What is the Pritikin Diet ?

The Pritikin Diet Plan

The Pritikin Diet was invented by Nathan Pritikin in 1976 from his diet book “The Pritikin Program for Diet and Exercise” — where the dietary guidelines, also known as Very-Low-Fat-Diet and high fiber diet, are as follows:

• less than 10% fat,
• 10% to 15% protein and
• the remainder 75% to 80% mainly from unrefined, complex carbohydrates.

In a small three-week study combining statins, diet, and vigorous exercise, those on the Pritikin diet resulted in a further 19% reduction in total cholesterol. There was also an incremental benefit in low-density lipoprotein (LDL) cholesterol and triglycerides for those on the diet, but also a slight reduction in HDL cholesterol ¹.

In another very short-term therapy ², 12-15 days, involving 67 subjects (52 men and 15 women; mean age, 60±10 years) diagnosed with Metabolic Syndrome. All subjects were obese (BMI ≥30 kg/m2). Forty (60%) of the subjects had diabetes, determined by either a prescription for medication to treat hyperglycemia or a fasting blood glucose of ≥126 mg/dL. Fifty-one (76%) subjects were taking medications to treat ≥1 clinical feature of the metabolic syndrome, which included antihypertensive, hypoglycemic, and lipid-lowering agents. At the start of treatment, subjects were taking an average of 2.4±2.0 medications. Subjects were excluded if they had severe uncontrolled hypertension (blood pressure ≥190/120 mm Hg), severe hypertriglyceridemia (serum triglycerides >600 mg/dL), untreated hypothyroidism, or were pregnant or lactating. Body weight; BMI; fasting blood glucose; blood pressure; and serum HDL-C, triglycerides, total cholesterol, and LDL-C concentrations were recorded at the beginning and end of 12–15 days of treatment.

All subjects ² were treated with a comprehensive diet and exercise program. The diet consisted of 10%–15% of calories from fat, 15%–20% from protein (primarily from plants but also from seafood, fowl, or bison), and 65%–75% from carbohydrate (comprising whole grains, vegetables, and fruits), and contained about 40 g/1000 kcal of fiber. Salt was limited to <1500 mg/d and cholesterol to <100 mg/d. Alcohol, tobacco products, and caffeinated beverages were not allowed. Subjects were instructed on how to reduce total energy intake to achieve gradual weight loss, but meals and snacks were provided ad libitum, with the exception of seafood, fowl, or bison, which was limited to 3.5 oz/d. Subjects also received instruction for a personalized exercise program (outdoor walking plus daily exercise classes) for a total of 45–60 minutes of aerobic exercise performed to achieve a heart rate of 70%–85% of maximal heart rate.

At the end of treatment, 21 out of 67 (31%) subjects no longer met criteria for the metabolic syndrome ². Moreover, with the exception of serum HDL-C concentration (serum “good” HDL cholesterol concentrations decreased in their subjects), all metabolic abnormalities of the metabolic syndrome improved with treatment. The number of medications used to treat the metabolic syndrome decreased in 16 (24%) subjects and increased in 6 (9%) subjects.

Comment: Due to the very small sample size, not a randomized clinical trial and the very short duration (12-15 days) of the study, we cannot determine whether Pritikin diet therapy is better (or worse) than other low-fat, high-fiber diets in treating obesity/overweight and Metabolic Syndrome X. Second, the participants in this study may not be representative of other patients who have the metabolic syndrome. Therefore, these results may not necessarily reflect the outcome that would be achieved in other subjects. Third, the duration of the intervention was approximately 2 weeks. Therefore, the results from this short-term intervention cannot determine long-term outcomes. For example, data from most lifestyle therapy interventions designed to achieve weight loss have shown that many obese persons who achieve short-term weight loss during therapy often regain much of their lost weight over time ³. Additional studies are needed to evaluate long-term effectiveness and compliance with this type of Pritikin diet and activity program.

There is currently no firm evidence ⁴ of the long-term (at least six months) effects of low-fat diets for otherwise healthy people with acquired, that is not familial hypercholesterolaemia (high cholesterol levels in the blood).

Since then his son Robert Pritikin has tweaked the Pritikin Diet concept to still a very low in fat diet (under 10% fat), but with a new focus on something he calls the calorie density solution.

There are 10 simple steps to The Pritikin Edge

1. Start each meal with soup, salad, fruit, or whole grains. They fill you up, so you’re less likely to eat high-fat, high-calorie food.
2. No more high-calorie drinks, especially soda. A daily glass of wine can be good for the heart, but skip most alcoholic beverages.
3. Avoid high-calorie foods.
4. Snack at set times and only on healthy foods.
5. Choose whole, unprocessed foods as often as possible, and always avoid fast food.
6. Exercise regularly, combining lots of walking with strength training.
7. Go easy on meat, especially red meat. Instead, opt for fatty fish like salmon.
8. Skip extra salt.
9. Don’t smoke.
10. Ease stress.

