Below are recommendations for Pritikin Alumni who have not achieved optimal LDL cholesterol levels but are reluctant to take statins.

No diet-and-exercise program or drug therapy has proven more effective than the Pritikin® Program in lowering virtually all known risk factors for cardiovascular disease, including LDL cholesterol, total cholesterol, and triglycerides(1), as well as blood pressure(2), insulin levels(3), C-reactive protein(4), and excess weight(5). Landmark research by UCLA scientists also found that the Pritikin Program more than doubles the effectiveness of cholesterol-lowering statin drugs(6).

At the Pritikin Longevity Center®, the Pritikin Program is the primary prescription for achieving optimal cholesterol levels. Current federal guidelines advise that people with coronary artery disease reduce LDL levels to less than 100; however, new research suggests that perhaps less than 65 is even better(7). For now, the Pritikin Scientific Advisory Board recommends LDL levels less than 100, and reaching 80 or below is even better. For healthy people, current federal guidelines are less than 130. At the Center, guests exercise daily and eat a diet rich in natural, high-fiber foods like fruits, vegetables, whole grains, beans, and soy products. They also enjoy moderate servings of seafood, nonfat dairy foods, and lean meat like poultry and bison.

For one reason or another, some Pritikin Alumni do not reach optimal cholesterol levels. Some may not adhere to the Pritikin Program as perfectly as they would like; others may struggle with genetic susceptibilities to abnormally high cholesterol levels. Yet many of these Alumni resist taking cholesterol-lowering drugs, or don’t want to increase current dosages. Like all drugs, statins carry both benefits and risks. Though they reduce heart attack risk, statins’ short-term adverse effects may include liver toxicity, muscle pains, and cognitive problems like memory loss(8). No one knows for sure what statins’ long-term risks are because they are still relatively new drugs.

If you are striving for better cholesterol levels and want additional recommendations before resorting to statins, the Pritikin Scientific Advisory Board and the physicians at the Pritikin Center suggest, first and foremost, that you ask yourself: “Am I following the Pritikin Program as best I can? Is there anything more I can do, with either diet or exercise, to improve my adherence?” If not, if your current efforts are indeed your best efforts, we recommend the Pritikin Eating Plan with an emphasis on foods rich in soluble fiber, soy foods, and small servings of nuts, and the addition of 2 supplements: plant sterols and psyllium. Each of these 5 diet/supplement strategies has been scientifically proven to have cholesterol-lowering properties. When you achieve optimal LDL levels, you may return to the basic Pritikin Eating Plan, or continue following the Pritikin Eating Plan with these 5 steps as your focus. They are:

Foods

Step 1 Foods rich in soluble fiber – 20 to 25 grams daily.
Foods naturally plentiful in soluble fiber have always been an important part of the Pritikin Program. Excellent choices include oats, barley, and legumes, or beans, like pinto beans, black beans, and garbanzo beans. There’s soluble fiber, though to a lesser extent, in fruits, carrots, sweet potatoes, yams, beets, and other vegetables. Scientists estimate that for every 1 to 2 grams of soluble fiber added to a daily diet, LDL cholesterol drops about 1%(9). Nicely, the grams add up quickly. With, for example, just 1/2 cup of oatmeal, a bowl of berries, and 1 1/2 cups of beans, you’ve tallied up 20 to 25 grams of soluble fiber.

Step 2 Soy foods such as soy milk and tofu – 4 to 5 servings daily.
For years, the Pritikin Program has recommended soy foods. Research has found that a diet with plenty of soy foods, adding up to about 45 grams of soy protein daily, may lower LDL cholesterol about 12%(10).

Step 3 Nuts – 1 ounce daily of raw or dry roasted, unsalted nuts.
Small servings of nuts have always been included in the Pritikin Program, especially for people at their ideal weight. Nuts have been proven to reduce cholesterol levels, though to a lesser degree than the other 4 steps recommended. The best choice is walnuts because of their high omega-3 fatty acid content. Foods rich in omega 3s, particularly many varieties of fish, lower the risk of dying from sudden heart attacks. Do keep in mind that nuts are dense with calories, so they’re not beneficial for weight loss. Just 1 ounce of walnuts tallies up 180 calories, so do your best not to exceed the 1-ounce-a-day guideline.

Supplements

Step 4 Plant sterol supplements or foods enriched with plant sterols – 1 to 2 grams daily.
Sterols are naturally occurring substances found in plants. A daily intake of 1 to 2 grams of plant sterols has been shown to lower cholesterol about 12%(11). A good choice are supplements like Benecol Softgels because they do not have the calories, hydrogenated fats, and salt of margarines enriched with plant sterols, like Benecol and Take Control. Of currently available food products, another choice is orange juice enriched with plant sterols, like Minute Maid Heart Wise Orange Juice. It does not have hydrogenated fat or salt, but it is liquid calories, which are not very filling, so be careful not to exceed 8 ounces daily. (8 ounces contain 1 gram of plant sterols.)

