Choosing to Have a Normal Blood Pressure

Oct 5 Blood Pressure copy.jpeg

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many "low"-salt diets can be considered high-salt diets. That's why it's critical to understand what the concept of "normal" is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes, like heart attacks and strokes.

Doctors used to be taught that a "normal" systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone's blood pressure creeps up as we get older. And if that's normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake--ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we'd be protected. Of course, to test that theory you'd have to find a population in modern times that doesn't use salt, eat processed food, or go out to eat. For that, you'd have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that's like saying they have a diet deficient in Twinkies. They're the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn't drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we'd do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake--that is, a normal-for-the-human-species salt intake--and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn't been invented yet.

His diet wasn't just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner's rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year--causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood Pressure, Shaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound.

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won't everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with Diet, How to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can't get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you're exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through Diet?.

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:

Original Link

Choosing to Have a Normal Blood Pressure

Oct 5 Blood Pressure copy.jpeg

For the first 90% of our evolution, humans ate diets containing less than a quarter teaspoon of salt a day. Why? Because we ate mostly plants. Since we went millions of years without salt shakers, our bodies evolved into salt-conserving machines, which served us well until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but does that matter if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many "low"-salt diets can be considered high-salt diets. That's why it's critical to understand what the concept of "normal" is when it comes to salt.

As I discuss in my video High Blood Pressure May Be a Choice, having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes, like heart attacks and strokes.

Doctors used to be taught that a "normal" systolic blood pressure (the top number) is approximately 100 plus age. Babies start out with a blood pressure around 95 over 60, but then as we age that 95 can go to 120 by our 20s, then 140 in our 40s, and keep climbing as we age. (140 is the official cut-off above which one technically has high blood pressure.) That was considered normal, since everyone's blood pressure creeps up as we get older. And if that's normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

If blood pressures over 100 are associated with disease, maybe they should be considered abnormal. Were these elevated blood pressures caused by our abnormally high salt intake--ten times more than what our bodies were designed to handle? Maybe if we ate a natural amount of salt, our blood pressures would not go up with age and we'd be protected. Of course, to test that theory you'd have to find a population in modern times that doesn't use salt, eat processed food, or go out to eat. For that, you'd have to go deep into the Amazon rainforest.

Meet the Yanomamo people, a no-salt culture with the lowest salt intake ever reported. That is, they have a totally normal-for-our-species salt intake. So, what happens to their blood pressure on a no- or low-salt diet as they age? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt-deficient diet, that's like saying they have a diet deficient in Twinkies. They're the ones, it seems, who are eating truly normal salt intakes, which leads to truly normal blood pressures. Those in their 50s have the blood pressure of a 20-year-old. What was the percentage of the population tested with high blood pressure? Zero. However, elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

Of course, there could have been other factors. They didn't drink alcohol, ate a high-fiber and plant-based diet, got lots of exercise, and had no obesity. There are a number of plant-based populations eating little salt who experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we'd do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure (so called malignant hypertension) where you go blind from bleeding into your eyes, your kidneys shut down, and your heart fails, and then we withhold from these patients blood pressure medications so their fate is certain death. Then, what if we put them on a Yanomamo level of salt intake--that is, a normal-for-the-human-species salt intake--and, if instead of dying, they walked away cured of their hypertension? That would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients started with blood pressures of 210 over 140, which dropped down to 80 over 60. Amazing stuff, but how could he ethically withhold all modern blood pressure medications and treat with diet alone? This was back in the 1940s, and the drugs hadn't been invented yet.

His diet wasn't just extremely low salt, though; it was also strictly plant-based and extremely low in fat, protein, and calories. There is no doubt that Kempner's rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension (the rising of blood pressure as we age) and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. During this time, how many people have died? Today, high blood pressure may kill 400,000 Americans every year--causing a thousand unnecessary deaths every day.


I have a whole series of videos on salt, including Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt, The Evidence That Salt Raises Blood Pressure, Shaking the Salt Habit and Sodium & Autoimmune Disease: Rubbing Salt in the Wound.

Canned foods are infamous for their sodium content, but there are no-salt varieties. Learn more with my video Canned Beans or Cooked Beans?. Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health, reducing salt intake could also help our kidneys (How to Treat Kidney Stones with Diet) but if you cut down on salt, won't everything taste like cardboard? See Changing Our Taste Buds.

