Autopsy of Pritikin May Renew Debate

Nutrition guru Nathan Pritikin met his death by suicide in the face of two different kinds of leukemia last February with arteries like those of a child and a heart like that of a young man, according to results of his autopsy being published today for the first time.

But while the extraordinary condition of the vessels supplying blood to the 69-year-old Pritikin’s heart is being seized on by advocates of the dietary regimen Pritikin pioneered as proof that his eating habits can cause reversal of hardening of the arteries, the question is likely to remain unresolved and controversial for many more years.

Effects of Leukemia?

Controversy may also arise over whether the double-barrelled leukemia from which Pritikin suffered itself might have been at least partially responsible for the absence of fatty deposits in Pritikin’s cardiovascular system. Some cancer specialists, however, say such an effect seems unlikely based on current evidence.

The pathologist who performed the autopsy conceded such questions may arise, though he said he personally does not believe either the cancer or the therapy influenced Pritikin’s coronary health. And a cancer specialist who treated Pritikin for two years said he is convinced the nutritionist’s cardiac health “has nothing to do” with the cancer or its treatment.

“Frankly, I think the man was onto something,” concluded the cancer specialist, Dr. Ken Foon of Ann Arbor, Mich.

To the end, said Foon, Pritikin insisted to his doctors--the combination of two different strains of lymphoma, a type of leukemia, was unusual and perhaps unique, Foon said--that he knew what the autopsy would show and that the results would be his vindication.

The unusual step of publishing a summary of the autopsy in the New England Journal of Medicine was taken, said the three doctors who collaborated on it, to bring a halt to the word-of-mouth spread of unscientific reports of the Pritikin findings that began shortly after the nutritionist killed himself in an Albany, N.Y., hospital in late February.

He had checked into the facility under an assumed name suffering from extreme side effects of last-ditch therapy to control his leukemia, according to Foon, who was treating Pritikin until the time of his death.

Foon had met Pritikin and started to design a complex chemotherapy program for him while Foon was on staff of the federal government’s National Cancer Institute in Bethesda, Md. Pritikin, however, experienced extremely uncomfortable side effects to virtually every treatment. Finally, Pritikin was so sick from the effects of his drugs and anemia that developed as a result of the leukemia that he decided there was no reason to continue living, Foon said.

After Pritikin took his own life by slicing through arteries in his arms with a razor blade, the case routinely was referred to the local coroner’s office because it was an apparent suicide. The autopsy was conducted by Dr. Jeffrey D. Hubbard, a local pathologist, before he learned Pritikin’s true identity, Hubbard said.

In a telephone interview, Hubbard said it was only by coincidence that he subjected Pritikin’s heart to an especially thorough autopsy examination--because the actual immediate cause of death was beyond question. He said he did such a complete job because the details of the leukemia and the patient’s determination in taking his life intrigued him, but also because a resident physician undergoing training in pathology was on hand and Hubbard chose that body to demonstrate techniques for complete dissection and evaluation of the heart. Pritikin’s body was cremated a few days later.

The account of the autopsy results being published today was written jointly by Hubbard, Dr. Stephen Inkeles, an internal medicine specialist at Pritikin’s Longevity Center in Santa Monica, and R. James Barnard, a cardiovascular disease researcher at the Pritikin program who also holds an appointment at UCLA.

What Hubbard found was a heart remarkably free of disease and coronary arteries that were completely open, without any hint of development of fatty plaques that plug up the vessels of heart disease victims and result in angina pain and often fatal heart attacks. While there were small traces of fatty tissue both in the heart muscle and in the coronary arteries, all four of the major arteries examined were totally free of any restriction--a condition virtually unheard of for a 69-year-old man living in a Western country.

The size and weight of Pritikin’s heart were well within optimal ranges, the report noted, and the muscle tissue itself was thick, well developed and uncompromised, indicating the heart’s pumping ability was essentially unrestricted.

Pritikin first developed his diet in the late 1950s and insisted for the rest of his life that his nutritional regimen (the Spartan diet emphasizes almost complete avoidance of saturated fats and other substances that contain cholesterol) could not only prevent the development of coronary artery disease but reverse it. The contention was one of the most significant of the controversies surrounding Pritikin’s program.

Pritikin based the argument on the fact that he, himself, had been diagnosed as having heart disease and high blood fat levels in about 1955. He insisted that the diagnosis then established with virtual certainty that his own coronary arteries were blocked when he began his dietary system and that the absence of such plaques on his death would prove the validity of his arguments.

The cholesterol level in Pritikin’s blood dropped from 280 milligrams in 1958--a reading at the high end of what American physicians say is the normal range but which other doctors say is far too high--to 94 milligrams in November, 1984. Doctors questioned by The Times said seeing a patient with cholesterol below 110 would be almost unprecedented in any American physician’s practice.

But because Pritikin was not subjected to definitive diagnostic techniques in the 1950s, there was no confirmation of fatty deposits in his arteries. His doctors agreed it will never be known to what extent--if at all--they existed in his body. The diagnostic failure will mean it cannot be said with certainty that the Pritikin diet had the effect in its inventor that he claimed for it.

Nevertheless, said Inkeles, “the autopsy findings are highly suggestive that regression took place, even though we can’t make a definitive statement. I think the message is that if you want to place a bet on minimizing atherosclerosis, the bet would have to be placed on the kind of diet Nathan Pritikin espoused and lived by the remainder of his adult life.”

Whatever the result of the research, though, both Barnard and Foon agreed Pritikin died utterly confident in the veracity of his claims. Pritikin, said Barnard, “really had a vision to try to change the eating habits of the people of this country.”