Foods on the Pritikin Diet include:

• Fruits
• Vegetables
• Whole Grains like whole-wheat bread, brown rice, whole-wheat pasta, and oatmeal
• Starchy Vegetables like potatoes, corn, and yams
• Legumes such as beans (like black beans, pinto beans, and garbanzo beans); peas; and lentils
• Lean Calcium-Rich Foods such as nonfat dairy milk, nonfat yogurt, and fortified soymilk
• Fish (a rich source of omega-3-fatty acids)
• Lean Sources of Protein (very low in saturated fat) such as skinless white poultry; lean red meat like bison and venison; and plant sources of protein, such as legumes and soy-based foods like tofu and edamame (soybeans)

Items to minimize include oils, refined sugars, salt, and refined grains. The plan recommends avoiding processed meats, foods high in saturated fat and those made with trans fat, organ meats, processed meats, and high-cholesterol foods like eggs.

1) Unrefined Complex Carbohydrates

5 or more servings daily of whole grains (such as whole wheat, oats, rye, brown rice, barley, quinoa, and millet); starchy vegetables (like potatoes, yams, and winter squashes); chestnuts; and legumes (beans, peas, and lentils). A serving is 1/2 cup cooked. For whole-grain bread products (like breads, bagels, and crackers), a serving is 1 ounce, which is generally half a common portion.

Limit refined grains (like white bread, white rice, and white pasta) as much as possible. But keep in mind that “white” does not necessarily mean “unhealthy.” There are many healthy foods that are white, such as cauliflower, white potatoes, jicama, and nonfat yogurt.

2) Vegetables

5 (preferably more) servings daily. A serving is 1 cup raw or 1/2 cup cooked. Enjoy a variety of colors, like dark green, yellow, red, and orange vegetables. The more vegetables and other low-calorie-dense foods you eat, the less need there is for counting calories. You’ll just naturally eat fewer calories, and shed excess weight.

3) Fruit

4 or more servings of whole fruits daily. For most fruits, a serving fits in your hand. Examples include all fresh and raw fruits, and frozen and canned fruits without added sugar. Enjoy whole fruit, not fruit juices. And don’t believe silly science that says fruit is fattening. To the contrary! People have shed 100 pounds and more with Pritikin’s fruit-rich diet.

4) Dairy and/or Dairy Substitutes

2 servings daily of dairy foods and/or dairy substitutes.

For dairy foods, choose from nonfat milk (1 cup), nonfat yogurt (3/4 cup), and nonfat varieties of ricotta and cottage cheese (1/2 cup). Choose plain nonfat milk, not flavored varieties like chocolate. Nonfat Lactaid is also acceptable.

For dairy milk substitutes, choose those that closely match the nutritional richness of nonfat cow’s milk for calcium, vitamins D and B-12, and protein. Optimal choices tend to be fortified soymilks (original or unsweetened). Almond and rice milks usually score well for calcium, D, and B-12, but poorly for protein. So if you drink a cup of almond or rice milk, add to your daily diet a lean, protein-rich food like 1/2 cup cooked legumes (beans) or 2 egg whites. Steer clear of coconut milk because it contains saturated fat.

For all dairy milk substitutes, make sure they contain very little or no added sugars, sodium, and saturated fat.

Note: Many plant foods are rich sources of calcium, such as leafy greens like collard greens, turnip greens and kale, as well as tofu and tempeh.

5) Protein-Rich Foods

• Protein-Rich Animal Foods:
  Fish, White Poultry, Lean Meat

No more than 1 serving per day. A serving is about 3½ to 4 ounces cooked (the size of a deck of cards).

Below are fish/poultry/meat choices rated from “Best” to “Poor”:
Best: Omega-3-rich fish (such as salmon, sardines, herring, mackerel, and trout). Choose at least 2 times weekly. If you’re using canned fish, such as canned sardines, select very-low-sodium or no-salt-added varieties.
Good: Most other fish, plus shelled mollusks (clams, oysters, mussels, scallops).
Satisfactory: Crustaceans (shrimp, crab, lobster),
Poultry (white meat, skinless),
Game meat (bison, venison, elk), optimally free-range and grass-fed.
Poor: Red meat (beef, pork, veal, lamb, goat). For all red meat choices, select cuts that are under 30% fat.

For optimal heart-health results, limit “Satisfactory” choices to no more than 1 serving per week and “Poor” choices to no more than 1 serving per month.

Egg whites

Up to 2 daily. If you prefer egg whites instead of other land-based animal foods like white poultry and lean meat, you may eat more. About 7 egg whites is the protein equivalent of 1 serving of poultry or meat. Steer clear of egg yolks and their high dietary cholesterol.