For more on hypertension, see How to Prevent High Blood Pressure with Diet, How to Treat High Blood Pressure with Diet, and How Not to Die from High Blood Pressure. What if you already eat healthfully and still can't get your pressures down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flaxseeds (Flax Seeds for Hypertension) to your diet, and, of course, make sure you're exercising regularly (Longer Life Within Walking Distance).

Dr. Kempner and his rice diet are so fascinating they warrant an entire video series. Check out Kempner Rice Diet: Whipping Us Into Shape, Drugs and the Demise of the Rice Diet, Can Diabetic Retinopathy Be Reversed?, and Can Morbid Obesity be Reversed Through Diet?.

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:

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, 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:

Image Credit: Community Eye Health / Flickr. This image has been modified.

Original Link

Reversing Diabetic Blindness with Diet

Reversing Diabetic Blindness with Diet.jpeg

Though many reported feeling better on Dr. Walter Kempner's rice and fruit diet, he refused to accept such anecdotal evidence as proof of success. He wanted objective measurements. The most famous were his "eyegrounds photographs," taken with a special camera that allowed one to visualize the back of the eye. In doing so, he proved diet can arrest the bleeding, oozing, and swelling you see in the back of the eye in people with severe kidney, hypertensive, or heart disease. Even more than that, he proved that diet could actually reverse it, something never thought possible.

In my video, Can Diabetic Retinopathy Be Reversed?, you can see before and after images of the back of patients' eyes. He found reversal to such a degree that even those who could no longer distinguish large objects were able to once again read fine print. Dr. Kempner had shown a reversal of blindness with diet.

The results were so dramatic that the head of the department of ophthalmology at Duke, where Kempner worked, was questioned as to whether they were somehow faked. He assured them they were not. In fact, he wrote in one person's chart, "This patient's eyegrounds are improved to an unbelievable degree." Not only had he never seen anything like it, he couldn't remember ever seeing a patient with such advanced disease even being alive 15 months later.

The magnitude of the improvements Kempner got--reversal of end-stage heart and kidney failure--was surprising, simply beyond belief. But as Kempner said as his closing sentence of a presentation before the American College of Physicians, "The important result is not that the change in the course of the disease has been achieved by the rice diet but that the course of the disease can be changed."

Now that we have high blood pressure drugs, we see less hypertensive retinopathy, but we still see a lot of diabetic retinopathy, now the leading cause of blindness in American adults. Even with intensive diabetes treatment--at least three insulin injections a day with the best modern technology has to offer--the best we can offer is usually just a slowing of the progression of the disease.

So, in the 21st century, we slow down your blindness. Yet a half century ago, Kempner proved we could reverse it. Kempner started out using his plant-based rice diet ultra-low in sodium, fat, cholesterol, and protein to reverse kidney and heart failure; he actually assumed the diet would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however, the opposite proved to be true. He took the next 100 patients with diabetes who walked through his door who went on the rice diet for at least three months and found their fasting blood sugars dropped despite a drop in the insulin they were taking. What really blew people away was this: Forty-four of the patients had diabetic retinopathy, and, in 30% of the cases, their eyes improved. That's not supposed to happen; diabetic retinopathy had been considered "a sign of irreversible destruction." What does this change mean in real life? Patients went from unable to even read headlines to normal vision.

The remarkable success Dr. Kempner had reversing some of the most dreaded complications of diabetes with his rice and fruit diet was not because of weight loss. The improvements occurred even in those patients who did not lose significant weight, so it must have been something specific about the diet. Maybe it was his total elimination of animal protein, animal fat, and cholesterol? Or perhaps it was his radical reduction in sodium, fat, and protein in general? We don't know.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. If that doesn't work, there's always pan-retinal laser photocoagulation, in which laser burns are etched over nearly the entire retina. Surgeons literally burn out the back of your eye. Why would they do that? The theory is that by killing off most of the retina, the little pieces you leave behind may get more blood flow.

When I see that, along with Kempner's work, I can't help but feel like history has been reversed. It seems as though it should have gone like, "Can you believe 50 years ago the best we had was this barbaric, burn-out-your-socket surgery? Thank goodness we've since learned that through dietary means alone, we can reverse the blindness." But instead of learning, medicine seems to have forgotten.

