Health and Religion

Arteriosclerosis—causing coronary heart disease, hypertension, strokes, and occlusive peripheral vascular disease (hardening of the arteries)—remains the leading cause of death among Americans. Increasing interest in the relationship of diet to arteriosclerosis and the reported success of the Longevity Research Center in Santa Barbara, California, in initiating a reversal of this process, prompted MINISTRY to request an interview with its founder, Mr. Nathan Pritikin. Dr. Ethel Nelson, a pathologist, was assigned by MINISTRY to do the interview.

Q.—I understand, Mr. Pritikin, that you are an engineer by profession. How is it that you have become interested in medical research in atherosclerosis and related degenerative diseases?

A.— During World War II, my assignment in the armed services gave me access to confidential material acquired through military intelligence. In the course of my work I learned that cardiovascular disease in occupied countries had dropped to half the prewar levels.

Q.—Was it thought that this drop was related to the dietary restrictions imposed by the war?  

A.— Yes. Thanks to the meticulous record-keeping of German doc tors in concentration camps, it was found that prisoners entering the camps with angina, hypertension, and diabetes, who were fortunate enough to survive, left without their diseases when released. They had been eating moldy bread, leftover vegetables, roots, and bark. This all added up to a very low-fat diet.

Q.—This is what originally sparked your interest in nutrition?

A.— After the war, I subscribed to medical journals in an effort to learn the second chapter of this interesting story. Nutrition has been an avocation of mine for the past thirty-five years. I've probably spent a third of my time reading the literature in this area.

Q.—You've been more devoted to reading than most doctors have! Did you have any other motivation?

A.—About 1957, one of the medical researchers with whom I became acquainted suggested I get a cholesterol level on myself. I was horrified to learn that my own serum cholesterol was more than 300. A stress test also indicated significant coronary blockage.

Q.—Mr. Pritikin, you look quite fit now. Do you mind if I ask your age?  

A.—I am 62. This occurred just twenty years ago. My cardiologist was very concerned and limited my walking to two blocks a day.

Q.—I imagine that you instituted in your own behalf some of the things you were learning about the relationship between diet and coronary heart disease.

A.—Yes, my ten years of study convinced me I should modify my diet, but I had no definite guidelines. I tried to get help from the nutrition departments of two leading California universities. When I explained that I wanted to lower my cholesterol by eliminating animal products, I was told that vegetable protein was deficient and that such a diet would mean committing suicide. I finally quit trying to fight the establishment, and made arrangements with a pathologist to monitor my own laboratory tests.

Q.—Obviously your results must have been good.

A.—It didn't take long to learn that all the ideas about vegetable protein were unfounded. My cholesterol level changed just as it does in animal studies when dietary fat is eliminated. However, I will ,admit it took a year and a half to get my cholesterol from 300 to 160, but only because I was reluctant to change my whole diet. For one thing, I hated to give up my pint of ice cream a day.

Q.—Did your EKG simultaneously improve?

A.—Not until I started exercising. As I learned, a modified diet can stop further vessel closure, but exercise is needed to build new collateral circulation.

Q.—This brings up the point of actual regression of atherosclerotic lesions in the vessels. As a pathologist I have noted many times the relatively clean vessels in elderly patients who have lost considerable weight prior to death, in contrast to the average patient of the same age group, with far advanced atherosclerosis. I personally have been convinced of the reversibility of the process.

A.—This result has been proved to occur in many animal models. There are also a number of cases in medical literature of angiographic (artery X-ray) evidence of arteriosclerotic regression in human beings.

Q.—I am familiar with several of these spectacular cases, even though it did not seem these individuals were on either model diets or exercise programs. I understand the diet you recommend is limited to 10 per cent of total calories in fat, 10 per cent in protein, and 80 percent in complex carbohydrates—very different from the ordinary American diet.

A.—The American diet of 45 to 50 percent fat, largely of the saturated variety, causes atherosclerosis. In addition, a high proportion of the carbohydrates used is of refined sugar, which also raises the fatty-acid levels.

Q.—How did you arrive at the 10 percent fat, 10 percent protein, level?

A.—If one examines the diets of populations where there is little or no atherosclerosis, one will find this is the fat and protein level they have in their diets.

Q.—These peoples have no nutritional deficiencies?

A.—Their nutrition appears to be adequate as evidenced by their daily activity. We couldn't compete.

Q.—I read your book Live Longer Now, and considered it well written. It appeals to both the nonmedical and medical person.

A.—The 130 medical references in it were designed to give it credibility.

Q.—I was quite impressed by the extensive bibliography in your book. I notice also that you permit small amounts of meat, chicken, and fish in the diet. However, at the Center the only animal protein allowed is skim milk. What is the discrepancy?

A.—We actually have two diets: a reversal diet, which is used at the Center for those on an initial month-long live-in program, and a maintenance diet, such as is described in the book. The reversal diet cuts animal protein to an ounce a week, this amount being added merely for taste.

Q.—I'm particularly interested in your stand in regard to the current controversy over saturated and unsaturated fats. What about essential fatty-acid needs? Is not eliminating fat-containing natural foods such as olives, avocados, and nuts unnecessarily restrictive?

