For decades, doctors have subscribed to the belief that changing the way we eat and how much we move could improve overall health. But it wasn’t always that way.
As recently as the 1970s, the medical establishment would often tell people with heart disease to take it easy and stop exercising to reduce the risk of heart attack, and that there was little that could be done to lower cholesterol levels. Medications that reduced these levels would only come along in the late 1980s.
But some researchers believed that diet and lifestyle had to have an impact on health, and Nathan Pritikin, an engineer-turned-nutritionist, thought there must be a connection between what we eat and how we feel.
An inventor who had a passion for nutrition and fitness, Pritikin believed that diet and lifestyle changes could yield better results in slowing and preventing heart disease than surgery and medications.
In search of improved health after his own brush with heart disease, Pritikin pioneered a low-fat approach to food that, though initially considered controversial, would go on to influence many cardiac intervention programs around the country.
[See: Heart-Healthy Snacks.]
Reducing Fat for Heart Health
We now know that Pritikin was correct in that diet and lifestyle do play a big role in heart health and overall wellness. The Pritikin diet he developed is still used by many people with heart disease and those rehabbing from a cardiac event. It’s grounded in what eventually became the prevailing nutritional idea of the late 20th century: Reducing fat in the diet would reduce risk of heart disease, lower cholesterol levels and improve overall health.
As such, “it’s a very low-fat, high-carbohydrate, high-fiber diet focusing on whole foods,” says Lori Chong, a registered dietitian with the Ohio State University Wexner Medical Center in Columbus.
The diet emphasizes inclusion of whole foods and the avoidance of processed foods and added sugars. There are restrictions surrounding certain foods and food groups, which are color-coded into three groups.
Go foods are coded green and include:
— Whole grains, including whole wheat bread, brown rice, whole-wheat pasta and oatmeal.
— Starchy vegetables such as potatoes, corn and yams.
— Legumes, including beans, peas and lentils.
— Lean calcium-rich foods, such as nonfat dairy milk, nonfat yogurt and fortified soy milk.
— Fish, which are a rich source of omega-3 fatty acids.
— Lean sources of protein that are low in saturated fat such as skinless white poultry, lean red meat such as bison and venison and plant-based proteins such as legumes, tofu and edamame.
[READ: Heart-Healthy Soups.]
Caution foods are coded orange and should be used sparingly:
“Less is better,” reports the Pritikin Longevity Center + Spa, a health resort founded by Nathan Pritikin in 1975 that’s now based in Miami.
These “caution” foods include:
— Refined sweeteners including sugar, corn syrup and honey.
— Refined grains including white bread, white pasta and white rice.
These caution foods have been “proven to increase the risk of obesity and/or multiple health concerns,” the Center reports. These health concerns include:
— High blood sugar.
— Heart disease.
— Some cancers.
Stop foods are coded red and include non-optimal foods that shouldn’t be consumed:
— Saturated-fat-rich foods such as butter and tropical oils such as coconut and palm oil, fatty meats and whole-fat dairy foods like cheese and cream.
— Organ meats.
— Processed meats such as hot dogs, bacon and bologna.
— Partially hydrogenated vegetable oils.
— Cholesterol-rich foods like egg yolks.
These foods are singled out because they have been proven to “substantially increase” the risk of obesity and the same list of health concerns, listed above, the Pritikin Center reports.
Kimberly Gomer, director of nutrition at the Pritikin Longevity Center, says that while the Pritikin Eating Plan, which is offered to guests who come to the center for a week or longer to get tailored education and support to shift to a healthier lifestyle, may appear rigid on paper, there’s actually a lot of room for individual tailoring.
“It’s critical to understand that we are not a diet,” she says. The PEP is tailored to each individual, and there’s no counting of calories like in a traditional diet. For people attending the Longevity Center, this personalized coaching and support means that those following the Pritikin approach can adapt the eating plan to their needs and tastes.
Pritikin Is an Evolving Plan
Originally, the Pritikin approach diet aimed for a macronutrient breakdown of:
— 75% to 80% carbohydrate.
— 10% to 15% protein.
— Less than 10% fat.
But Gomer says, “our program has evolved. We really went from a very extreme alternative to heart surgery to more of a lifestyle program. We no longer target or focus on macronutrient ranges. Instead, the Pritikin Eating Plan focuses on encouraging individuals to consume minimally processed, mostly plant-based whole foods, rich in nutrients, including carbohydrates.”
Foods emphasized include:
— Whole grains.
— Starchy vegetables.
— Non-starchy vegetables.
— Nonfat diary.
— Diary substitutes.