I documented the extraordinary Kempner story previously in Kempner Rice Diet: Whipping Us Into Shape and Drugs and the Demise of the Rice Diet. The reason I keep coming back to this is not to suggest people should go on such a diet (it is too extreme and potentially dangerous to do without strict medical supervision), but to show the power of dietary change to yield tremendous healing effects.

The best way to prevent diabetic blindness is to prevent or reverse diabetes in the first place. See, for example:

Why wouldn't a diet of white rice make diabetes worse? See If White Rice Is Linked to Diabetes, What About China?

For more on the nitty gritty on what is the actual cause of type 2 diabetes, 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:

Image Credit: Community Eye Health / Flickr. This image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

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:

Image Credit: Sally Plank / Flickr. Image has been modified.

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Introducing the Kempner Rice Diet

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Franklin Delano Roosevelt brought us through the Great Depression and World War II. Who knows how history would have been different had he not died in his fourth term as President from a massive stroke. In the following days and months, we learned that Roosevelt had suffered from severe high blood pressure for years. In spite of this, he was on no medications or other treatments. The reason for the lack of treatment is stark and simple: there were none. The state of the art at that time was death. Death, from so-called malignant hypertension--out-of-control high blood pressure--for which, it was thought, there was no remedy. But they were wrong. There was Dr. Walter Kempner and his rice-fruit diet.

A physician-scientist, Kempner trained with the best, fled Nazi Germany and set up shop at Duke, where he began treating malignant hypertension patients with a radical diet consisting of only white rice and fruit, with strikingly favorable results: a rapid reduction in blood pressure, rapid improvement in kidney failure, eye pressure, heart failure and other manifestations of this previously fatal illness.

He figured that if a low salt diet helped with blood pressure, a low protein diet helped with kidney function, and a low fat and cholesterol diet helped the heart, why not take it to its logical conclusion and design a no-salt, no cholesterol diet of almost pure carbohydrate. So, he designed a diet with less sodium than any low-sodium diet, less protein than any low-protein diet, and less cholesterol and fat than any other low-fat diet.

His hope was that it would just stop progression of the disease. Instead, something miraculous happened. In about two-thirds of cases, the disease reversed. There were reversals of heart failure, reversals of eye damage, and reversals of kidney failure. At the time, this was effectively a terminal disease where people just had a few months to live, but with Kempner's rice diet, they got better. In my video Kempner Rice Diet: Whipping Us Into Shape, you can see before and after pictures of the back of people's eyes. They started out swollen, bloody and leaking and then were nearly normal in a matter of months.

After being effectively cured by the diet over many months, many patients could then relax the diet to a more conventional plant-based diet and go on to live a normal, active life. The rice diet may actually drop blood pressures too low, so we have to add back other foods to bring the pressures back up to normal.

An editorial in the New England Journal of Medicine described Kempner's results as "little short of miraculous." Practically speaking, there's probably no more effective diet for obese cardiac patients. The problem, though, is that most physicians lack the extraordinary persuasive powers required to keep the patient eating such a restricted diet.

When Dr. Caldwell Esselstyn presented his study results demonstrating in some cases reversal of near end-stage heart disease with a whole food plant-based diet, the Chair of Cleveland Clinic cardiology department asked, "How can we expect patients to stay on a strict diet like this when we can't even get them to quit smoking?" Just like penicillin drugs don't work at all unless we take them, plant-based diets don't work unless we actually eat them.

The answer may be that the physician must have a zealous belief in the diet and must convey that passion to the patients. For Kempner, to keep his patients on the rice diet, he "brow-beat, yelled at, and castigated them when he caught them straying." And he didn't just browbeat them; he sometimes actually beat them. It came out in a lawsuit in which a former patient sued Dr. Kempner, claiming that he had literally whipped her and other patients to motivate them to stick to the diet.

Reminds me of the famous diabetes physician back in the 1800s, Arnoldo Cantani, who knew the remedy for diabetes was not in the drugstore, but rather the kitchen. To ensure compliance, if necessary, he would lock a patient up in a room for six weeks.