Step 5 Psyllium (sugar-free Meta-mucil) – 1 tablespoon 3 times a day.
Psyllium is a seed grain sold as a soluble fiber supplement and laxative (Metamucil is the best known brand, but it is also available in less expensive store brands). Studies have indicated that 9 to 10 grams of psyllium each day reduces LDL levels 6% to 7%(12).

PLEASE NOTE: The reductions in LDL described for each of the above 5 components occurred in people who were not following diets as low in saturated fat as the Pritikin Program. For people already on low-saturated-fat diets, reductions in LDL may be significantly smaller(13)(14). Therefore, we do not know what benefit, if any, each of these diet/supplement steps would have for individuals closely adhering to the Pritikin Program. We do know that the biggest LDL-lowering benefits come from diets, like the Pritikin Program, that are very low in saturated fats, not from higher-in-saturated-fat diets that have been enriched with supplements.

Your best plan, then, for lowering LDL levels is 100% adherence to the Pritikin Program. It is very low in saturated fat, and it incorporates the three key food groups that have cholesterol-lowering properties: soluble-rich foods, soy-rich foods, and a few nuts. Psyllium and plant sterol supplements may provide some additional LDL lowering in some people.

If you are not following the Pritikin Program as closely as you would like, the addition of psyllium, plant sterols, a few nuts and seeds, and more soy protein and soluble fiber-rich foods may help push LDL levels closer to the range where atherosclerotic plaque stops growing, or even regresses.

New research validates the effectiveness of these five components. University of Toronto scientists put 46 men and women with high LDL cholesterol (over 158 mg/dL) on a vegetarian diet rich in psyllium, foods full of soluble fiber, soy products, nuts, and margarine enriched with plant sterols and found that the diet reduced cholesterol levels about as much as statins(15). A typical day’s diet included hot oat bran cereal, soy milk, strawberries, enriched margarine, oat bran bread and psyllium for breakfast; bean soup and a sandwich made of veggies, soy deli slices, enriched margarine, and oat bran bread for lunch; soy-based entrees like tofu ratatouille, vegetables, and pearled barley for dinner; and fresh fruit, psyllium, tofu shakes, and almonds for snacks.

At the end of one month, the group on this eating plan netted an average 28% drop in LDL cholesterol. That was very close to the 31% reduction seen in a comparison group taking statins and following a low-fat diet (25% calories from fat) with no soy products, psyllium, nuts, plant sterols, or foods rich in soluble fiber.

Admittedly, the study was small and short, as were almost all studies analyzing the cholesterol-lowering power of specific foods. Scientists are calling for more research. Nothing as yet is definite.

But the science we have is promising. Several health organizations concur. To boost the effectiveness of diet in preventing heart disease, the National Cholesterol Education Program now recommends plant sterols and soluble fiber. The American Heart Association has discussed the possible benefits of soy proteins and nuts. And the Food and Drug Administration now permits health claims promoting the cholesterol-lowering benefits of foods containing adequate amounts of plant sterols, soluble fiber, and/or
soy protein.

Bottom Line:

The optimal, scientifically proven plan for substantially reducing virtually all known risk factors for coronary artery disease, Type 2 diabetes, hypertension, and many cancers is the Pritikin Program. Research indicates that there would be small benefit, if any, to adding cholesterol-lowering supplements to a diet, like the Pritikin Program, that is already very low in saturated fat. For Alumni who may not be following the Pritikin Program as closely as they would like and wish to try additional drug-free steps before starting statins or increasing statin dosages, the Pritikin Scientific Advisory Board recommends the Pritikin Program with an emphasis on 1) foods rich in soluble fiber, 2) soy foods, and 3) small servings of nuts, and the addition of two supplements: 4) plant sterols and 5) psyllium. Each of these foods and supplements has been documented to lower cholesterol.

To help you blend these 5 recommendations easily and successfully into your basic Pritikin Eating Plan, the following chart illustrates the Pritikin Daily Five modified to emphasize and include all 5 food groups and supplements with cholesterol-lowering properties.

(1) N Engl J Med, 1990; 323:1142.
(2) Circulation, 2002; 106: 2530.
(3) Diabetes Care, 1994; 17: 1469.
(4) Metabolism, 2004; 53: 377.
(5) Arch Int Med, 1991; 151: 1389.
(6) Am J Card, 1997; 79: 1112.
(7) N Engl J Med, 2004; 350: 15.
(8) Circulation, 2002; 106: 1024.
(9) N Engl J Med, 1993; 329: 21.
(10) N Engl J Med, 1995; 333: 276.
(11) BMJ, 2000; 320: 861.
(12) J Nutr, 1997; 127: 1973.
(13) Am J Clin Nutr, 2002; 76: 365.
(14) Metabolism, 2002; 51: 189.
(15) JAMA, 2003; 290: 502.