days on meat and over 200 days on rice⁶.

In 1954 he criticized a modified version of his diet published by other researchers that added meat, butter, eggs and dialyzed milk: it held only three times his diet’s salt but more than twenty times its fat, which he judged unsuitable because most of his hypertensive patients already had high cholesterol⁵. In his 1975 obesity program, lean poultry or meat came back only at a late stage¹.

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Low-fat eating

Kempner wrote in 1954 that of all the diets used for kidney disease, hypertension, hardening of the arteries and heart disease, his contained the least fat, under 5 g in 2,400 calories, and no cholesterol at all⁵. He showed the arithmetic: 300 g of white rice, a day’s orange and grapefruit juice and a pound each of apples, grapefruit and peaches add up to under 5 g of fat⁵.

He argued that other low-salt diets offered as easier substitutes went the right way on salt but let fat stay too high⁵. By 1954, he noted, the case for restricting salt, fat and cholesterol had been broadly accepted, while the value of restricting protein was still argued over⁵.

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Cholesterol

Kempner recalled in 1954 that when he first exhibited charts of the rice diet lowering serum cholesterol, about ten years earlier, critics replied that cholesterol did not matter in vascular disease and that diet could not lower it⁵. He held that moderate cuts in fat and cholesterol often failed, whereas the rice diet had lowered cholesterol in 93% of his patients who started with high values⁵. In his 1950 Paris talk he reported that cholesterol fell in 96% of 511 patients, on average from 279 to 205 mg/dl, after about 100 days⁶.

His 1958 paper on 100 diabetic patients found cholesterol fell in 68 of the 80 who started above 220 mg/dl, from an average of 325 to 227 mg/dl, though it rose in 12⁷. The results were not uniform over time: in the 1975 obesity paper serum cholesterol did not change significantly, which the authors linked partly to patients’ fairly normal starting values⁸.

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Carbohydrates and low-carb diets

Kempner built his diet on carbohydrate on purpose. In 1954 he described the protein-sparing effect of carbohydrate as one of its principles: when someone eats no protein but gets enough calories from carbohydrate, daily nitrogen loss can drop from about 8 g to under 2 g⁵. The 1975 obesity paper gave the same reason, along with carbohydrate’s effect of limiting sodium loss, for using it as the main calorie source⁸.

In 1958 he wrote that with over 90% of the diet’s calories from carbohydrate, he had expected diabetic patients to need more insulin, but the opposite proved true⁷.

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Weight loss

On the regular rice diet, Kempner said in 1950, the calorie level was set for each patient depending on whether weight gain or weight loss was wanted⁶. For massive obesity, the 1975 paper called calorie reduction the cornerstone of any weight program and argued that fairly severe restriction gave the quick losses that keep patients motivated⁸. The same paper gave four reasons for the very low salt, among them that retained water can mask a real loss of fat⁸.

The program combined diet, exercise, a stay in Durham away from home stress, the company of other patients and steady motivation; patients counted as successful only once they reached normal weight, and the authors admitted many grew tired of the monotonous diet⁸. They warned against drastic diets and rapid weight loss without medical supervision, with daily checks for side effects such as low blood pressure on standing⁸. The 106 patients analyzed lost 63.9 kg on average, and 43 reached normal weight⁴.

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Exercise

Kempner’s 1975 obesity program prescribed a daily minimum of exercise for every patient, tailored to age, sex, any disabilities and an exercise ECG, and encouraged patients to go as far as they comfortably could¹. In the discussion the authors judged that exercise adds only a little to calorie use but matters for muscle tone, heart and lung fitness and keeping boredom away⁸.

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Heart disease

In 1954 Kempner listed heart enlargement and heart failure of any cause, familial high cholesterol, angina and past heart attacks among the conditions to treat with the rice diet⁵. In 500 patients who followed it for about five months, the heart shrank on X-ray in 96%, by an average of 11.8% in width, and grew slightly in 4%⁵. In his 1950 Paris talk he added that the shrinking did not depend on lower blood pressure or weight loss⁶.

He also described the limits: one heart failure patient’s heart grew and shrank for six years in step with how strictly he kept the salt down, until the failure was no longer reversible⁵.

What all the experts say about heart disease

High blood pressure

Kempner’s 1948 paper recalled that until 1944 medical opinion held diet to be useless in high blood pressure without kidney disease². By 1954 he reported on 860 patients treated for at least 90 days: pressure fell decisively in 82% of them, from an average of 195/114 to 145/91, and reached normal in 34%⁵. Among 388 patients with advanced retinal damage from hypertension or kidney disease, 125 had swollen optic discs, and in 119 of them the swelling disappeared completely⁵.

He argued that only drastic salt cuts work: going from 10 g to 2 g of salt a day may do little, while going from 2 g to 0.3 g or less can change the disease⁵. He also called the diet dangerous without close control, since some patients, especially with damaged kidneys, lose too much salt, which is why his patients were supervised daily for four months⁵.

What all the experts say about high blood pressure

Diabetes

Kempner’s 1958 paper followed 100 diabetic patients treated between 1944 and 1955 for an average of 22 months. Fasting blood sugar fell in 63, from an average of 236 to 135 mg/dl, and rose in 15; insulin doses went down in 42 patients and could be stopped altogether in 18, while 9 needed more⁷. In 1954 he proposed the diet for diabetics beginning to show heart, eye, kidney or circulation damage, since so many died of vascular disease⁵.

In a 1993 article written when he was about 90, he set out his own theory: blood sugar depends on adrenal hormones as well as on insulin, and since salt is given to raise low blood pressure and blood sugar in adrenal failure, he reasoned that cutting salt to a minimum should lower both when they are high, which he said had proved useful⁹. He added that in his experience patients found it easier to blame heredity for their diabetes than to give up a diet rich in calories, protein, fat and salt⁹.

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Longevity and aging

In 1954 Kempner rejected the idea that hardened arteries and high blood pressure are a normal part of aging, pointing to how far these processes reversed in many of his older patients⁵. He held that a 75-year-old should have the same blood pressure target as a 30-year-old, under 130/90, and gave examples of a 79-year-old whose heart shrank by a fifth in width and an 81-year-old whose heart conduction block disappeared on the diet⁵.

What all the experts say about longevity and aging

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