Thankfully, in terms of personality, Dr. Esselstyn is the opposite of Dr. Kempner. He is polite, soft-spoken, gentle and able to keep his patients on track without whipping them. And last but not least, Esselstyn walks the talk, following the diet himself, whereas Kempner died of a heart attack (though at the age of 94). Kempner's work continues on in Durham, where they continue a relaxed version of the diet, allowing actual vegetables.

A year before Roosevelt died, Kempner had already published his miraculous results. It seems highly likely that had the rice diet been "provided to President Roosevelt a year before his death, his disease might have been controlled before his fatal stroke, and that this fatal event could have been averted."


For those unfamiliar with Dr. Esselstyn's work, check out:

Kempner was a lifestyle medicine pioneer. What's lifestyle medicine? See, for example:

For more on Kempner's work, 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--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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Evidence-Based Nutrition

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Dr. Esselstyn's landmark study, demonstrating that even advanced triple vessel coronary artery disease could be reversed with a plant-based diet, has been criticized for being such a small study. But the reason we're used to seeing large studies is that they typically show such small effects. Drug manufacturers may need to study 7,000 people in order to show a barely statistically significant 15% drop in ischemic events in a subsample of patients. Esselstyn achieved a 100% drop in those who stuck to his diet, all the more compelling considering that those 18 participants experienced 49 coronary events (like heart attacks) in the eight years before they went on the diet. These patients were the sickest of the sick, most of whom having already failed surgical intervention. When the effects are so dramatic, how many people do you need?

Before 1885, a symptomatic rabies infection was a death sentence, until little Joseph Meister became the first to receive Pasteur's experimental rabies vaccine. The results of this and one other case were so dramatic compared with previous experience that the new treatment was accepted with a sample size of two. That is, the results were so compelling that no randomized controlled trial was necessary. Having been infected by a rabid dog, would you be willing to participate in a randomized controlled trial, when being in the control group had a certainty of a ''most awful death''? Sadly, such a question is not entirely rhetorical.

In the 1970's, a revolutionary treatment for babies with immature lungs called "extracorporeal membranous oxygenation" (ECMO), transformed immature lung mortality from 80% dead to 80% alive nearly overnight. The standard therapy caused damage to infants' lungs and was a major cause of morbidity and mortality in infants. ECMO is much gentler on babies' lungs, "providing life support while allowing the lungs to 'rest.'"

Despite their dramatic success, the researchers who developed ECMO felt forced to perform a randomized controlled trial. They didn't want to; they knew they'd be condemning babies to death. They felt compelled to perform such a trial because their claim that ECMO worked would, they judged, carry little weight amongst their medical colleagues unless supported by a randomized controlled trial. Therefore, at Harvard's Children's Hospital, 39 infants were randomized to either get ECMO or conventional medical therapy. The researchers decided ahead of time to stop the trial after the 4th death so as not to kill too many babies. And that's what they did. The study was halted after the fourth conventional medical therapy death, at which point nine out of nine ECMO babies had survived. Imagine being the parent to one of those four children.

Similarly, imagine being the child of a parent who died other conventional medical or surgical therapy for heart disease.

In her paper "How evidence-based medicine biases physicians against nutrition," Laurie Endicott Thomas reminds us that medical students in the United States are taught very little about nutrition (See Evidence-Based Medicine or Evidence-Biased?). Worse yet, according to Thomas, their training actually biases them against the studies that show the power of dietary approaches to managing disease by encouraging them to ignore any information that does not come from a double-blind, randomized controlled trial. Yet humans cannot be blinded to a dietary intervention--we tend to notice what we're eating--and, as a result, physicians are biased in favor of drug treatments and against dietary interventions for the management of chronic disease.

Evidence-based medicine is a good thing. However, Thomas points out that the medical profession may be focusing too much on one type of evidence to the exclusion of all others. Unfortunately, this approach can easily degenerate into "ignoring-most-of-the-truly-important-evidence" based medicine.

Heart disease is a perfect example. On healthy enough plant based diets, our number one cause of death may simply cease to exist. The Cornell-Oxford-China Study showed that even small amounts of animal-based food was associated with a small, but measurable increase in the risk of some chronic diseases. In other words, "the causal relationship between dietary patterns and coronary artery disease was already well established before Dean Ornish and Caldwell Esselstyn undertook their clinical studies." The value of their studies was not so much in providing evidence that such a dietary change would be effective, but in showing that "physicians can persuade their patients to make such changes," and in "providing interesting data on the speed and magnitude of the change in severe atherosclerotic lesions as a result of dietary therapy."