A.—The need for polyunsaturated fats is very small. A synthetic diet for hyper-alimentation contains only 0.8 percent fat with 90 percent glucose and 8.5 percent protein. In a thirty-month program 8-year-old children gained six inches in height in one year on this diet. It has been shown that 0.1 percent fat is sufficient only two calories—one large drop from a dropper. Three extensive studies have demonstrated that the death rates from coronary heart diseases are identical in men using polyunsaturated fats and those using saturated fats at the 40 percent level.

Q.—You are speaking, of course, in terms of the lack of regression of atherosclerosis on a high polyunsaturated-fat diet?

A.— Yes, a low-fat diet is superior to a 40 percent corn-oil diet, for ex ample, in reduction of atherosclerosis.

Q.—What is your exercise pro gram?

A.—Walking at one's capability. A person on a high-fat diet has fatty aggregates and clumping of red cells resulting in increased viscosity of the blood. This in turn impairs the blood circulation through markedly diseased and narrowed vessels. The poor circulation with oxygen lack gives rise to anginal pain or cramping in leg muscles on exercising. Very soon after instituting a low-fat diet, these symptoms disappear, as there are no longer aggregates of fat and the blood becomes more fluid, thus permitting better circulation through partially occluded arteries.

Q.—Do you differ with Dr. Kenneth Cooper about strenuous exercise?

A.—We believe that as people feel better they will walk more, and that exercise to tolerance is very beneficial.

Q.—Your book indicates that you are a proponent of the evolutionary theory. Do you conceive of man as an original meat eater or a vegetarian?

A.—Man does not have the capacity to eat much meat. A man can handle the cholesterol in about only one pound of animal protein a week without storing it. This presents a problem.

Q.—Your ideas differ from many who are researching the area of atherosclerosis. Most consider meat to be the natural diet of man.

A.—Animal proteins are inefficient and create excess ammonia waste products. The whole intestinal flora is abnormal on animal products.

Q.—What do you think about milk?

A.—I don't believe man was ever intended to have milk after he was weaned.

Q.—Some nutritionists believe that yogurt is a healthful adjunct. It has been pointed out that the diet of the African Masai tribes contains yogurt, in addition to blood and raw meat.* They never seem to have coronary thrombosis.

A.—In 1972 autopsies on Masai dying by accident demonstrated extensive arteriosclerotic plaques. These people eat 800 milligrams of cholesterol per day, which is very high, but they have a serum cholesterol of 135—very low. The only thing that saves them is their constant exercise. They have coronaries almost twice the size of ours. Yogurt does apparently lower serum cholesterol, but it does not prevent the arterial deposits.

Q.—How do you motivate change of eating habits in a person who loves ice cream and steaks, and has never had any warning symptoms of disease?

A.—Diet is a cultural habit. You can unlearn dietary habits. First you have to have conviction. One of my teen-age sons used to give diet lectures to his peers. He had them so convinced of the importance of a low-fat diet that they decided that if their mothers would not provide the healthful type of food they wanted, they would cook their own. If you can convince a teen-ager, you can convince anyone, since there is no one more rigid in his views.

Q.—Don't you feel it would be preferable to begin such education with children who are just forming lifelong dietary habits?

A.—It would be nice to begin there. But a teen-ager can train his friends, who in turn will train their friends and thus reach out in an ever-widening circle. Because we've been doing this, there is a whole circle of parents who hate me in Santa Barbara. We have younger adults coming to the Center who want to learn prevention. Those who have been on this diet become convinced of its benefits and do not desire to return to their former tastes.

Q.—I understand that you had some input into the dietary recommendations coming from the McGovern Select Senate Committee on Nutrition and Human Needs of the United States. How did this happen?

A.—This came about because of help we gave a congressman from Illinois who was being considered for coronary-bypass surgery. His original pain cleared up, and he has not had to have the bypass operation, and this has been more than two years ago. He was so thankful that he pushed my program with McGovern's committee.

Q.—Did this promotion cause any ripple among the medical advisers to the committee?

A.—I have felt that the National Heart and Lung Association has been negligent in trying to safeguard the health of the American public, by closing its eyes to any ideas of therapy other than its own.

Q.—What diet does the American Heart Association recommend?

A.—One that contains 35 to 40 percent fat with less than 10 percent saturated fat, and less than 300 milligrams of cholesterol. This amounts to no more than four to six ounces of cooked fish, lean meat, or poultry a day. I made claims to various interested congressmen, based on our experience, that we can take more than two thirds of diagnosed hypertensives back to normal, completely off drugs, within thirty days. Hypertensive drugs can be quite harmful. Fifty percent of hypertensive men on drugs may become sexually impotent; 50 percent could have uricacid levels raised to the gout level. These medications can force those using them toward diabetes and occasionally into kidney failure. If we could get only 20 percent off hypertensive drugs and back to normal, it would be a tremendous boon. Actually our experience has resulted in 80 to 90 percent of hypertensives reverting to normal. Since there are 25 million of these people in the country, we are dealing with a big slice of the population.

Q.—Did you testify before the McGovern Committee?

A.—No. Senator Proxmire sent a physician, Dr. Miles Robinson, as an observer to our Center. He wrote a 180-page critique of our work. It formed the basis of questions that committee members asked representatives from the National Heart and Lung Association. There are more than 80 pages in the Congressional Record containing the information that we gave them from our studies.

Q.—The recommendations of the Senate Committee sound very much like your program.

A.—If we had written the recommendations ourselves, they would not have been any different.