The Gadfly: Walter Kempner

Stranger in a Strange Land

Note: This post is largely about Kempner as a person, not so much dieting.

When I decided to do a month of rice diet recently, I decided to read the book on Walter Kempner and the Rice Diet. It’s available on Amazon.

Part of the reason was to psych myself up and learn more about the mysterious Dr. Kempner. I also hoped to gain more insight into the rice diet itself. Unfortunately, the book is pretty light in actual details on the diet, especially when it comes to fat loss.

The book is largely a biography of Kempner, written by a lady who worked with him for decades at Duke University. I think it’s fair to say that she’s drooling over him the entire time, clearly a huge fan.

If you don’t know anything about Kempner, he was a Jewish-German physician who fled to the U.S. from the Nazis and ended up spending the rest of his life working at Duke University.

Kempner’s work

Even back in Germany, he had developed a special interest in dealing with patients who had fatal kidney disease, some only given weeks to live by their doctors.

He had put these “dead men walking” on a diet of just plain white rice and later some fruit, and their fatal disease often seemed to revert. He got patients to live years, even decades, instead of weeks and months. Remember, this was in a time where we couldn’t just hook people up to dialysis & other machines and keep them alive indefinitely. The method for producing artificial insulin was only invented in 1920, when Kempner was already practicing in Germany. Antibiotics were a brand new innovation (1910). 100 years ago was a very different medical environment.

Soon, Kempner noticed that the rice diet also tended to make obese people lose fat, and improve the glucose control of diabetics.

Kempner was meticulous and took extremely detailed & thorough lab tests of anything he could think of, so when American physicians doubted his results, he had the receipts to prove his successful treatments.

I think it’s important to note that, first and foremost, Kempner was NOT originally an obesity guy.

This means that many of the things we read about his diet approach, or his patients, do not necessarily apply to us who are trying to reverse obesity.

We sometimes read of his 2,400kcal/day diet. This diet was NOT intended for weight loss, it was for weight-stable patients with diagnosed, fatal renal failure. Kempner utilized different variants of the diet for different purposes, and these are often conflated.

Similarly, “x% of his patients died!!!” is a common complaint. But these weren’t healthy, “just” overweight people. His average renal patient had weeks to live. Even stretching that to half a year would’ve been a miracle at the time, and if only 30% of the patients died, this would be a phenomenal success.

Later in his career, Kempner got pretty famous in the U.S. and his Rice Clinic became popular among celebrities and rich business leaders like CEOs. They certainly didn’t seem to be under the impression that the diet was in any way risky or harmful to them.

All of that is to say, we can’t simply compare Kempner’s total body of work to e.g. that of Atkins or Paleo or some other modern diet. The times were very different, and for decades of his career, Kempner’s focus was on people with, essentially, a death sentence.

The Whippings & other Controversy

Let’s address the elephant in the room: at least one patient went public and said Kempner whipped her with a riding crop as a disciplinary measure, as part of the rice diet treatment. Duke apparently knew of this happening at least with a few patients, told him to cut it out, and then looked the other way. The book doesn’t go into this at all.

Did Kempner whip all his patients? Some of them? Was the whipping important to diet adherence?

We’ll probably never know.

Later, another patient came out claiming Kempner had sexually molested her. On this case, the book makes it seem like the patient, a young woman, was known to be “troubled” and had likely made up the accusation. Reportedly, she had been unsuccessful in sticking to the strict rice diet, and Kempner had eventually refused to continue treating her.

This is, of course, just the perspective of a fawning lady who got a start in her career from Kempner, worked with him for most of it, and then wrote a book about him. We’ll probably never know. Wikipedia says the patient reached a private settlement with Duke.

Where Kempner came from

Roughly the first half of the book is about Kempner’s life before he fled from the Nazis.

Kempner was born in 1903. Let’s just appreciate that this was when the German Empire was ruled by the Kaiser, and World War I wouldn’t start until Kempner was 11.

Kaiser Wilhelm, wearer of both fancy mustaches & crosses

The story really begins with his parents. His mother, Lydia, was only the 2nd woman in all of Prussia to be awarded a professorship. This was apparently very controversial at the time.

