It
started out simply enough. Arthur Agatston, MD, a cardiologist, decided
to develop an eating plan that would improve the cholesterol and insulin
levels of his patients with heart disease. Now, the South Beach diet
has grown into something much bigger. That's because the plan Agatston
created not only improves cholesterol and insulin levels, but it also
has helped many people lose weight.
"We've
had people lose anywhere from five to 100 pounds on the diet," says
Agatston, who is director of the Mount Sinai Cardiac Prevention Center
in Miami Beach, Fla. "That's great, but what it really is good at is
improving heart patients' lipid profiles."
In
clinical trials, people on the South Beach diet see dramatic reductions
in LDL (bad) cholesterol and increases in HDL (good) cholesterol. And
they do so without much calorie counting.
Agatston's
book about his plan, The South Beach Diet: The Delicious, Doctor-Designed,
Foolproof Plan for Fast and Healthy Weight Loss, has become a best
seller and it appears to be poised to overtake the controversial Atkins
diet in popularity.
"My
medical orientation has always been in prevention," he says. "The diet
grew out of the frustration in seeing more and more patients becoming
obese, having metabolic syndrome and diabetes, and all the heart disease
associated with those conditions."
Despite
the South Beach diet's glitzy title, Agatston's research and inventiveness
is well respected in cardiology circles. Among other achievements, he
is one of the developers of the electron beam tomography scan, or EBT,
a screening method used to detect coronary artery disease and other
diseases. EBT scans for this purpose are given a score on the "Agatston
Scale," to gauge the severity of the disease.
"This
plan really does meet several criteria for a health-promoting diet,"
says Cindy Moore, RD, a director of nutrition therapy at The Cleveland
Clinic in Ohio and a spokeswoman for the American Dietetic Association
(ADA). "It appears to be scientifically based. It is rich in vegetables,
fruits, whole grains, and lean protein, and it doesn't omit any major
food groups."
So
what is the South Beach diet all about?
In
the first phase of the South Beach diet, which lasts two weeks, you
eat normal-sized helpings of lean meats, such as chicken, turkey, fish,
and shellfish. Vegetables are also allowed, as are nuts, cheese, and
eggs. A salad with real olive oil dressing is fine. Coffee and tea are
OK, and lots and lots of water is required.
The
Atkins diet differs in that carbohydrates are severely restricted during
the initial phase. The South Beach diet instead groups "good" and "bad"
carbohydrates based on their glycemic index, a measure of how foods
affaect your blood sugar.
"The
goal is to eat three balanced meals a day, and to eat enough so that
you don't feel hungry all the time," Agatston says.
Forbidden
in those first 14 days, however, are fruit, bread, rice, potatoes, pasta,
or baked goods. No sugar, ice cream, cookies, or cake. And no alcoholic
drinks of any kind (wine, fruit and whole-grain breads may be added
back to the diet in subsequent phases).
Highly
processed carbohydrates cause a cycle of overeating, says Agatston.
White bread, for example, is digested quickly, resulting in a spike
in insulin levels. Once the carbohydrates are used up, he says, you're
left with too much circulating insulin, which causes your body to crave
more food. Eating simple carbohydrates makes you want to eat more simple
carbohydrates, and in the process, you gain weight, disrupt your lipid
levels, and expose your cardiovascular system to unnecessary stress.
A
typical South Beach diet breakfast is two eggs and lean bacon. Lunch
is salad greens with grilled chicken. A small amount of dry-roasted
nuts makes up an afternoon snack. Dinner is lean meat again with fiber-rich
vegetables. Cheese and low-fat yogurt are allowed, as is sugar-free
gelatin for dessert.
According
to Agatston, at the end of two weeks, most South Beach dieters are eight
to 14 pounds lighter. He says the weight loss doesn't happen because
you're eating less, but rather because eliminating simple carbohydrates
has broken a bad eating cycle. As a result, you'll continue to lose
weight after the initial two-week period ends.
"I
would like to see more backing to that specific weight-loss claim,"
says Moore, of the ADA. "While the first two weeks are heavy on protein,
I'm not convinced that dropping carbohydrates would be enough to induce
ketosis."
It's
a well-established fact that rapid weight loss can be achieved when
your body does not have carbohydrates to digest. This state is called
ketosis.
Moore
adds that despite the many positive aspects of Agatston's South Beach
diet, you would be wise to work closely with a registered dietitian
or your doctor with any diet that induces ketosis because the body is
shedding water and, according to Moore, this might cause an electrolyte
imbalance without proper hydration.
The
second phase is similar to the first phase, but you'll start to reintroduce
some of the banned foods. You can start eating high-fiber carbohydrates,
such as whole-grain breads, which raise your insulin levels in a much
milder way that do simple, starchy carbs.
"We
don't want prolonged, severe weight loss," says Agatston. "You stay
on the second phase only until you reach your goal weight."
The
third phase of the South Beach diet is really all about weight maintenance,
which Agatston describes as a "way of life." Should your weight begin
to climb, you simply repeat the process.
"What's
become clear recently is that the epidemic of obesity is caused partly
by government health organizations promoting a carbohydrate-rich, low-fat
diet, the kind you see in developing countries like China," says Agatston.
"But those recommendations are based on people eating very high-fiber
diets with low protein."
In
the U.S., a carbohydrate-rich diet translates into lots of highly processed,
low-fiber carbohydrates.
"The
food we eat has often already been digested in the factory," says Agatston.
"Eating white bread is like eating table sugar."
Though
Moore agrees that the South Beach diet can be healthy, she reiterates
the need for dieters to see a dietitian before trying it.
"The
skill of a dietitian is to work within the parameters of what an individual
needs," she says. "It's fine to use this diet for weight loss, but no
diet fits everybody. For that reason, you need to work with someone
to make sure the general diet is tailored to your particular body."
John
Casey is a freelance writer who lives in New York City.
Published
May 19, 2003.
SOURCES:
Arthur Agatston, MD, director of the Mount Sinai Hospital Cardiac Prevention
Center, Miami Beach, Fla.; author, The South Beach Diet. Cindy
Moore, RD, director of nutrition therapy, The Cleveland Clinic; ADA
spokeswoman.
