ex_kempner review: CICO and FO

In which your humble author does a carolie restriction (and fails, obviously)

I’ve previously written about my 30 day rice diet, inspired by Walter Kempner, a crazy doctor who emigrated from Nazi Germany and ran a “rice diet clinic” at Duke University in Durham, NC from the 1940s to the 1990s.

My rice diet experiment was “successful” in several unexpected ways:

• After 9 years of strict keto, I tolerated a diet of nearly 100% carbohydrates perfectly fine

• Unlike the potatoes on my earlier potato diet trial, I could digest white rice no problem and generally felt fine

• My Non-24 sleep/wake circadian rhythm disorder, which had previously been on remission only on a strict keto diet, did not come back - for the first time in 9 years when reintroducing carbs

Unfortunately, this blog is titled “Experimental Fat Loss” and not “Experimental Feeling Generally Fine & Not Having Non-24” and I did NOT lose any fat.

It is debatable if I gained any fat - I did, by DEXA, but that included the preceding high-protein refeed period. It is thus not clear if I would’ve gained any fat had I not done the refeed. Science is hard, man.

Should I have done a washout period between the refeed and the rice experiment? It probably would’ve changed the result, but I’ve written about the difficulty with finding a neutral washout diet before.

True Kempner has Never Been Tried

In my retrospective of ex_rice, I speculated why I didn’t lose any weight.

One big reason was, of course, that I was eating ad libitum rice & marinara sauce, averaging around 3,300kcal/day.

The patients at Kempner’s rice clinic who were obese & subject to the weight loss version of his diet were restricted to under 1,000kcal/day. It seems to have varied a little bit, but insane levels of caloric restriction seem to have been the rule, not the exception.

When I wrote about Kempner previously, I had searched for his name and only found a biography, more about the man’s life and circumstances than the specific implementation of his famous diet. It does feature some information about the rice diet, but not the specifics, and it focuses more on the variant intended not for weight loss but clinical issues like kidney failure, in which caloric restriction did not feature as heavily.

But Coconut, a member of r/SaturatedFat, informed me that there was indeed a book called The Rice Diet Report, specifically about the weight loss version of the diet.

It was written in the 1980s by Judy Moscovitz, who had been a patient at Kempner’s rice clinic in Durham for several years, and graduated to a sort of informal advisory/mentor role for other rice dieters.

The book is a pretty typical diet book even by modern standards. It presents the rice diet as a revelatory, unique, and amazing solution that WORKS FOR EVERYBODY if they will just fucking stick to the plan (ominous foreshadowing is ominous).

You could summarize the entire idea of the diet plan in a paragraph or two, and, conveniently, Moscovitz did just that.

This is just about the only half-page of the book you need to read. The rest is fluff, experience reports, and recipes. That’s not to say you shouldn’t read it if you’re interested in this diet; just that all the core information is very simple.

Every day you will be eating:

1. Two portions of rice

2. 5 pieces of fruit

One portion of rice is defined as about 3/4 of a cup of COOKED rice. That means one of the rice portions has about 210kcal.

Fruit varies a lot, of course. She makes sure to remind you that the intent is about a medium sized piece of fruit, like a medium apple or banana. Don’t eat 5 entire watermelons in a day.

But, for example, slices of watermelon can vary a lot in size & thickness, as do apples, bananas, and other fruits.

The type of fruit you choose can also make a huge difference. For simplicity, let’s assume that a typical piece of fruit has about 100kcal, which seems to roughly be the case for a medium sized banana or apple.

Overall, therefore, this diet is EXTREMELY low in carolies. You’re getting 420kcal from rice and ~500kcal from fruit, leaving you with less than 1,000kcal/day.

This will be an insane level of caloric restriction for pretty much anyone. My resting metabolic rate has been measured various times at 2,200-2,400kcal, and my total energy expenditure at anywhere from 2,900kcal, 3,300kcal, up to even 4,600kcal/day.

Even if we take the lowest of these numbers, a TEE of 2,900kcal, this level would be absurd. It is practically a water fast.

Let’s take another look at the first paragraph in the above half-page:

I’ll say it right now: this did absolutely not happen. Similar claims are made by proponents of prolonged fasting - if you just willpower through the first few days, it becomes easy and you’re no longer hungry.

Suffice to say, this does absolutely not work as promised for me.

