Nathan Pritikin is one of the most inspiring and thought leaders in health I have listened to. He was an engineer with heart disease who bet his life on lifestyle measures. What he proved, what he did not, and the 7 habits to take from himt.
Dr. Kevin Ham, MD
As I jogged to the NY Academy of Sciences this past August, from Hell’s Kitchen to the World Trade Center, I listened to the many hours of lectures that Nathan Pritikin gave decades ago. I was astonished at his first principles thinking and experiments over decades. I marvelled at his engineering and scientific mind but also his mind of curiosity and going against the grain.
He was 42, wealthy enough, but told he had both leukemia and severe heart disease. In the 1950s, that sounded close to a life sentence or death sentence. His doctors advised him to rest and stop exercising. He did the opposite, and started running, gradually running 3 to 10 miles a day. Nearly 3 decades later, a letter in the New England Journal of Medicine described what was found inside his chest at autopsy. He was 69. He had committed suicide as his leukemia recurred but gave instructions for an autopsy to look at his heart coronary arteries. His coronary arteries were described as soft and pliable. The letter noted only some fatty streaks, and it used a word doctors rarely put in print about an old heart.
"...the near absence of atherosclerosis and complete absence of its effects are remarkable."
Hubbard, Inkeles and Barnard, New England Journal of Medicine, 1985
I have read that sentence many times, because I am a physician (and patient) with a calcium score of 505 and a 77% narrowing in a side branch of a heart artery. I immediately switched from a very high saturated fat diet to an extreme very low fat diet too. So I wanted to know something simple. Did this man reverse his heart disease, or did he simply never have much of it? The answer is more interesting than either camp will tell you.
The Engineer
Pritikin was born in Chicago in 1915. He left the University of Chicago during the Depression, built a business, and became a wealthy inventor with patents used by companies such as Honeywell and General Electric. He had no medical degree. He had something else: an engineer's habit of asking what the data said. By his organization's account, he saw records after World War 2 showing that European deaths from heart disease fell sharply during wartime rationing. War is stressful, so stress alone could not be the answer. Food had changed.
Then he found a California cardiologist, Dr. Lester Morrison, who had put 50 heart attack survivors on a low fat diet, with 50 others as controls. By the same account, 38% of the diet group were alive 12 years on, and every control had died. It was small, patients were assigned alternately, and it would not pass as a modern trial. But it changed his life. When he went to see Morrison, his own cholesterol was over 300, on 3 eggs each morning and a pint of ice cream after dinner. He cut animal foods and ran 3 to 4 miles a day. By January 1960, his cholesterol was about 120, and his heart tracing was normal. UCLA cardiologists, he said, had told him cholesterol could not be controlled.
At the same time, he was living with leukemia, diagnosed in 1958. He retired in 1966 to study nutrition full time, published Live Longer Now in 1974, and opened his center in California, the Pritikin Longevity Center, in the mid 1970s. In 1977, 60 Minutes followed 3 men with severe heart disease through it, and by his organization's account their chest pain disappeared. Then, in 1984, months before he died, a large National Institutes of Health trial confirmed that lowering cholesterol lowers heart disease risk. The outsider had lived to see it. He died in February 1985, at 69, after decades with leukemia and severe complications at the end. By one account, he wanted the autopsy done, to show what his way of living had done. He made his own body the final data point.
His 5 Big Insights
Heart disease is not simply fate. In his day, that was heresy. Today it is the premise of every prevention program on earth.
Diet can drive the blood numbers, quickly. You need not wait years to see change. In his largest group, most of the LDL fall came within 2 weeks.
Food and movement work together. Almost every result below came from both, so nobody can give all the credit to the plate.
Small cuts do not move big numbers. He went far beyond moderation, and asked people to change the pattern, not trim it.
Measure everything. Engineers do not guess. Neither should you. What was your LDL the last time you checked, and do you even know the date? Below are studies done based on the insights Pritikin had.
Blood pressure, insulin and LDL can move within weeks. That is the real legacy. In 2010, Medicare added the Pritikin program to its approved intensive cardiac rehab list.
Did He Reverse It?
Here is where I have to be tougher on him than his fans are. There is no angiogram from before. His diagnosis came from a stress heart tracing, not a picture of his arteries, so nobody knows how much plaque he ever had. A normal tracing says little about plaque. The autopsy is 1 man, reported by people close to his work. Leukemia and its treatment may also have played a part in his low cholesterol, and that is my inference, not a finding.
