Rice Diet - The Residential Clinic

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"Most people when given the choice of "Paradise" or a "Lecture about Paradise" choose the latter."

Walter Kempner, MD

Q:	What is the Rice Diet Program & Heart Disease Reversal Clinic?
A:	We are an outpatient treatment center in Durham, NC. Patients from all over the world come here for the treatment of obesity, diabetes, heart disease, hypertension and renal disease.

Q:	When happens when I get there?
A:	Patients are seen daily by medical staff, have 3 meals a day at what we call "The Rice House," and attend daily activities of stress management, yoga, group therapy, and nutritional lectures.

Q:	What does the diet consist of?
A:	After a brief initial period where menu selection is limited, participants choose form a large selection of items consisting of fresh fruits and vegetables, grains, fish, and legumes (beans). Variety is assured as the menu changes every day. Despite our name, the diet is not centered on rice. We serve a number of rices, but they are just a part of over 30 items available at any given meal.

Why is salt restricted on the Rice Diet?

Your body swells with salt and water. Most of us eat a diet that contains approx. 4,000-7,000 milligrams (mgs) of sodium. A very small amount - less than 500 mgs. a day - is necessary for normal body function. On the Rice Diet Program, participants feel better in a matter of days because they get rid of the extra salt and water they are carrying. Salt makes you feel bad and stimulates your appetite. Salt is obviously a problem for patients with high blood pressure and kidney failure, but it is probably not good for most of us.

Q:	What about rising Triglycerides?
A:	Triglycerides and cholesterols go up in about 15% of patients while they are losing weight. Triglycerides will come down if you persist with the diet and keep losing weight. They will also come down when you stop losing. There is no reason to measure more than every 3-6 months unless you go off the diet or they stop changing.

Q:	Is it is dangerous to lose so much weight so quickly? I am afraid if I don't eat enough calories, I won't have for healthy skin, hair, nails, etc
A:	People worry about nutritional deficiencies, but we have never seen them in people who are losing weight (because they recycle the protein as the fat cells shrink). People who are eating the Rice Diet at a Body Mass Index of 20 may need further consideration. The short answer is "No."

Okay, so now you have sold me on The Rice Diet, but how do I know I will keep the weight off for the rest of my life?

Along with everything else in life, it takes hard work to make important changes. Still, people often feel so good after being on this program that it makes it easier to want to continue to maintain that feeling. We don't send you home with a magician, but we do provide you with the tools necessary to continue to stay focused on your health.

To help you maintain your success at home we have created a web site filled with instruction, recipes, tips, support forums and much, much, more. In addition, we give new patients a copy of Heal Your Heart, a wonderful resource written by one of our staff nutritionists. A copy of Heal Your Heart can be purchased through our on-line bookstore.

Q:	Where can I learn more about the program and its costs?
A:	Click here

What about muscle loss during rapid weight loss?

It may be true that some muscle is lost during rapid weight loss, but this can probably be mostly overcome by exercise. Below is the weight training record of a 20-year-old student who lost 103 pounds in 161 days (0.64 pounds per day).

Exercise	Day 3	Day 154	Best Ever
Bench Press	285 lbs	370 lbs	397 lbs
Leg Press	3 sets 20 reps 400 lbs	3 sets 25 reps 690 lbs	??
Squat	1 rep 400 lbs	1 rep 525 lbs	1 rep 550 lbs
Biceps Curl	5 sets 10 reps 25 lbs (each arm)	5 sets 20 reps 40-45 lbs (each arm)	3 sets 15 reps 60 lbs (each arm)
Triceps Pushdown	3 sets 15 reps 90 lbs	3 sets 15 reps 160 lbs	??

"In addition to all of this, my cardiovascular endurance has improved 10-fold. When I arrived, I could do no more than 30 minutes of any sort of cardio. Now, I am doing about 4 hours of cardio each day." If this young man lost any muscle, it sure doesn't show up in his performance.