• Protein-Rich Plant Foods:
  Legumes like beans, peas, and lentils
  Soy products like tofu and edamame

For maximum cholesterol reduction and giving yourself the best chance at reversing atherosclerosis (heart disease), choose on most days protein-rich plant foods like beans instead of land-based animal foods like poultry and meat. And yes, you can get plenty of protein with a plant-based diet.

6) Miscellaneous Foods

• Beverages

Water (plain, bottled, low-sodium, mineral); hot grain beverages (coffee substitutes); non-medicinal herbal teas (such as peppermint, rosehips, and chamomile); and cocoa – up to 2 tablespoons per day (use non-alkali processed cocoa). You do not have to drink large amounts of water daily. Simply drink when thirsty.

Caffeinated Beverages

If you choose to drink caffeinated beverages, Pritikin recommend green or black tea over coffee because of tea’s many health benefits. Pritikin also recommend moderation: no more than 400 mg of caffeine daily (the amount in about 4 eight-ounce cups of coffee or 8 eight-ounce cups of tea).

Coffee, both regular and decaf, does contain chemicals (diterpenes) that may modestly raise LDL cholesterol. However, by brewing with paper filters like paper cones or capsule filters like Keurig, the diterpenes are largely eliminated.

Alcoholic Beverages

Use in moderation or not at all. For women, up to 4 drinks per week, with no more than 1/2 to 1 drink per day. For men, up to 7 drinks per week, with no more than 1 to 2 drinks per day. A drink is approximately 5 oz of wine, 12 oz of beer, or 1½ oz of 80 proof liquor. Choose red wine over white wine, wine over beer, and either over liquor.

Herbs

Culinary herbs are rich sources of many beneficial phytonutrients, and are a good way to add flavor without extra calories, fat, or salt. Include at least 1 to 2 teaspoons of dried herbs or 1 to 2 tablespoons of fresh herbs each day.

Artificial Sweeteners

While artificial sweeteners have not been proven to aid weight loss, they may be of benefit to people with diabetes, elevated triglycerides, and those following the Pritikin Eating Plan to lose weight. Limit intake to no more than 10 to 12 packets per day. Sucralose (Splenda) and stevia (brand names include SweetLeaf and Truvia) appear to be the safest choices.

If You Want To Lose Weight

Go wild on vegetables. The more vegetables, including dark green, yellow, red, or orange vegetables, the better! They’re among the best foods for weight loss.

Limit calorie-dense foods such as dried grains (breads, crackers, cold cereals), dried fruits, nuts, and seeds. Avoid refined or concentrated sweeteners. They all pack a lot of calories into very small amounts of food. You’ll find it much easier to feel full and satisfied – and curb hunger – if you focus instead on high-water, high-fiber foods like cooked grains (such as oatmeal and brown rice), vegetables, and whole fruits. These foods are low in calorie density. You’ll eat more – and weigh less.

Steer clear of fruit and vegetable juices because they provide less satiety than whole fruits and vegetables.

Summary

The overall Pritikin diet is low in fat and high in fiber. The recommended foods are fruits, vegetables, low-fat dairy, legumes, lean protein, and fish. Items to minimize include oils, refined sugars, salt, and refined grains. The plan recommends avoiding processed meats, foods high in saturated fat and those made with trans fat, organ meats, processed meats, and high-cholesterol foods like eggs.

For weight loss, in recent randomized trial comparing 4 diet plans (Weight Watchers, Ornish, Pritikin and Atkins), found that all 4 diets resulted in modest statistically significant weight loss at 1 year, with no statistically significant differences between diets, but only for the minority of individuals who can sustain a high dietary adherence level.

Studies show the Pritikin diet can help reverse heart disease, lower cholesterol and blood pressure, and result in weight loss. Many people following the plan have been able to cut back on medications and use the diet and exercise program to help manage their condition.

It’s also heart-healthy. A Washington University School of Medicine study found that the Pritikin Program lowers many risk factors for heart disease, including weight (measured by body mass index, or BMI) and blood pressure.

References

1. R.J. Barnard, S.C. DiLauro, S.B. Inkeles. Effects of intensive diet and exercise intervention in patients taking cholesterol-lowering drugsAm J Cardiol, 79 (1997), pp. 1112-1114
2. Wiley Online Library. Effect of Short-Term Pritikin Diet Therapy on the Metabolic Syndrome. First published: September 2006. http://onlinelibrary.wiley.com/doi/10.1111/j.1559-4564.2006.05732.x/full
3. Klein S, Wadden T, Sugerman HJ. AGA technical review on obesity. Gastroenterology. 2002;123:882–932. https://www.ncbi.nlm.nih.gov/pubmed/12198715
4. Cochrane Review. 16 February 2011. Low-fat diets for acquired hypercholesterolaemia. http://www.cochrane.org/CD007957/ENDOC_low-fat-diets-for-acquired-hypercholesterolaemia