She was a microbiologist and did work on tuberculosis, proving that the bacteria could be transmitted via infected cow’s milk. Ironically her daughter, Kempner’s sister, would die of tuberculosis at a young age.

Her husband, Walter Kempner Sr., was a wealthy man and gentleman-scientist. The couple collaborated on several studies, including this incredible 1899 study on PubMed about tuberculosis-infected cow’s milk.

Curiously, Walter Sr. apparently thought it was unladylike for his wife to get paid for work. He clearly wasn’t against his wife working & having a very successful career. He just didn’t think she should get paid in exchange. This apparently led to the bizarre situation of Lydia Rabinowitsch-Kempner having a long & productive career, including being the department head at a Berlin hospital, but doing most of it as unpaid volunteer work.

Different times, I suppose.

Seeing how both of Kempner’s parents were scientists researching human disease, it’s not a huge surprise that Young Walter took up the same profession.

The book regales us with lots of funny anecdotes of Walter the Curious Child, then Walter the Stubborn but Smart Young Doctor. He trained under Nobel Prize winner Otto Warburg, who is credited with discovering much of what we now know about the metabolism of cancer.

There’s a funny anecdote in the book about Kempner interviewing with Warburg. Apparently, Warburg ran a very tight ship in his lab and asked Kempner if he knew anything about chemistry. Kempner shook his head. Biology? Nope. After a few more rounds of this, Warburg offered young Walter Kempner an opportunity to sit on a chair in the corner of the lab, watching, but not disturbing anybody.

Between the World Wars, Kempner learned & studied & was involved in the haute culture of Berlin. He was apparently fond of a famous poet, who kept a little cult of personality around where they had lavish dinners and read poetry to each other.

Kempner was so fond of this poet that he offered to become his personal doctor. Later in the poet’s life, when he fell sick, Kempner would live with him for months at a time, travel with him to his vacation home in Switzerland, and generally take care of him until his death.

This poetry circle was quite hip at the time, and included a lot of famous people. Amongst them were the Stauffenberg brothers, one of which (Claus) is famous for his assassination attempt on Hitler with a briefcase bomb.

Claus Philipp Maria Justinian Schenk Graf von Stauffenberg, famous for trying to blow up Hitler & being portrayed by Tom Cruise.

It is unclear, from the book, if Kempner and Stauffenberg had any direct personal contact, or if they just hung out in the same circles. Let’s just say that Kempner got around quite a bit in pre-World War II Berlin.

Another fun anecdote: a powerful Nazi official once left incriminating information when sleeping with a prostitute. The prostitute tried to go public, and Walter Kempner’s brother Robert, a prosecutor, talked her into accepting a lump sum cash payment for her silence.

Years later, Robert called in that favor with the powerful official to allow members of his family escape the Nazi clutches. It is quite possible that Walter Kempner only escaped to America because some Nazi couldn’t keep his dick in his pants.

Incidentally, Robert Kempner is much more famous than Walter: as a prosecutor, he tried to prosecute Hitler for treason and ban the Nazi party. He was subsequently canned when the Nazis gained power.

After the war, Robert Kempner helped the Americans prosecute the Nazis for war crimes in the famous Nuremburg trials, as he was familiar with the German legal system and the intricacies of Hitler’s rise to power.

Robert Kempner, just following orders

Another fun fact: Robert’s godfather was Robert Koch, the inventor of modern microbiology. The Kempners were VERY well connected in the biology and medicine circles of their time. I don’t know if Koch was also godfather to Walter, or just his brother.

In 1934, the situation in Nazi Germany became untenable for Walter Kempner. As a Jew, he was being kicked out of his job. He briefly tried opening a private practice, but that was shut down too.

Kempner started looking towards America. He sent letters to various universities and collected some favors from important people he knew.

He finally settled for Duke in Durham, North Carolina.

Durham was, by the accounts of the book, a pretty quaint little Southern town at the time. Kempner settled in, starting with a very small lab and only a few assistants.

He soon published copious studies, many about the results of his Rice Diet, and built out the lab. At one point, his Rice Clinic was a major revenue center for Duke university, to the point that they pretty much gave him everything he wanted.

