Nathan Pritikin — The Father of Plant-Based Nutrition
“An optimal diet should permit man to be free of the ravages of cardiovascular degenerative diseases, including angina and hypertension, and diabetes and arthritis, as one of its major attributes.”
These weren’t the words of a medically trained physician or dietitian but from a successful businessman and talented inventor whose ambition did not limit to the dozens of patents collected over his life— from the fields of engineering, photography, aeronautics, and more.
Before the memorable work of American physicians, Dean Ornish and Cadwell Esselstyn in cardiac rehabilitation, a man named Nathan Pritikin was defying all odds and sailing through the turbulent and neglected waters of nutritional science as a lone captain. He would be one of the earliest to establish a route for treating and reversing metabolic and chronic diseases with lifestyle medicine.
This article is in honor of Nathan Pritikin, one of the early fathers of lifestyle medicine & plant-based nutrition and a doctor not by credentials but by heart.
Context — 5 Historical Facts You Should Know
1. Nathan Pritikin was born in Chicago, Illinois, in 1915 — a little over a year after the start of WWI (1914–1918).
2. 3 years after this birth, the world would face the Spanish Flu (aka H1N1 Influenza)— the worst pandemic in humanity’s history. This was 13 years before the discovery of penicillin (1928) by Scottish physician Alexander Fleming, during a time when infectious diseases were among the deadliest diseases.
3. Despite the fear of infectious diseases, heart disease was already the number one killer in the U.S. and in many parts of the Western world; however, it was seen largely as a disease of old age (a concept that would be challenged in 1953 when a study published in the JAMA showed advanced coronary atherosclerosis in young soldiers who died prematerely in the Korean War).
4. Being diagnosed with heart disease at that time was considered a death sentence since it was decades before cholesterol-lowering drugs like statins became a reality in the 80s (thanks to the earlier work of Japanese biochemist Dr. Akira Endo), and before the most common and effective medical procedures for heart disease, such as coronary artery bypass surgery (1960) and percutaneous transluminal coronary angioplasty (PTCA) (1977).
5. When Pritikin was diagnosed with heart disease at age 40 in 1955, lifestyle interventions for the treatment of metabolic and chronic disease was heavily disregarded by conventional medicine, despite all the observational and clinical evidence at disposal that indicated that diet was directly associated with chronic diseases.
The War Influence
At the time of WWII, heart disease also majorly associated with stress. Based on this notion, Pritikin predicted that heart disease events would double during the war. After all, what could be more stressful than wartime?
However, the opposite ended up happening to the surprise of Pritikin and doctors at the time. In countries in which fat and cholesterol were limited, the population saw a drastic drop in the rates of heart diseases.
In England and Wales, for instance, there was a significant drop in heart disease to prewar levels during the first years of WWII (1940–1942). Though Barker & Osmond noted that “there is no evidence that time trends in CHD were much influenced by the war,” there was indeed a drastic change in dietary patterns in these countries during wartime and shortly-after.
“Levels of consumption of fat, fibre, and sugar during the 1940s differed markedly from those in the 1930s and 1950s. Total fat consumption fell from 39% of food energy in 1934–38 to 36% in 1941 and 33% in 1947. It returned to 38% in 1950 and increased thereafter.(2)”
Occupied countries that suffered from food shortages saw similar trends, pointing to a positive association between fat consumption and coronary heart disease, as this 1979 study shows.
But why Denmark showed the exact opposite?
Well, while overall fat consumption declined via margarine and animal fat shortages, butter consumption actually increased during the same period, as this Danish study reveals.
As Schettler pointed out, coronary heart disease in postwar Germany (1945–1948) was rare — a period in which the German population suffered from malnutrition, which would change drastically in 1948 with the currency reform.
And as Germany recouped its economy and calories, so did heart disease (alongside obesity), as this graph shows.
Of course, association isn’t causation, and Pritikin knew that; however, such remarkable associations between fat consumption and heart disease were hard to be dismissed and consistent enough to sparked his interest in lifestyle medicine.
The Influence of Dr. Lescer Morrison
Pritikin closely accompanied the early work of Dr. Lester M. Morrison, an L.A.-based physician who was a pioneer in the use of diet as a form of treatment for cardiovascular diseases.
In his study, he put 100 patients with a proven history of severe cardiovascular disease on either a low-fat and low-cholesterol diet that mimicked the wartime food rationing diet of Europeans (50%), or what he called a ‘prethrombosis diet,’ a.k.a. the standard American diet (SAD) at the time — the control group (50%).