My version

When I read that it was 3/4 cup of COOKED rice, I was shocked. I had somehow assumed it would be a full cup of DRY rice. Rice of course gains a ton of weight when cooked, because it is rehydrated. Typically, cooked rice will weigh 3-4x as much as dry rice.

For this reason, and for practicality, I decided to allow myself a little bit more rice. As I wrote in my ex_rice review, there seems to be some sort of “asian rice cooker cup” that is unrelated to the standard cup measurements.

When I weigh dry rice in the cup that came with my rice cooker, it tends to be about 130g worth, depending a bit on how full you get it and the variety of rice.

I decided to use one of these rice cooker cups of dry rice for one “portion of rice” on the diet. One such cup expands to about one medium sized bowl of cooked rice and contains almost exactly 500kcal.

The amount of rice I was eating was therefore more than double what Moscovitz recommended. Then again, at 6’1 I’m probably on the upper end of lean mass compared to most people. I don’t know if the good doctor scaled up his recommendations for people with more or less lean body mass or by height, but <1,000kcal/day just seemed too crazy to me.

I would therefore be getting around ~1,000kcal/day from the 2 rice portions, and another ~500kcal from the 5 pieces of fruit, for a total of ~1,500kcal/day.

Keep that in mind, as this time that’s really the only way in which I deviated from the exact plan Kempner set out, I think.

When it comes to fruit, I tried averaging a “medium sized” fruit. With natural variety that can be hard; sometimes you get a tiny banana, sometimes a huge banana. I’d also buy pre-sliced portions of watermelon and similar tropical fruits since a whole melon would be way too much and would go bad before I could finish it.

These pre-sliced packages were typically around 200-400g. Again, I tried to average it and not always go for the biggest portion they had.

I typically got apples, bananas, watermelon, or papaya.

Could it even work?

I hope I’m not jinxing these, but similar to the Sugar Diet recently, I didn’t give this one a big chance. Just based on my history with caloric restriction, which has never worked super well for me.

In my experience, drastic reductions in caloric intake are just “inefficient fasts” in that the “trick” is just not eating. Compared to my usual intake of ~3,300kcal/day, the 1,500kcal version of the Kempner diet would cut my calories by 55%. A water fast will cut caloric intake by 100% - hence the term “inefficient fast.”

If this was just going to be an inefficient fast, it would fail quickly. I failed the Sugar Diet on day 9, and previous water fasts on the evenings of day 5.

Since this reduction of my energy intake would merely be 55%, I calculated that I should last nearly twice as long as on a water fast, so about 9 days like on the Sugar Diet seemed reasonable.

Starving myself for a few days until I crash hard, then regaining all the weight rapidly upon resuming normal eating, has never worked as a sustainable fat loss strategy for me. Even if I don’t binge upon resuming a normal diet, the weight comes back. It just takes a little bit longer.

The only hope for the Kempner diet was therefore that there is some magic to sticking to the exact foods he prescribed.

Would my appetite largely disappear after a few days? Would the “blandness” of white rice & fruit without any added salt, meat, herbs, tomato sauce, or anything else help reduce my appetite and allow me to restrict energy intake more or longer?

No, naturally it didn’t work

tl;dr, I crashed hard the evening of day 6. It’s actually astonishing that I only lasted 1 day longer than on a water fast despite eating 1,500kcal/day.

My explanation for the discrepancy from the ~9 days based on the pure “missing calories under the curve” is that the high carb intake prevented me from being in ketosis or blocked lipolysis, meaning my body actually had LESS access to body fat than on a water fast, which will definitely put you into ketosis rapidly.

Did I lose weight? Some. But interestingly, not faster than on 1. the ad lib sugar diet or 2. just regular old ad lib ex150, my heavy cream diet.

I went from just over 240lbs (peak of a swampy refeed) down to 231.4lbs. On day 6, I even plateaued, and my weight was exactly the same as on day 5.

Of course this is just short term and probably mostly water retention. But given the extreme level of caloric restriction, it’s not exactly impressive.

2 days after ending the diet, I was back up at 238.5lbs, having regained nearly all the weight lost. (I only did a 2 day refeed, but it would’ve probably gone all the way back up on day 3 or 4, had I done more.)

And, obviously, after starving myself for 6 days, I was extremely hungry during the refeed and probably “overate” to make up for it.

Plain Diet? LOL

Moscovitz makes it sound in her book as if a diet of just white rice & fruit will be really boring and plain.

But I can tell you that a starving man will salivate at the thought of white rice, and fresh fruit tastes amazing.