During the Nazi regime, Kempner helped many Jewish intellectuals and doctors flee to America. There was sort of an “underground railroad” network, and he used his connections and money to finance people’s visas and stays in America, including renting houses for them and even giving them jobs at his own lab.

Soon, Kempner had built a little enclave of Nazi refugees in Durham. But they didn’t just stick to each other. Kempner apparently recreated a similar situation to the poetry circle he knew in Berlin, with lots of Duke personnel invited, including the author of the book. They would hold barbeques, read poetry together, sing, and more.

Walter would eventually return the favor to his brother. From his now established position as a successful doctor he wrote to various U.S. government officials until he could secure visas and passage for Robert and his family when they finally fled, too.

I can only imagine the culture shock as Kempner moved from Weimar/Nazi Berlin to the American South of 1934.

Who was Walter Kempner?

This is Walter Kempner. Looks kind of Hitlerish, doesn’t he? Black & white photo, leaning on the podium, an aggressive stance - makes you believe this guy could’ve whipped people.

This is also Walter Kempner. Starched white shirt, a nice young man looking thoughtful, maybe listening intently. He seems focused, interested.

And a much later photo. Kempner, seemingly a nice older man, eating a bowl of rice in what looks like a photo-op that none of the people in it seem to enjoy very much.

These are pretty much all the photos left of Kempner.

Kempner spoke English badly and with a strong accent. One person described him as “hacking his way through English sentences". Yet by all accounts, he was an extremely charismatic guy. He immediately began to accumulate an ever-growing circle of friends, colleagues, and admirers.

In fact, the introduction to the book, written by yet another young lady that worked in Kempner’s lab, reads like a romance novel. She tells of the first time she met Kempner while visiting a friend. The handsome young doctor drove up in a stylish automobile, collecting the two girls at the railway station. He immediately impressed them with his worldly attitudes, poetry, singing, and stories from travel all over the world. Did I mention he was a doctor?

He convinced this young lady to study medicine, and she did so, working to get her degree and then getting a job - in Kempner’s lab, of course. I imagine that young ladies becoming doctors wasn’t quite the norm in 1930s Durham, so Kempner must’ve left quite an impression on her.

The anecdotes about Kempner’s patients tell a similar story. The strange young doctor with the weird accent & the strong opinions seems to have been quite intriguing. Word spread fast. He soon had celebrities, singers, actors, CEOs and other business executives coming to check into his Rice Clinic.

Through all this, there is no mention of Kempner ever marrying, or even of having a girlfriend. I’m quite sure that a wife would’ve been noted in the book, but I can imagine that girlfriends were something one simply didn’t talk about back then.

He had a lifelong female friend, Clothilde Schlayer. They’re even buried together in Switzerland. Maybe they were lovers and it was just not polite to talk about?

Or, my personal suspicion, maybe Kempner was gay. I mean, c’mon. A well-respected, wealthy doctor, celebrities kissing his hand and waiting at his door, young ladies practically throwing himself at him - you can’t tell me this guy didn’t have the opportunity to find a girlfriend or wife.

Another indication is the German poet I mentioned above, the one who’s personal doctor Kempner became. The poet was apparently somewhat publicly gay, and several of the young followers in his poetry circle were known to be his boyfriends. The book doesn’t give any indication, but I don’t think it’s crazy to suspect that Kempner was in love with this guy.

Imagine being openly gay in the Kaiserreich and then Nazi Germany. (Apparently the Nazis liked the poet, though, because his poetry was full of strong, masculine warriors and germanic ethos.)

While Kempner seems to have been quite charismatic and attracted a huge following, he was also quirky and a troublemaker.

He had just about zero respect for “the way we do things here” and established medicine. When people didn’t accept his findings or methods, he’d call them names and generally treat them with a lack of respect.

He got the nickname “The Gadfly” for his penchant to attract the ire of powerful establishment figures in the realm of medicine.

Luckily for him, Kempner thoroughly collected blood, urine, and other data for all his patients. When establishment doctors or researchers called his results into question, Kempner had all the receipts and then some. His work was hard to reproduce by others, but it was also hard to question.