Gomer says adherents are also encouraged to include “two to three (servings of) omega-3-rich fish per week and to keep other lean animal protein, added fats and added sugars low.”
She also notes that while the Pritikin approach was originally intended to help people reverse or avoid heart disease, now, the organization’s efforts extend to helping people manage a range of chronic conditions including high cholesterol, diabetes, high blood pressure and other health conditions.
To do that, the program is delivered at the resort-type spa location in Miami, where guests stay a week or two or even up to six months “to have a lifestyle overhaul,” Gomer explains.
During that stay, guests are busy learning a new way of living. “Eating is the foundation,” she adds, “so we work on food and dieting.”
Guests also work with an exercise physiology team to develop sustainable exercise programs and a chef to learn how to cook healthier meals. Staff also help guests learn about sleep and stress via an educational series. The center has behavioral health and addiction specialists on site to help guests who need support in those areas too.
Everything is supervised by a doctor, Gomer says. “It’s a complete, immersive kind of program.”
After guests leave, they can maintain contact with the Center for ongoing support, Gomer says.
For people who can’t afford such intensive and expensive interventions out of pocket, Medicare now covers some aspects of a stay at Pritikin. Pritikin Foods also offers breakfast, lunch and dinner options via a frozen meal delivery service that conforms to the Pritikin Eating Plan.
In terms of cost, adopting a Pritikin-style eating plan at home shouldn’t be outrageous, given that the plan emphasizes whole foods and whole grains, which are often some of the least expensive food items in the store. Fresh produce and lean meats can be a bit more expensive than processed foods, so you may see an increase there if you’re switching from a diet that’s full of these cheap and nutritionally limited foods.
Though the Pritikin diet does have some selling points, super low-fat diets have fallen out of favor somewhat in recent years.
Chong says she doesn’t think it’s a “good long-term approach for anyone. However, it’s certainly better than the standard American diet or ‘Western’ diet that’s high in refined carbohydrates, added sugar, inflammatory fats and lacking in fiber, micronutrients and phytonutrients.” So, while it may not be ideal, you certainly could do worse.
Chong also expresses concern that some followers might not take in enough essential fatty acids while following the Pritikin plan, but Gomer says the inclusion of fatty fish a few times a week and seeds and nuts should provide more than adequate levels of omega-3s.
Omega-3 fatty acids are essential nutrients that must come from the foods we eat, because the body can’t manufacture them on its own. Your body needs these compounds to support heart and blood vessel function, the lungs, the immune system and the endocrine system, which makes hormones.
The National Institutes of Health’s Office of Dietary Supplements offers guidelines for intake of one essential fatty acid called alpha-linolenic acid or ALA. Your body can convert this omega-3 fatty acid into another compound called eicosatetraenoic acid or EPA and then to docosahexaenoic acid or DHA, but only in small amounts. So you need to get those two omega-3 fatty acids, EPA and DHA, from foods or supplements.
The ODS recommends that you consume the following amounts of ALA daily:
— Men over age 18: 1.6 grams.
— Women aged 18 and over: 1.1 grams.
Foods high in omega-3 fatty acids include:
— Fish, especially cold-water fatty fish, such as salmon, mackerel and herring. The Pritikin diet encourages consumption of these foods.
— Nuts and seeds. The PEP encourages consumption of nuts and seeds (1 ounce per day) and avocadoes (2 ounces per day) “based on a patient’s nutrition priorities,” Gomer says.
— Plant oils, such as soybean, canola and flaxseed oils. Oils are limited on the PEP, but Gomer says unsaturated fats such as canola oil and olive oil “are included in modest amounts, no more than 1 teaspoon per 1,000 calories” on the plan. If a patient needs to lose weight, fats will be “limited until a healthy weight is restored. So it’s only a temporary time that these higher fat foods are excluded.” They can be added back once the patient has achieved their target weight.
— Fortified foods such as eggs, yogurt, juices, milk and soy beverages. Egg yolks and processed foods are not permitted on the Pritikin diet.
If you’re not getting enough omega-3s, you may develop skin symptoms including rough, scaly skin and a red, swollen itchy rash. This deficiency is very rare in the U.S., the ODS reports.
Chong notes that adding more nuts, seeds and other heart-healthy fats could turn the Pritikin diet from a fairly good diet to a best diet. “If more fat were allowed from nuts, seeds and olive oil, then the Pritikin diet would be similar to the Mediterranean diet,” Chong says.
The Mediterranean diet consistently ranks No. 1 on U.S. News’ annual ranking of Best Diets. The Pritikin diet shares some similarities with that diet, which is near-universally endorsed by dietitians.
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Update 04/05/21: This story was published at an earlier date and has been updated with new information.