I have allergies; will the Rice Diet work for me?

When people are tested for food allergies, skin and blood are often tested, but not the actual stomach. Many patients, who had been previously diagnosed with food allergies, find success with the Rice Diet Program. Patients are started on a bland diet of rice & fruit with medical supervision. Then slowly, foods are added, one at a time, such as vegetables to see if they have any reactions (diarrhea, itching, hives, etc).

Q:	What causes low potassium? Can the Rice Diet cause this?
A:	There are conditions that can cause low potassium. The Rice Diet is not one of them. We have not seen low potassium in a patient on the Rice Diet who was not either taking diuretics or taking too many laxatives.

Q:	What about the Rice Diet and the liver?
A:	It is now recognized that people who are overweight may develop liver disease. The Rice Diet certainly helps this problem. In the early days of the diet, Dr. Kempner did show some improvement in liver function in people on the Diet.

Q:	What about the Rice Diet and menstrual cramps?
A:	Most woman report feeling better with less fluid retention, cramps and symptoms of PMS.

Is brown Rice OK to use instead of white rice?

Brown rice actually has some advantages over white rice and we prefer for people to have brown rice on most occasions, unless white rice is the only option. White rice starts out as brown rice, but after the husk, bran and germ are removed, then the starchy core, or endosperm is left. Brown rice has had just the outer husk removed, which is inedible, and because the bran and germ remain, the brown rice has 3.5 grams of fiber per cup of cooked rice, vs. 0.74 grams left in the white rice. The goal is to get at least 30 grams of fiber in one day, so you can see where brown rice has quite a leg up on white rice.

Another type of rice that is nutritionally slightly better than white rice is "parboiled or converted" rice. This rice is steamed before being dried and then polished to make it white. This steaming pressure forces B vitamins and minerals into the endosperm from the bran and germ. Also, white rice is often enriched, so these enriched rices will have more thiamin, folate and iron, than brown rice. However, brown rice is superior in fiber, vitamin E, protein, magnesium, and essential oils.

Will taking diuretics help me lose more weight faster?

Diuretics have no place in a weight loss program. Diuretics are used primarily for the treatment of high blood pressure and heart failure. They are also sometimes used to treat swelling in the feet, ankles and legs caused by mechanical problems involving the veins of the legs, though they are less effective in these conditions. In all these conditions, diuretics are not as effective as a low salt diet. It is a lot easier not to put things into the human body than it is to try to get them out after you’ve put them in.

The loss of sodium and fluid caused by diuretics does result in weight loss, but diuretics should not be used specifically to lose weight. Diuretics cause loss of substances other than sodium. The diuretic induced loss of potassium can be particularly dangerous and can lead to death. Diuretics can also cause the blood volume to contract leading to kidney problems or fainting.

Why is salt restricted on the Rice Diet?

Your body swells with salt and water. Most of us eat a diet that contains approx. 4,000-7,000 milligrams (mgs) of sodium. A very small amount - less than 500 mgs a day - is necessary to normal body function. On the Rice Diet Program, participants feel better in a matter of days because they get rid of the extra salt and water they are carrying. Salt makes you feel bad and stimulates your appetite. Salt is obviously a problem for patients with high blood pressure and kidney failure, but it is probably not good for most of us.

Why is it important to watch sodium? How much is
too much?

It's important to watch your sodium intake for two reasons:
The first has to do with being as healthy as you can be, the second has to do with losing weight or maintaining weight loss.

If you have high blood pressure, heart disease, heart failure, diabetes or kidney disease, there is no question that lowering your salt intake is good for you. Many of these conditions can be treated with a very low salt diet without medications and less medication can make you feel better.