The low-fat & low-cholesterol diet allowed for 20–25 g of daily fat and 50–70 mg of daily cholesterol, purely from low-fat animal products since nuts, seeds, avocados, and vegetable oils were not part of the menu. The control group's daily fat consumption ranged from 80–160 g and 200–1,800 mg for daily dietary cholesterol.
3 years after the start of the study, the cholesterol levels of the experimental group dropped from an average of 312 to 220 mg/dL whereas the control group’s cholesterol had remained unchanged.
The experimental group suffered 7 deaths out of 50 patients (14% mortality rate) whereas the control group suffered 15 deaths out of 50 patients (30% mortality rate). In other words, twice as many deaths.
Follow-up studies revealed that 8 years later, the diet group still showed a lower mortality rate (44%) than the control group (76%). 12 years later, 38% of the diet group was alive whereas 100% of patients in the control group had died.
Despite the criticism on the flaws of his randomization and controlling methods, Morrison was marked by being one the first to demonstrate in a significant group of cardiac patients the potential of dietary interventions for the treatment of cardiovascular disease.
Inspired by his earlier impressive results, Pritikin decided to have his own cholesterol levels checked with Dr. Morrison himself in 1956.
The Cholesterol Shock
Pritikin was diagnosed with coronary insufficiency by Dr. Morrison via a stress electrocardiogram. His disbelief was so great that he followed up with 12 different cardiologists for multiple opinions. Subsequent testing confirmed that he had substantial coronary artery disease at age 42.
But how could a relatively active, normal-weight, person like him be diagnosed with heart disease?
These were his words after the shock.
His cholesterol was allegedly above 300 mg/dL, which by today’s standards would be considered extremely high; however, at that time this was considered a ‘higher normal range,’ so his physician told him not to worry about it and gave him the normal prescription at the time: no exercise, rest, and plenty of medications (aka a ‘slow death’ treatment).
However, Pritikin ended up doing the opposite of what he was recommended. As someone who had done his own research, he was convinced that these weren’t the only options to treat his condition.
He ended adopting a low-fat, high-carbohydrate diet, with minimal animal protein, and composed of whole grains, legumes, fruits & vegetables, and tubers as the bulk of the calories.
Not surprisingly, his doctors and specialists weren’t happy about it and said things like these to him:
- “switching diets wouldn’t make a difference”
- “he would face malnutrition and fall apart”
- “you can’t control your cholesterol”
By ignoring his doctors’ recommendations,* Pritikin ended up cutting his total cholesterol by half and, in 3 years, he was able to drop it to ~100 mg/dL. However, as soon as he decided to incorporate daily animal protein again, his cholesterol started shooting up accordingly. He figured that about 3–4oz of animal protein a week wouldn’t significantly alter his cholesterol levels.
*This is not something medically advisable as lifestyle changes MUST be closely accompanied by your doctor’s recommendations as part of the treatment, and not as an exclusive treatment.
Convinced that he had reversed his coronary artery disease, he underwent a cardiac stress test via a treadmill in which he ran 8 miles without a single abnormal heartbeat, to the surprise of his cardiologist who had particularly told him to limit his physical activity to 4 blocks of daily walks plus a number of medications for the rest of his life.
Regardless of his experimentation success, Pritikin’s stubbornness did not come only from the work of a single physician, but from multiple controlled studies showing the harms of high-fat & high-cholesterol diet and epidemiological studies done on populations in which heart disease and other common Western chronic diseases were unheard of.
Enter the Blue Zones
During his early research in lifestyle medicine, Pritikin bumped into many epidemiological studies reporting populations around the globe with very few cases to almost none heart disease, independent of age.
In his article published in the Journal of Applied Nutrition in 1976, entitled: “HIGH CARBOHYDRATE DIETS: MALIGNED AND MISUNDERSTOOD,” Pritikin reviewed the scientific literature at the time and noted an undeniable pattern between fat consumption and incidence of heart and other chronic diseases.
If you are a nutritional nerd like me, there’s also an extended 538-page long comprehensive review that can be seen here.
He noted that “the coronary heart disease rate of Bantus in Africa who live on a 10% fat diet is almost zero.” Autopsies performed on the Bantus and Europeans showed that over 83% of the Bantus “lacked even a trace of fatty streak on the intima — the earliest clinical sign of arterial damage,” while 100% of the Europeans showed extensive artery damage, even a 15-year-old.
The same results can be found in autopsies of African Ugandans, in which heart disease is practically non-existent. Outside Africa, autopsies performed on 600 natives from New Guinea, whose diet comprised of 10% fat and only 7% protein, showed not even a single death attributable to coronary artery disease. In an Ecuatorian population of 800 villagers “with an unusual number of aged people (centenarians),” cardiovascular disease was “virtually non-existent.”