Then there is the wider record. Much of the data comes from the program itself, over weeks, without control groups. When the BMJ compared 7 named diets in 2023, Pritikin had just 1 trial, and those named programs generally showed little or no benefit. Low fat programs as a group did better, with moderate certainty. So Pritikin showed that the numbers can change fast. He did not prove that plaque reverses. The best controlled evidence for narrowing that improves is the Ornish trial, and it is small.
My own scans teach the same lesson. On my adapted Esselstyn diet, with fasting and exercise, my LDL went from 168 to 84 in 5 weeks, and 61 in 12 weeks. My neck artery wall went from 1.8 to 0.84 millimetres, confirmed on repeat scans. But at 12 months, my heart CT had not changed much, and my calcium score is slowly rising. Blood can move in weeks. Heart arteries may take years, if they move at all. I am 1 person, and I take no statin, which is not advice. So what should you do?
7 Habits to Take From Him
Build the plate. The program asks for at least 5 servings a day of whole grains, beans or starchy vegetables, 5 of vegetables and 4 of whole fruit.
Cut the fat. About 10% to 15% of calories, and no more than 1 teaspoon of oil per 1,000 calories. Trials do favor olive oil patterns over standard low fat diets, so this is a choice, not a settled fact.
Keep a stop list. Butter, fatty and processed meats, egg yolks, whole dairy, fried food, rich desserts. Less than once a month.
Make plants your protein. The plan allows 1 serving of animal protein a day, with fish first. I eat none. This was very interesting to me. 3 to 4 ounces of lean fish or lean meat (chicken) per day. I gave this all up but have some theories and want to further research as I am looking to either arrest plaque or reduce plaque or increase blood flow directly or via collateral blood vessels.
Watch salt. The target is 1,200 to 1,500 milligrams of sodium a day.
Move daily. The men in those studies walked briskly for 45 to 60 minutes. The program adds strength work 2 or 3 times a week, and stretching. Get cleared first.
Train your mind, then measure. Build commitment, control, challenge and connection. Then test LDL, ApoB, triglycerides, HDL, fasting glucose, waist and home blood pressure. Follow the plan for 21 days, and retest at the same lab.
Before you start, ask your doctor: if my blood pressure or blood sugar falls quickly, which of my medicines would need to change? Insulin can cause low blood sugar. If you take warfarin or have kidney disease, ask about greens and beans. Very low sodium is not right for everyone. Do not stop any medicine. Statins have far more randomized outcome evidence than any diet, and if your doctor has advised one, this is not a substitute. Chest pain or pressure, sudden breathlessness, fainting or signs of a stroke means call 911. This is education, not medical advice.
A Request
Do the 21 day test with your doctor, then write and tell me your before and after. Real numbers teach us more than opinions.
Your Question
If you could scan your arteries today, would you want to know? Reply and tell me why, or why not.
For Someone You Love
Send this to the person who says nothing he eats will change his numbers. Pritikin was told the same thing.
PREVIOUSLY IN COMPOUNDING WISDOM
I pray you unlock your heart to reach the height of your full potential by discovering your calling.
Kevin Ham, MD
Sources:
Hubbard JD, Inkeles S, Barnard RJ. Nathan Pritikin's heart. N Engl J Med. 1985;313(1):52. The autopsy letter. Quote read through secondary sources.
Barnard RJ. Arch Intern Med. 1991;151(7):1389 to 1394. 4,587 adults; lipid changes in 3 weeks. CMS Pritikin decision memo, 2010. Approval; summary of Barnard 1983 and evidence limits. Roberts CK, Vaziri ND, Barnard RJ. Circulation. 2002. Release. 11 men, blood pressure and insulin. Roberts CK, et al. J Appl Physiol. 2006. Summary. 31 men, metabolic syndrome and diabetes. Intensive vs traditional cardiac rehabilitation. Circ Cardiovasc Qual Outcomes. 2023;16(12):e010131. Medicare cohort, HR 0.88.
Seven structured dietary programmes. BMJ. 2023. Release. Low fat and Mediterranean programs; Pritikin in 1 trial. Morrison LM. Am Heart J. 1951;42(4):538 to 545. Low fat diet after heart attack, 50 and 50 alternate patients. Later figures are the Pritikin organization's account.
Pritikin Longevity Center. Nathan Pritikin, Founder. Organization history. Life story, cholesterol, doctors' advice, 60 Minutes.
Pritikin Eating Plan. Program guidance. Go, caution and stop foods; sodium; oil.
Healthline. Pritikin diet review. Fat range, exercise amounts, 4 traits of stress hardiness, limits. Wikipedia. Nathan Pritikin. Secondary. Dates, leukemia, fatty streaks in the autopsy letter.
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