Lower salt intake can improve your health even if you are basically healthy. First, it has been shown that lowering your salt intake lowers your blood pressure. This is important even if you have a "normal" blood pressure. A person with a blood pressure of 90/60 has only about 70% of the risk of having a cardiovascular event as does a person with a "normal" blood pressure of 120/80. A person with a blood pressure of 140/90, where the doctor usually says we have to watch it carefully, has a 40% higher risk than the person with a pressure of 120/80. So the lower your blood pressure the better and lower salt intake will lower your blood pressure. In four weeks, the patients on the Rice Diet with normal blood pressures lowered their pressures from 117/75 to 112/71. This may not sound like much but it can be very important in terms of lowering your risk of heart attacks or strokes.

Additionally, you will feel better with a lower salt intake and will benefit from nonspecific advantages such as less stiffness in your joints. Most of us are waterlogged. We are carrying around 5-15 pounds of extra fluid, but we have gotten used to it and think that we feel fine. Only when you eat really high salt food, such as Chinese food, do you appreciate how bad being waterlogged feels. When you cut back on salt the extra fluid leaves and you feel better. Only when you lower your salt intake can you appreciate this feeling of well-being.

The second reason low salt is good for you is that it helps to control your eating. Salt, like refined sugar, is an appetite stimulant. Without added salt you will eat less. If you've been on the Rice Diet, you know that no matter how good the food is your appetite begins to diminish almost after the first meal. If you've never been on the Rice Diet, you'll just have to take our word for it.

As far as how much salt you should eat, I have two answers to almost all questions. The first answer is: eat as little as possible! Most people don't like that answer, so I have a second answer: from 500 to 1000 milligrams of sodium a day (that's about one to two grams of salt). Basically, you should not add salt and you should limit your intake of processed foods or products to which salt has been added. Staying low sodium while eating processed foods is challenging. If you eat plain food (grains, fruits and vegetables and even fish, chicken and meat), including nonfat dairy products, you will have no problem keeping within these guidelines.

What about drinking when you are on a low salt diet?

There are two answers to most questions. The first is that alcohol is probably not good for us, so if you don't drink, don't start: no matter what the supposed benefit. The second answer is wine is a fruit. This is the rice and fruit diet. Therefore, wine is permissible. (Most other alcoholic beverages are made from grains: the grains and fruit diet.) Unfortunately, alcohol has more calories than fruit: about 100 for three ounces and 80-100 per ounce for liquors. So, plan accordingly a 3 ounce of red wine would be the exchange for 2 fruits. Doesn't seem hardly worth it.

Q:	What about powdered creamer and Sweet-n-Low or Equal?
A:	Our medical staff always recommends having the "real thing"- like a little real 2% milk. Artificial sweetener is not encouraged but is okay in small doses. We now use a new sweetener called Splenda.

Q:	Is juice okay instead of the eating the whole fruit?
A:	Regular fruit is better than juice as it's higher in fiber, but unsweetened juice is okay once in a while.

Q:	What's a better choice: decaf or regular coffee and tea?
A:	Decaf tea and decaf coffee are served at the Rice House. The reason our staff nutritionists prefer decaf coffee and tea is that research shows that regular caffeinated coffee and tea may lead to arrhythmia (irregular heart beat).

What is your position on the use of monounsaturated and polyunsaturated fat in diet? Specifically, is there an optimal amount? HEAL YOUR HEART mentions 1 to 2 teaspoons when needed to raise HDL. Is this a general upper limit?