Therefore, any complaints that these studies were small or unblinded are simply irrelevant. Because the evidence of the role of diet in causing atherosclerosis is already so overwhelming, "assigning a patient to a control group eating the standard American diet could be considered a violation of research ethics."

Evidence of the value of plant-based diets for managing chronic disease has been available in the medical literature for decades. Walter Kempner at Duke University, John McDougall, the Physician's Committee for Responsible Medicine, Nathan Pritikin, and Denis Burkitt all warned us that the standard Western diet is the standard cause of death and disability in the Western world. Yet physicians, especially in the US, are still busily manning the ambulances at the bottom of the cliff instead of building fences at the top.

If you're not familiar with Dr. Esselstyn's work, I touch on it in:

Sadly, medical students learn little about these powerful tools:

If you haven't heard of Pritikin, I introduce him here: Engineering a Cure

An intro to Dr. Ornish: Convergence of Evidence

Dr. Burkitt: Dr. Burkitt's F-Word Diet

The Cornell-Oxford-China Study: China Study on Sudden Cardiac Death

Dr. Walter Kempner: Kempner Rice Diet: Whipping Us Into Shape

-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 Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: clement127 / Flickr

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Dr. Greger’s 2015 Live Year-in-Review Presentation

Food as Medicine

View my new live presentation here: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

Every year I scour the world's scholarly literature on clinical nutrition, pulling together what I find to be the most interesting, practical, and groundbreaking science on how to best feed ourselves and our families. I start with the thousands of papers published annually on nutrition (27,000 this year--a new record!) and, thanks to a crack team of volunteers (and now staff!), I'm able to whittle those down (to a mere 8,000 this year). They are then downloaded, categorized, read, analyzed, and churned into the few hundred short videos. This allows me to post new videos and articles every day, year-round, to NutritionFacts.org. This certainly makes the site unique. There's no other science-based source for free daily updates on the latest discoveries in nutrition. The problem is that the amount of information can be overwhelming.

Currently I have more than a thousand videos covering 1,931 nutrition topics. Where do you even begin? Many have expressed their appreciation for the breadth of material, but asked that I try to distill it into a coherent summary of how best to use diet to prevent and treat chronic disease. I took this feedback to heart and in 2012 developed Uprooting the Leading Causes of Death, which explored the role diet may play in preventing, arresting, and even reversing our top 15 killers. Not only did it rise to become one of the Top 10 Most Popular Videos of 2012, it remains my single most viewed video to date, watched over a million times (NutritionFacts.org is now up to more than 1.5 million hits a month!).

In 2013 I developed the sequel, More Than an Apple a Day, in which I explored the role diet could play in treating some of our most common conditions. I presented it around the country and it ended up #1 on our Top 10 Most Popular Videos of 2013. Then in 2014 I premiered the sequel-sequel, From Table to Able, in which I explored the role diet could play in treating some of our most disabling diseases, landing #1 on our Top 10 Most Popular Videos of 2014.

Every year I wonder how I'm going to top the year before. Knowing how popular these live presentations can be and hearing all the stories from folks about what a powerful impact they can have on people's lives, I put my all into this new 2015 one. I spent more time putting together this presentation than any other in my life. It took me an entire month, and when you see it I think you'll appreciate why.

This year, I'm honored to bring you Food as Medicine, in which I go through our most dreaded diseases--but that's not even the best part! I'm really proud of what I put together for the ending. I spend the last 20 minutes or so (starting at 56:22) going through a thought experiment that I'm hoping everyone will find compelling. I think it may be my best presentation ever. You be the judge.

You can watch it at no cost online, but it is also available on DVD through my website or on Amazon. If you want to share copies with others, I have a five for $40 special (enter coupon code 5FOR40FAM). All proceeds from the sales of all my books, DVDs, downloads, and presentations go to the 501c3 nonprofit charity that keeps NutritionFacts.org free for all, for all time. If you want to support this initiative to educate millions about eradicating dietary diseases, please consider making a donation.

After you've watched the new presentation, make sure you're subscribed to get my video updates daily, weekly, or monthly to stay on top of all the latest.

-Michael Greger

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