Some of his patients achieved such reversal of symptoms that other doctors doubted Kempner, suspecting he had falsified the data or switched out the before/after x-rays or pictures. But Kempner was able to get credible colleagues who testified that, yes, these patients had been in dire shape, and, yes, incredibly, they were now much better in ways not commonly understood to be possible by establishment medicine. This included reversal of kidney damage and damage to the retina of the eye.

You can probably see why I’m fascinated by this guy. He didn’t care for The Establishment. He found their results & methods lacking, and he decided to go his own way. He had very little patience for sitting around and repeating what was in the textbooks when it didn’t deliver results. He was loyal to his friends and combative toward ignoramuses.

I can imagine that fleeing from the Nazis gave Kempner sort of a “hardened” personality. After you narrowly flee certain death due to your prosecutor brother calling in favors, I suspect that the average Durham faculty meeting did not seem particularly scary to Kempner.

A fancy establishment professor calls you a fraud at a medical conference? Big deal when your friends died in camps.

Walter Kempner seems to have cared tremendously about his patients, and had very few fucks to spare for his critics.

Over his career Kempner tended to thousands of patients at his Rice Clinic, and he achieved extremely impressive results for many or most of them.

Why & how did Kempner’s Rice Diet work?

It’s not a big question IF the rice diet worked. Kempner was famous across the country for it, and business executives & movie stars would travel to Duke to stay at his Rice Clinic. There are copious studies and even photos demonstrating the success.

Two examples of massive weight loss from the book

Unfortunately, the rice diet rarely seemed to work in any other setting. Many other physicians tried to copy it, and it apparently never seemed to work.

Most of them tried to “modify” the diet and ease restrictions, and Kempner was very adamant about changing nothing at all. Even the addition of an egg 3 times a week, a piece of meat per week, and so on, would cause the diet not to work.

Kempner also took lots of blood tests from his patients to ensure electrolytes and other numbers stayed in range. He also used these tests to monitor diet adherence: from the blood values, he was able to tell if people had eaten anything not allowed on the diet, and he would admonish his patients.

There are a handful of anecdotes of the rice diet working outside of Kempner’s clinic. One young lady was sent home after a successful stint at the clinic. For some reason, she had gotten the impression that she was supposed to just continue the rice diet at home forever. So when she came back for a checkup, months later, everyone was surprised that she had continued to lose a lot of weight and was in perfect health.

Unfortunately, this seems to have been a very rare exception.

The book mentions several times, and even quotes Kempner, on how difficult and unpalatable the rice diet was. At one point he’s quoted as calling it “Total War,” or that it’s painful but must be done because it’s necessary in the face of impending death (for renal patients).

Kempner described his diet as "a monotonous and tasteless diet which would never become popular.... Kempner's only defense of its use was the fact that “it works,” and that the diet was preferable to the alternative of certain death"
- Wikipedia, “Rice Diet”

This is weird to me, because I just did a month on a version of a rice diet that was quite tolerable and not painful at all.

Of course I didn’t do Kempner’s diet exactly, but can the delta really explain this?

Let’s compare the 2 diets:

Kempner’s rice diet was plain white rice, some fruit, some fruit juice. For renal/heart disease patients it was typically restricted to 2,400kcal/day. For weight loss patients, it was restricted to way less than that - but the book doesn’t give an exact number. Common numbers cited range from 400-1,000kcal/day, which would be an extreme deficit, almost starvation. I got the impression that Kempner would specify an individual number for each patient, maybe depending on the weight to be lost and other subjective (“how disciplined does Kempner think this patient is”) factors. Kempner’s version is completely salt-free and spice-free.

My own rice diet was ad-libitum white rice with ad-libitum fat-free marinara sauce. No fruit or juice. The marinara sauce contains tomatoes, spices, and some salt. I didn’t add any additional salt (I haven’t added salt to my food in years). I ate quite a lot of the marinara sauce, though, basically drowning most of my rice.

Carolies

The obvious difference is ad-lib energy intake vs. caloric restriction. Any diet will be difficult, painful, and hard to sustain if it severely restricts your carolies. It will also very likely produce acute weight loss in many people, but that weight would mostly come back relatively quickly once people stop restricting their carolies.