Fat, any fat, is loaded with calories. Therefore, it must be carefully consumed, especially if you are losing weight. Ideally, whatever fat you do consume should come exclusively from monounsaturated and polyunsaturated sources - olive oil, canola oil, almonds, walnuts, avocado, flax, or fish - in the amount of 10 - 20% of calories for heart disease reversal and weight loss. We have to say "10 - 20 %" to account for different calorie levels. To translate into grams, which are listed on the food labels, here are some examples: (1) On 1000 calories, 10 - 20% fat would be between 11 - 22 grams of fat per day. (2) On 1200 calories, 13 to 27 grams per day, and (3) on a 1500-calorie diet, 10 to 20% fat is 17 to 33 grams per day. For a frame of reference, 1 teaspoon of oil has 4.5 grams of fat and 40 calories. Six almonds is about the same, 1/8 of an avocado is about the same. One teaspoon, however, is sometimes considered a small amount. One tablespoon (3 teaspoons) is listed on most oils as the serving size, which is 14 grams of fat and 120 calories. Therefore, if mostly fruits, vegetables, grains and beans are eaten without any fat used in the preparation process, then 1 tablespoon of oil can be added somewhere, however, it is VERY RARE to have ZERO fat during the entire rest of the day. Therefore, to account for fat that will likely be added or found in other foods, adding just 1 - 2 teaspoons of oil (or 6 almonds to a salad, or 1/8 of an avocado) to the day will guarantee that the fat in the calorie count for the day stays below 20%.

It is difficult to say what is the "optimal" amount or "general upper limit", but I would say 10 - 20% of calories is a good goal with an upper limit being 20 - 30% if there are no risks for heart disease, no diabetes, and no weight gain.

I don't eat fish. What are good substitutes??

We recommend fish for the omega 3 fatty acid content that can help raise the HDL level (the "good" cholesterol). The types of fat that are found in fish have been found to be highly beneficial, whereas the saturated fat in beef, chicken and pork will raise the LDL, or "bad" cholesterol. So, we say that anytime you can choose fish over other meats, you're doing yourself a favor. SO if there are ANY types of fish you are willing to eat, that would be one of the best and known ways of improving the HDL.

There are a few other ways to raise the HDL that have seen some results in research. The best-accepted way is to get regular exercise (we recommend 1 hour of walking daily). In addition, moderate consumption of alcohol (1 drink a day for women, 2 drinks a day for men) will raise the HDL. However, if you do not currently drink alcohol, we would not recommend that you begin to drink just to improve the cholesterol.

Some studies have seen promise in olive oil, flaxseed, soy products, and moderate consumption of nuts, like almonds, pecans and walnuts. We do not recommend nuts for a snack, but rather as a condiment, with 6 - 8 thrown over a salad, or 1 tablespoon of chopped nuts spread over steamed vegetables. It is important to use a good quality olive oil. Be sure it is in a dark bottle and it should say "hand-picked, first-cold pressed" on the bottle. We like the Laudemio brand as well as the Badia a Coltibuono. Flaxseed must be ground and not consumed in the seed form, because it will not breakdown in the digestive tract if in the seed form. Many people grind it in a separate coffee grinder and sprinkle it over their salad or cereal. Any soy product EXCEPT for miso soup, the soy powders and products flavored with lots of sodium would be OK. Soy milk, tofu made with calcium, plain tempeh, unsalted soy nuts are some good soy products to use.

If you have given up meat and are eating fish for protein, beans and legumes are a great substitute. They also have been shown to have a beneficial effect on the lipid profile by lowering the total cholesterol. Also, if you eat plenty of whole grains, your protein intake should not be a concern.

What if I get hungry at night?

First of all, most of the people who come to the Rice House and are on the first phase of grains and fruit report NOT feeling hungry. What they may mean is that they do not have any cravings. We believe this is due to the elimination of sodium. When people go to the vegetable stage, that seems to change, even though there is still no more than 300 mg of sodium consumed. On the vegetable phase, people report feeling "hungry", however, we think it may be cravings, and not necessarily TRUE hunger. Often times we want to eat, NOT because we have not eaten in many hours, but because we want to FEEL better. We may be angry, stressed, bored, lonely, anxious, excited, or tired, but not hungry.

We recommend doing an experiment: If you feel hungry at night, have some water and go to bed without eating something. If you get up the next morning and you are still hungry, then you were probably hungry the previous night. However, most people will get up and realize they are not hungry, which means they were experiencing one of the triggers listed above, or they saw a pizza commercial on the TV, and they wanted some!