How do we know that this is not gene-related?
Before we knew that African Americans are particularly susceptible to heart disease and other chronic diseases, epidemiological studies done by Dr. Ancel Keys on 25 populations scattered across the globe who lived on a low-fat diet showed, without exception, very low rates of heart disease.
His studies showed that as Japanese people migrated from their homeland to Hawaii to San Francisco, their rates of heart disease went up as fat consumption increased — a positive correlation. Maybe the same could have happened with African Americans.
As Pritikin noted, these populations had not only extremely low rates of heart disease — our #1 killer — but also diabetes, hypertension, cancers of the breast, colon, and prostate, arthritis, glaucoma, and other diseases thought to be an inevitable consequence of aging in the Western world.
These studies seem to be in accordance with the blue zones — Ikaria (Greece), Seventh-day Adventists (Loma Linda, California), Nicoya (Costa Rica), Okinawa (Japan), and Sardinia (Italy) — , populations that live on a predominantly or 100% plant-based diet, with minimal fat, cholesterol, and animal protein.
The Recognition
Despite not being a physician, Pritikin started financing and organizing his own medical studies, lecturing across the U.S., and working directly with American physicians as an educator by writing programs, protocols, and blood and other tests for their patients.
He attracted so much attention that he was invited to give a speech at the International Congress of Rehabilitative Medicine in 1975. His results were so impressive that he was selected by the conference as the most important research, despite being the only non-physician lecturing.
He began giving nutritional seminars at Cornell Medical School, Sloan Kettering Cancer Center, and Rockefeller Institute (as they were known at the time), and earned a solid reputation with the Mayo Clinic, Cleveland Clinic, and Ochsner Medical Center, and other world-renowned, prestigious medical institutions.
Over his 25+ years career as a researcher and educator, Pritikin published over 115 studies on heart disease, diabetes, hypertension, and nutrition in some of the most prestigious medical journals, such as the New England Journal of Medicine, the Archives of Internal Medicine, Diabetes Care, and Circulation.
He also wrote many best-sellers on nutrition, exercise, and health, including Live Longer Now, The Pritikin Program For Diet and Exercise, The Pritikin Weight Loss Manual, and Diet For Runners, reaching the homes of over 10 million people worldwide.
The Pritikin Program has published a total of 10 books to date, including the most recent The Pritikin Edge: 10 Essential Ingredients For a Long and Delicious Life (2008) and Understanding Common Diseases and the Value of the Pritikin Eating and Exercise Program (2013).
In of his books, Pritikin featured the grandmother of Dr. Michael Greger — the creator of Nutritionfacts.com and whose grandmother was given a death sentence at age 65 after running out of arteries for another bypass surgery. Thanks to a healthier diet, she prolonged her death sentence for another 28 years, inspiring her grandson to become a medical doctor.
The Pritikin Longevity Center
In the mid-70s, Nathan Pritikin opened the Pritikin Longevity Center (PLC) in California, now known as the Pritikin Longevity Center + Spa and located in Miami, Florida.
It operates as a “lifestyle-change education program and a research center — an internationally-acclaimed laboratory for investigative work into the relationship between lifestyle and disease prevention.”