I had set regular meal times around lunch and 6pm so I wouldn’t eat my entire portion immediately upon waking.

By day 3-4, I was counting down the minutes to my next meal. As I put on the tiny rice portion, I’d typically consume 1 of the 2 allotted fruit portions of that meal, and eat the second portion with or after the rice.

A ripe banana tasted stunning on its own. Mashed into a portion of white rice, it was the most delicious meal you could imagine.

Even plain white rice tasted great. I’d give it a 8.5/10 when starving. It was crunchy, nutty, savory, sweet, and creamy at the same time. I loved it watery, I loved it dry, I loved it slightly burned, I loved it on its own, and I loved it in combination with any of the fruits I tried.

None of the meals satisfied me. I’d be hungrier after the meal than before, but the hunger would go away about 45 minutes later.

This is remarkably similar to my hyperphagia experience with high-protein foods. Even if I’m not at all hungry before eating, I’ll actually GET hungrier from eating the high-protein food. This will trigger me to eat again 30-45 minutes later, and if I eat more protein, the cycle continues until I’ve eaten 5,000kcal or force myself to outlast one of these “hyperphagia waves.” If I willpower through the protein-induced hyperphagia long enough (say 45-90 minutes), the hunger will go away and not come back.

This felt very similar, and it’s not a good sign, in my experience. If you’re not getting satisfied from the meals you’re allowed to eat, ever, you’re on borrowed time.

The curious mirror experiment

Coconut, the r/SaturatedFat user who had told me about the Rice Diet Report book, had decided to do the rice diet once again with me. She had done it previously and reported great success.

It was very curious to see 2 people do the same experiment at the same time. Coconut weighs about 125lbs, having been normal weight for quite a while. She has restricted PUFAs for years, being one of the huge success stories of Modern PUFA Theory, and she also stays out of the metabolic swamp by eating relatively high-carb and low-fat, although not usually as extreme as the rice diet would be. I believe her normal diet these days is around 20% fat or less. So it’s low-fat, but not “intervention level” so.

Coming back to the rice diet was very easy for her. Despite only weighing 125lbs total to my ~230-240lbs, she lasted much longer on the diet than me. In fact, I spoke to her today and she is STILL on the diet (I’m 6 days into the next experiment.)

This is so bizarre to me. I have about 80lbs just of body fat on me, which is 65% of Coconut’s entire body weight. How come that I can’t seem to access this body fat and am getting starvation psychosis on day 6, when a skinny lady half my size can subsist on this extreme level of caloric restriction for weeks?

Talk about Mysteries of Obesity.

One hypothesis, of course, is that Coconut has depleted her adipose linoleic acid much farther than I have. She has taken various OmegaQuant Complete tests, so we actually have a pretty decent comparison between her numbers and mine:

My linoleic acid in orange, Coconut’s in blue

We can see that she started out around 18%, and rapidly depleted down to below 10%. Even after 2-3 years, now eating a less fat-restricted diet (very low fat can skew this value), she still tests around 11-12%, which is significantly lower than the 15% I test unless I am on an extreme low-fat diet like a pure rice or sugar diet.

On my amateur scale, Coconut is consistently in the deep green or close to it, whereas I haven’t even made it from the red zone into the yellow except by putting my finger on the (low-fat) scale.

It is thus fully consistent with Modern PUFA Theory that Coconut would be able to do the rice diet much longer than me, despite having much lower body fat.

By the way, see how rapidly her LA% dropped? Her strategy was very low-fat, high-carb diets and lots of fasting. One of the anecdotes that made me try out the rice diet in the first place.

“All your experiments seem to fail recently”

Somebody noted that all my recent experiments seem to fail.

Actually, this has always been the case. Remember, I was experimenting for close to 20 years before I found ex150, my heavy cream diet.

Almost all diets I’ve ever tried failed spectacularly.

That’s why I’m actually somewhat impressed by the relative success of ex_rice, or ex_honey. I was able to do the diet for 30 days and I barely gained any fat, despite eating carbs! That’s much better success than I had dared to imagine.

On most diets, I gain fat very rapidly, or get starvation psychosis symptoms within a week (like this time).

Even being able to finish a month of a diet is a huge outlier, and not gaining 10lbs of fat is just a cherry on top.

But yea, it is a bit disappointing of course, because 95% or more of all experiments will fail.

That’s just what it’s like being a tough obesity case :-)

Notes

As usual, I took notes. Since it’s only 6 days, I’ll just list all of them.