Therefore, we emphasize the importance of recognizing the trigger that may be leading you to the fridge or the pizza man, and find something else to keep you busy: take a walk, read a book/newspaper/magazine, take a bath, clean your apartment/house, call a friend or relative, write a letter, write in a journal, etc. If you have to eat something, have a piece of fruit or some hot tea or some shredded wheat.

What if I hit a plateau and don’t lose any weight for 7 days?

Generally, at the Rice House, plateaus are normal for 3 to 4 days. It is difficult to know what is going on physiologically, however we know people will be staying faithful to the diet and not lose any weight for 3 to 4 days. However, the scale is also not going up more than a pound in those 3 days. If people stick to the program, the scale will continue to go down. We believe there may be some fluid shifts, or perhaps the individual is having constipation or wearing slightly heavier clothes at weigh-in time. In addition, if anyone has begun an exercise program that has caused soreness, the muscles are holding onto fluid, which can keep the scale from going down. The important goal is to stay the course and the scale will move down. We really don’t see people (who are sticking to the program) have plateaus here for 7 days unless they are less than 20 pounds or so from their goal weight. Even then, the scale is going down, but it is going very slow.

When people go home from the Rice House, we emphasize that people should be happy with 1 pound a week weight loss. After a certain amount of time on this program, the fluid weight is gone and the fat weight is left to lose. This will come off much slower than the fluid weight. It takes a deficit of 3500 calories to lose one pound of fat. Therefore, when weighing on a daily basis as we recommend, it will appear as if the scale is not moving. It does move, but it moves VERY slowly and over a period of weeks. (This will vary widely depending on the amount of weight people have to lose.) We still recommend people weigh on a daily basis, NOT to see how much the scale has gone down, but to make sure it hasn’t gone UP from getting into some hidden source of sodium. If the scale does go up 2 –3 pounds in less than 3 days, most likely this is fluid weight (unless an additional 7000 to 10,500 calories has been consumed in those 3 days). The increase of 2 to 3 pounds is more likely from getting some extra sodium, which can come off with a return to a low sodium diet. A good jump-start would be a day of grains and fruit.

So, if you think you are on a plateau, re-evaluate. How much have you lost in the last 4 weeks? Has it been more than 4 pounds? Then you are doing well. Some people will lose more than 1 pound per week, but if you are going down at all over a period of 4 weeks, then you are successful. Just stay the course and the weight will come off!

Can you advise what the equivalent of 1,000 cc's of liquid is included in the program and if the 1,000 cc's includes water? How much caffeine is allowed (if any)?

The equivalent of 1000cc of fluid is 34 oz. In the old days of the program, the recommended amount of fluid was 32-48 oz per day, however, we now recommend 48-64 oz of non-caffeinated fluid per day (6 - 8 glasses of 8 oz each). The best way to tell if you are adequately hydrated is to be sure your urine is almost clear. It should not be completely clear, because you can drink too much on this program. The goal would be to have urine as close to clear as possible. Also, vitamins will add some color to the urine, so that should be taken into account. Some non-caffeinated beverages contain lots of artificial sweeteners. If you do consume these "diet" drinks, I would recommend diluting them. The sweeteners are hundreds of times sweeter than sugar, so when you have a diet soda, for example, a banana won’t taste good enough because it isn’t as sweet. Many have reported an increase in cravings with increased use of artificial sweeteners. We limit their use to 1 – 2 packs a meal.

We do not have caffeine at the Rice House for 2 reasons. For one, it is another addictive substance and we are trying to help people get off of addictive substances. Secondly, it has been shown to cause some cardiac arrhythmia’s, which is certainly not something we need to introduce here. If one cup of black coffee a day is all that a person consumes, it is generally not a problem. However, a double latte or any of the other fancy coffee drinks can have lots of calories. Some have speculated about caffeine’s appetite stimulating qualities, but so far, there's really no definitive research that has found that.