Some of its proven (and published) health benefits include:
Heart Disease
- In 3 weeks, out of 4,587 guests, an average 23% drop in total cholesterol, 23% drop in LDL (“bad”) cholesterol, 24% drop in non-HDL cholesterol, and 33% in triglycerides
- In 2 weeks, overweight children in the Pritikin Family Program decreased LDL bad cholesterol on average 25%, lost 9 lbs, lowered triglycerides 39%, reduced key markers for inflammation, and increased the body’s production of nitric oxide — thus, reducing the risk of heart disease
- In 2–3 weeks, a significant reduction in chronic inflammation and C-reactive protein (45% among women, 39% among men, and 41% among children)
- Enhanced effectiveness of statin therapy: 19% additional decrease in cholesterol on top of 20% before attending Pritikin’s program
- Eliminate the need for coronary bypass surgery: out of 64 high-risk heart disease guests, 80% remained free of CBS after 5 years of going through Pritikin’s program
- Relieve heart disease symptoms: out of the same 64 patients above, 80% experienced angina; after 5 years, only 32% still had angina symptoms
Diabetes
- In 3 weeks, 46% lower insulin levels
- Better control of diabetes 2–3 years after attending Pritikin’s program + out of 864 type-2 diabetics, an average 19% drop in fasting glucose; 74% went medication-free and the rest had their dosages reduced
Metabolic Diseases
- Alleviation of metabolic syndrome in adults (60% of men no longer tested positive after 3 weeks) and in children (100% no longer had a clinical diagnosis within 2 weeks)
- Lowering of blood pressure to normal levels: Out of 216 adults, 83% went medication-free and 17% significantly reduced their dosages
- In 3 weeks, out of 1,117 hypertensives, an average 9% reduction in systolic blood pressure and a 9% reduction in diastolic blood pressure; 55% went pill-free and the rest had their dosages reduced
Weight Management
- Promotion of healthy, long-term weight loss: out of 4,587 adults, men lost on average 11 lbs and women lost 7 lbs within 3 weeks; out of 64 people with heart disease, an average 11 lbs reduction in weight after 26 days and maintained after 5 years; out of 69 people with type-2 diabetes, an average 10 lbs reduction in weight after 26 days plus an extra 4 lbs after 2–3 years
- An average of 66 lbs reduction in weight, and maintained after 6 years, on nearly 4,500 people following a low-fat diet, high-fiber diet + exercise program similar to Pritikin’s — the most comprehensive study on long-term weight loss ever conducted (less than 1% followed a high-protein, high-fat diet like the Atkin’s diet)
Cancer
- Reduction in key risk factors for breast and prostate cancer (1, 2, 3)
- Retardation in the growth of prostate cancer cells and induced apoptosis: in vitro testing revealed retardation of prostate cancer cells and a 40% apoptosis (cell death) of cancer cells after 11 days following Pritikin’s program, compared to 3% before it, and 50% after 14 years.
- Retardation in the growth of breast cancer cells and induced apoptosis: significant reduction in breast tumor cell growth in 3 different cell lines (7%, 10%, and 19% respectively) and increased apoptosis (20%, 23%, and 30% accordingly)
- Prevention and control of benign prostate hyperplasia (enlarged prostate): in 2 weeks, a 13% reduction in the growth of prostate epithelial cells plus a 30% reduction in fasting insulin, a major contributor
More about their services can be found here and more about the Pritikin Eating Plan here.
The Pritikin Plan is covered by Medicare for people with heart disease as an Intensive Cardiac Rehabilitation (ICR) program, conducted at the PLC in Miami (alongside Dr. Ornish’s Program for Reversing Heart Disease and Benson-Henry Institute Cardiac Wellness Program).
In 1977, the PLC was featured in the American tv show 60 minutes in which they followed 3 patients with severe heart disease who attended a 1-month program. At the end of the program, all three patients’ angina symptoms vanished, their cholesterol, triglycerides, and blood pressure went back to normal levels, and they regained their health and vitality. 1 year after the show, a follow-up revealed that all 3 men remained symptom-free.
Pritikin’s Biggest Legacy
In an unfortunate event, Nathan Pritikin took his own life on February 21, 1985, at Albany Medical Center. He had been battling a long-term leukemia cancer, first diagnosed in 1958 in his early 40s, which had been in remission until late 1984 when symptoms and complications from treatment resurged.
Despite this tragedy, before his death, Pritikin requested that an autopsy of his body be performed and published in a scientific journal. His wish was attended in a Letter to the Editor published in the New England Journal of Medicine on July 4th, 1985.
The autopsy findings proved that Pritikin’s theory worked in real life — he reversed his own heart disease with diet and lifestyle changes.
As Pritikin bluntly said once:
“All I’m trying to do is wipe out heart disease, diabetes, hypertension, and obesity.”
And so he did.
Conclusion
Nathan Pritikin was one character of a lifetime. His ambition, audacity, and courage paved the way for the recognition of lifestyle medicine for the prevention, treatment, and reversal of chronic diseases caused by our poor dietary and lifestyle habits — once known as the ‘diseases of the old age.’
He was a man who defied the scientific consensus at the time by reversing his own heart disease and who influenced many other doctors who continue his legacy by inspiring people to change their lifestyle habits and improve their quality of life.
Today, the evidence clearly points out that any diet that approximates a low-fat, whole-food, plant-based diet 🌱 is a healthy diet. Just by dramatically reducing dietary cholesterol, unhealthy fats, and animal protein, he was able to demonstrate that chronic diseases are, for the most part, diseases that start at our plates.
And as time goes by, it’s becoming evident and clearer that the healthiest diet for us is also the healthiest diet for our planet 🌎. We have the power to not only continue Pritikin’s legacy by taking care of our health and that of loved ones but also going beyond and taking care of our only home and all of its living, sentient beings — Why not?