Hedonic value

The other difference is the marinara sauce. If the rice diet is “painfully boring” to people, maybe the flavor of tomato sauce & spices & a little bit of salt jacks that “hedonic factor” way up, making it more palatable?

Just anecdotally, I ate my white rice completely plain a couple of times toward the end of the experiment, and it wasn’t disgustingly boring. I thought it tasted quite good, sort of earthy/nutty, and I finished my bowl every time. But, of course, that was a handful of meals out of hundreds over the course of the month.

On the other hand, Kempner’s patients were eating fruit & drinking fruit juice. That’s certainly some variety I didn’t enjoy, and it adds some sweetness to a starchy, non-sweet diet. Sweetness is usually associated with hedonic eating pleasure and even “addiction” (if you ask low-carbers), so one could argue that Kempner’s diet was, hedonically, on a similar level as mine.

Salt

Kempner was very adamant about salt restriction, and his original kidney treatment was specifically targeted at minimizing salt intake as much as possible. A rice/fruit diet was just a vehicle for that.

This is interesting because it was apparently considered crazy & shocking at the time - remember, the majority of Kempner’s career was before the low-salt & low-fat craze instigated by Ancel Keys in the 1950s and 1960s.

In fact, Kempner’s diet is often described as a low-salt or low-sodium diet in clinical papers, not a “rice diet.”

Kempner had the hypothesis that salt overstimulates the adrenal system, therefore causing the body to produce excess sugar via gluconeogenesis.

Clinicians at the time had already observed that obese people with (type 2) diabetes produced an excess of sugar, and their glucose levels were elevated not just from intake, but chronically, even fasted. But why?

Kempner’s money was on salt.

It could thus be argued that the addition of the salt from my marinara sauce made a huge difference. Possibly in the diet not working for me, but it also might have made the diet way more tolerable.

I eat a pretty low-salt diet and have for years, but maybe going to pretty much zero salt makes a huge difference. Remember also that meat contains salt, and my normal diet contains daily meat. That’s lacking on the rice diet.

Funny coincidence: I am typing this at Whole Foods and literally have a jar of the fat-free marinara sitting next to me that I just bought. Yes, I still love it even after eating it daily on the rice diet. It lists a sodium content of 410mg per serving size (118g). I consumed at least 6 servings per day during my rice+marinara diet, which adds up to about 2.5g of salt per day. That is just over the RDA (recommended daily allowance) by the FDA of 2.3g of salt per day.

In other words, adding so much marinara to my rice turned my diet from a low-salt diet into a high-salt diet. It is a 100% certainty that Kempner would’ve disapproved of my modification to the rice diet, and he wouldn’t have been surprised that it didn’t work.

Certainly something to think about.

Whippings & Charisma

Another hypothesis, of course, is the whippings and Kempner’s charisma. He was described as an extremely pleasant & charismatic man. The author of the book certainly seems to have fallen for him as a young woman. The way she describes him, most of Durham, NC was under his spell and he convinced mayors to fund more rice clinic buildings, doctors to study his methods, and heads of departments to grant him funds, labs & personnel.

In fact, I’m quite certain we could describe the whole thing as a cult of personality. Kempner seems to have made daily rounds in the Rice Clinic buildings, talking to people, giving them personalized advice, shaking hands, working the room.

Add in the rumors of occasional disciplinary whippings.

Maybe the Rice Diet worked because people wanted to please Kempner? And maybe, when they didn’t, they’d let him whip them because it was the 1940s and people did weird things back then?

Think about it: people are taking Ozempic right now, fully aware of the risk of getting pancreatic or liver cancer, slowed digestion with all that entails, and much more.

For decades, the “gold standard” in weight loss was getting portions of your intestines removed surgically.

Is getting whipped a little really that bad in comparison?

It could be that Kempner’s Rice Diet only worked for him, in his Rice Clinic setting, because it was just a pretty severe calorie restrictive diet.

People might’ve showed up, bask in the Glory of Walter Kempner for a few weeks, hang out with other cool ricers (yes, the actual term they used) & celebrities, be part of the rice cult for a little bit. They’d severely undereat for a few weeks and rapidly shed pounds.