I'm a serious diabetic. I know that rice isn't "everything" in your diet, but avoiding carbs has been my goal. Your diet, with rice and fruits in what seem to me to be large amounts, scares me! Comments?

First of all, anyone who is a "serious diabetic" should not do this program on their own. You didn't mention if you were a Type 1 or Type 2 diabetic, but these are completely two different types of diseases. Carbohydrates are important, however it's the volume of carbohydrates that are the most important. When people are on the first phase here at the Rice House, the total calories are low. If we gave a high number of calories of grains and fruit, then this may cause a problem with diabetics. However, this amount of grains and fruits allows Type 2 diabetics to improve their blood glucose control dramatically, by giving the body a chance to "catch up" to the high level of circulating glucose. People stay on this phase for 2 - 6 weeks, then move to vegetables, and continue to see improvements in their diabetes. We've helped people get off insulin and diabetic medication by eliminating sodium and decreasing the calories. In the Going Home Meal plans, there is a variety of foods - fruits, grains, vegetables, beans, non-fat dairy and small amounts of fish, all cooked without salt, in a moderate amount of calories. These are the types of foods that are good for everyone, including diabetics.

How does the Rice Diet differ from the other popular low fat diets like the plan associated with Dr. Dean Ornish?

Dr. Dean Ornish actually based his diet on Dr. Kempner's Rice Diet, but made some changes.

His diet is completely vegetarian and he added sodium to the Rice Diet to bring it up to 2400 mg a day. On the Rice Diet, we have fish as well as small amounts of lean meats, and poultry (at home), as long as it doesn't "make you sick", meaning raise the blood pressure, blood sugar, or cholesterol. A lot of people eat these foods to excess and then need to give them up later on. Our sodium level is quite low in the treatment phase, then runs between 500-1000mg at home.

The Ornish diet is also VERY low fat. Less than 10% of total calories come from fat. The Rice Diet is initially less than 10% fat when in the treatment phases at the Rice House, but upon going home, patients are recommended to stay between 10 - 20% for heart disease reversal as well as weight loss.

When on the Dean Ornish diet, people are told to eat his foods until they feel full (but not stuffed), therefore not attaching specific calorie levels to his diet. We have several different calorie plans that our patients use at home, including 1000, 1200, and 1500 calorie meal plans.

To my knowledge, both programs emphasize exercise and stress reduction with meditation and yoga.

What are the phases of the Rice Diet and how long do you stay on each one? How much fat, protein and carbohydrates are on these phases? Is it the same?

The "phases of the Rice Diet" have changed over the years to mean different things, but currently, there are three phases, with the first two done at the Rice House and the third phase continued at home. The first two phases are the most restrictive and because of their calorie and sodium levels are to be monitored here at the Rice House. After spending time here, participants learn how to do portions of phases I and II at home.

The first two phases include grains, fruits, vegetables, and beans. Phase I is 5% fat, 6% protein and about 89% carbohydrates. On Phase II that shifts to 7% fat, 13% protein and 80% carbohydrates. On Phase III, when fish, nonfat dairy and other similar foods are added, the goal for fat percentage is 10 – 20%, 15% protein and 65 – 75% carbohydrates, which is actually quite a balanced plan.

The length of time for each phase depends on the individual, but we suggest people do at least 10 – 14 days of phase I. Some choose to do more based on how far they are from their goal. Occasionally, we also have patients who skip phase I entirely depending on their medical situation.

We strongly recommend not doing phase I at home without medical supervision. There is a significant risk involved. However, if one desires to do this program at home, then the book, "Heal Your Heart" by Kitty Rosati, MS, RD, LDN, has a lot of information and recipes that can guide you.

We are happy to answer your questions about the book and the Rice Diet. Please be patient, the emails are answered in the order they are received.

Best of health, The Rice Diet Staff

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