Day 1

Still pretty hungry after lunch, but went away 30 min later
Almost dinner time, not particularly hungry. But sort of looking forward to food?
Dinner wasn't that satiating, but forgot about it 30 min later

Day 2

When you finally do get to eat, it's very ecstatic - a piece of fruit or the small bowl of rice tastes AMAZING
Will see if I accumulate some massive deficit that makes me overeat soon
Fruit + rice is to die for, had banana mixed into my rice.. zomg
Dinner tasted amazing again, could've easily eaten 5x the amount

Day 3

No issues waiting for lunch, but man did it feel like not enough
I'm not sure I buy the whole "plain tasting food" thing; rice is delicious and so is fruit. Especially if you're hungry.
Feels a bit like a fast; I'm not at all hungry until I eat lol, then I'm hungry for about 30-45 min, when the hunger fades away
If this is any guide, I'll hit a wall hard eventually. Water fasting was end of day 5, maybe it'll be day 6-7 on this since I'm not fasting completely?
I'm painfully aware of my next meal time on this diet, lol
Hm, actually pretty satiated after dinner

Day 4

Sort of hungry before lunch again
But not in a crazy hurry to eat either
Again not as hungry before dinner. Seems I'm hungrier around lunchtime.

Day 5

Less hungry than expected around lunch
Not much hunger around dinner either. But it also wasn't that satisfying
There's definitely some sort of lack of psychological satisfaction to this CR thing
I'm just never "satisfied" on some level, I'm always stringing myself along from tiny meal to tiny meal

Day 6

Weight same as yesterday :'-(
Cause I went for a 1h walk yesterday?
Hungry all morning
Oof, day 6 is rough. Counting the minutes until lunch, annoying (not quite painful) hunger pangs
Surprised it's starting this early
Intrusive food thoughts are starting... "Oh, maybe I should eat more fruit"
Definitely not counting minutes until dinner :grimace.gif:
Dinner not very satisfying, hungry & thinking of food just 30 minutes later
Intrusive food thoughts and hunger on and off
Feels sort of like late-stage of a fast, don't think I'll make it much longer
Ok broke around midnight day 6. Ate a banana and made 6 cups of rice at once lol.
Funny, only lasted 1 day longer than a pure water fast

Day 7 (after refeed)

Lol omg it feels so relaxing not to think about food the whole day

Lessons

It went pretty much as I expected, just like any other drastic restriction in carolies. It doesn’t seem like Kempner’s “bland food/no salt” diet made a difference here. I actually under-performed my expectation of 9 days, maybe because I wasn’t in ketosis?

Now it is, of course, possible that it would’ve gone better on Kempner’s original <1,000kcal variant. But honestly, I think the best case of that is that it might closer approximate a water fast. Maybe only eating <1,000kcal/day would allow me to get into ketosis and last a bit longer.

But we already know how the game ends even in very deep ketosis on a complete water fast.

Even if we stipulate that I’d have made it 9 days, lost 1-2lbs of real fat instead of just water weight, and then did a moderate refeed and cycled it for another 9 days… I don’t count that as a success.

Spending almost the entire day thinking of food, never getting any real satisfaction from your meals, counting the minutes until you’re allowed to eat again… even if this actually worked (and I doubt that) it wouldn’t “work” in any real sense. Almost nobody’s going to stick to that. If your diet only works on prisoners, go back to the drawing board.

Maybe if you’re a huge narcissist or a fashion influence and your income depends on it you can power through it with discipline, but even those guys seem to suffer immensely from constant hunger.

Lots of these sixpack abs guys who tell you to restrict calories forever do admit that they suffer from constant “pre-meal hunger.”

Often times they will try GLP-1 agonist drugs and admit that it took the constant hunger & suffering off their shoulders and they love it.

That’s not “working.”

I’m Sorry, Dr. Kempner

The Mysteries of Obesity remain unsolved for now. I think it’s fair to say I gave it the old college try.

I'm sorry, Dr. Kempner (ooh), I am for real.
Never meant to gain so much weight on rice.
I apologize a trillion times.

That said, both rice & moderate amounts of fruit have been by far the best high-carb diets I’ve tried in the last decade. I continue to believe they’re probably a great way to rapidly deplete your adipose linoleic acid, even if they don’t have magic fat loss effects, at least not for everyone.

In that sense, every day I spend eating very-low-fat is a win in the long run.