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July 27, 1984

Hazards of Restrictive Diets

Author Affiliations

Centinela Hospital Inglewood, Calif

JAMA. 1984;252(4):483. doi:10.1001/jama.1984.03350040015013

To the Editor.—  Recent comments by Pritikin1 and others debate the safety of his diet for the general public. As a former member of Pritikin's advisory board, I can confirm several examples of clinical "improvement" of symptomatic cardiac patients in his program. However, it does not necessarily follow that his 10% fat, 10% protein diet is suitable for all.Four years ago we reported fatal "nutritional arrhythmia" among elite marathon runners.2 These deaths were associated with the triad of "low body fat, high training mileage, and diet restriction." Several of the cases involved diets similar to the Pritikin diet.Of course, marathon runners who use tobacco have increased risk of ischemic heart disease (Table 1), but these are easy to recognize clinically.However, the autopsy did not explain some of the deaths among 14 elite marathon runners who did not smoke (Table 2). These men had become lean, almost