Then they would’ve returned home, resumed their normal eating habits, and gained the weight back. Subsequently, they’d return the next summer for another stint at the Rice Clinic.

Does this sound like modern dieting to you at all?

Yes, there were tons of repeat patients. After all, it was literally the fad of the day and was considered very stylish. People traveled from Los Angeles and New York to hang out with the weird German doctor in Durham and lose weight.

In conclusion, I don’t think we know why the rice diet worked so well in the Rice Clinic setting, but almost nowhere else. Maybe you really need to be THAT strict. Maybe you do need to make it zero-salt, and that makes it super hard to tolerate. Maybe it is the “carbosis” hypothesis of HCLFLP diets we like ‘round these parts. A diet of pure plain white rice is also extremely low in PUFAs as it contains nearly 0 total fat.

Or maybe it really only worked because a cult of personality, sense of community & an occasional whipping helped people starve themselves for a few weeks out of the year, after which they gained it all back.

Curious. I honestly don’t know.

Ancel Keys - Kempner wannabe?

Remember, Kempner came to America in 1934, and he would’ve had a 20-30 year career before a young doctor named Ancel Keys would take the reigns of the U.S. medical & nutrition establishment.

This is only briefly mentioned in the book, but apparently doctors from Minnesota, where Keys worked, tried to convince Kempner to open a subsidiary or partner clinic at their university. After a bunch of discussion or negotiation, the idea fell apart.

But it is quite curious how most of the ideas that Ancel Keys would eventually become famous for - salt bad, fat bad - were staples of Kempner’s diet decades before that.

Before you say “Oh, c’mon, everybody thinks salt & fat are bad in mainstream medicine!” note that this was not the case at the time. Kempner really seems to have been a pioneer here, for better or worse. Even the idea that diseases like heart disease, hypertension, and renal failure could be treated with diet seems to have been controversial and revolutionary at the time. (Obesity less so.)

It’s not inconceivable that Ancel Keys got inspired by Kempner and eventually modified his diet or methods to fit his own goals.

The Kempner Legacy

While Kempner was somewhat of a legend in his day, his name is now pretty much unknown. He doesn’t have his own Wikipedia page, only mentioned on the one for “Rice Diet.” I only know about Kempner because of Denise Minger’s excellent article In Defense of Low-Fat.

Almost nobody these days talks about “going on a Kempner diet” or even “going on a rice diet.” Many of the diseases Kempner treated can now be treated with medicine. I think much fewer people die of renal failure these days. Heart disease has continued to be a problem, but medicine has gotten very good at fixing the symptoms with stents, bypass surgery, and so on. In short, we have more heart disease than ever, but we don’t die every time now.

There is still a Rice House in Durham and you can go there and book a stay at a rate of $2,300 a week.

Besides that, though, Kempner doesn’t seem to have left an institutional legacy. There is scarcely a Kempner diet tribe out there, and I don’t know of any faction in medicine or nutrition research dedicated to his ideas.

While Walter Kempner seems to have been charismatic and a force of nature, he didn’t build much of a self-sustaining legacy, at least not to the level of his prime, when he was famous and had thousands of celebrities come visit his clinic.

On the other hand, a whole generation of low-fat/high-carb diets were inspired by his Rice Diet:

The rice diet has influenced some contemporary advocates of the plant-based diet. For example, physician John A. McDougall has commented regarding the research of Walter Kempner that "all who have followed in his footsteps, including Nathan Pritikin, Dean Ornish, Neal D. Barnard, Caldwell Esselstyn, and myself, owe homage to this man and his work."
^{- Wikipedia, “Rice Diet”}

I suppose a little bit of Walter Kempner lives on in all those low-fat/vegan diets out there, and in everyone on r/SaturatedFat and on Twitter doing HCLFLP diets.

Edit: Someone mentioned a blog post by Jason Fung that was written 10 years ago (2015). He addresses many similar points and, as a nephrologist (kidney doctor) has some good insight into the kidney disease part of the diet.

Check it out here: https://www.thefastingmethod.com/thoughts-on-the-kempner-rice-diet/