South Beach diet

Definition

The South Beach diet is a three-phase, carbohydrate-restrictive diet. It emphasizes foods that are low on the glycemic index (GI) and low in saturated fat, such as lean meats, vegetables, cheeses, nuts, and eggs. Unlike other carbohydrate-restrictive diets , such as the Atkins and Zone diets, the South Beach diet promotes "good" carbohydrates, such as whole grains and fruit.

Origins

The creator of the South Beach diet, Dr. Arthur Agatston, is considered a leading cardiologist and is the director of the Mount Sinai Cardiac Prevention Center in Miami Beach. Originally, he had intended to design an eating plan to improve the cholesterol and insulin levels of his patients. However, Dr. Agatston soon discovered that his patients also lost weight on his plan. After further research, he approached Marie Almon, R.D., chief clinical dietician at the hospital, to help develop the eating plan into an effective diet. The results became the South Beach diet. Having sold more than a million copies since its publication in April 2003, The South Beach Diet book has remained on the New York Times bestseller list for over a year.

Benefits

The primary benefit of the South Beach diet is considered by many to be its initial rapid and significant weight loss—8–13 lb (4–6 kg) in the first two weeks. After the first two weeks, weight loss continues at a slower rate, averaging 1–2 lb (0.4–1 kg) weekly. In addition to weight loss, the diet reduces cholesterol and insulin levels, thus reducing the risks of diabetes and heart disease . It is claimed that the diet is easy to follow because it is designed to eliminate cravings and has more flexible food options after the first two weeks.

Description

In his book, The South Beach Diet, Dr. Agatston states that "this diet is not low-carb. Nor is it low-fat." Instead, the diet focuses on eating the "good" carbohydrates (fruits, vegetables, and whole grains) and "good" fats (olive oil and nuts) rather than eliminating them from the diet entirely.

Dr. Agatston based the core of his dietary plan around the glycemic index –the increase in blood sugar levels by foods containing carbohydrates during a set amount of time.

After consumption, food is metabolized into sugars and promotes the release of the hormone insulin. When the blood contains excess sugar, insulin removes it from the blood stream by storing it in cells, including fat cells. High-glycemic carbohydrates (greater than 70 GI) are metabolized rapidly, which causes elevated insulin production. High levels of insulin result in more blood sugar being stored as fat, thus causing weight gain. This pattern induces craving for more carbohydrates, thus leading to the consumption of more high-GI foods. Low to moderate-GI foods, however, raise insulin levels more slowly and sugars are metabolized more effectively, thus reducing the amount of blood sugar stored as fat. Cravings for more food is reduced. In addition, by eating these low-GI foods, the risk of insulin resistance that can lead to atherosclerosis and diabetes is reduced. As such, Dr. Agatston designed the South Beach diet to promote foods low on the GI and eliminate the body's craving for high-GI foods.

The South Beach diet consists of three phases. Phase one is the strictest part of the diet and lasts for two weeks. The purpose of Phase one is to banish the dieter's cravings for high-GI foods such as bread, rice, potatoes, pasta, and sugar. Alcohol, fruits, cereal, and such vegetables as carrots and corn are also restricted during Phase one. Instead, protein-rich foods are emphasized, such as lean meat, fish, eggs, cheese, nuts, and vegetables. Coffee and tea are also allowed. Three regular-sized meals are eaten each day, supplemented by mid-morning and mid-afternoon snacks as well as dessert. During this period, the body chemistry will change dramatically until cravings for high-GI foods are eliminated and insulin resistance is improved/lowered. In addition, rapid weight loss is typically experienced.

Phase two reintroduces several of the restricted foods and encourages eating from all the dietary food groups, the expected result being that the body will neither crave high-GI foods nor store food as excess fat to the same degree. Such high-fiber carbohydrates as whole-wheat pasta and bread and most fruits are now permitted. Moderation remains the key to success for this phase and low-GI foods are strongly encouraged. Phase two continues until the dieter reaches his or her ideal weight, ideally averaging a loss of one to two pounds per week.

Phase three, the ultimate goal, focuses solely on weight maintenance. Having reached the ideal weight, the dieter now makes the changed eating habits a lifestyle from this point forward. Basic dietary techniques are still maintained. Only the high-GI foods and "bad" fats from the previous two phases continue to be restricted. Altered body chemistry will promote long-term cardiovascular health and reduce the risk of diabetes. Should weight gain occur, Phase one of South Beach diet is reintroduced until the weight goal is achieved.

Preparations

There are no initial preparations required for the South Beach diet. However, as with most diets, it is wise to consult with a physician beforehand. Blood testing for insulin, glucose, and cholesterol levels is suggested. It is strongly recommended that dieters taking medications for medical conditions such as heart disease consult a physician before going on the South Beach diet. Similarly, diabetics on insulin or other medications are advised to have a doctor monitor their blood sugar regularly and determine if they are at risk of kidney impairment while on the diet. It is also recommended that a registered dietitian be consulted to determine the dietary needs of certain medical conditions, such as pregnancy .

Precautions

The South Beach diet is not recommended for people suffering from or at risk of kidney problems. The diet's high protein content can place increased strain on the kidneys, possibly causing long-term damage as well as kidney stones and bone loss. Additionally, the possibility of ketosis-induced dehydration during Phase one can increase the risk of further kidney impairment. Dehydration occurs when the body experiences water loss with accompanying loss of important blood salts like potassium and sodium . Ketosis occurs when carbohydrates are not available and the body burns an excessive amount of fat, during which some ketones, or fat fragments, are excreted. The restrictive nature of Phase one may also induce mineral and vitamin deficiencies. Remaining in Phase one of the diet for longer than two weeks greatly increases the risk of losing bone and muscle mass. Dieters should remain in Phase one for no longer than three or four weeks.

Some nutrition professionals contend that the South Beach diet menus provided in the book lack important nutritional information and detailed portion sizes as well as specific substitutes for foods the dieter cannot or will not eat. They claim that these aspects, combined with the restrictive nature of the diet, can make sticking with the South Beach diet on a long-term basis difficult for some people. Also, they assert that the diet does not emphasize an exercise regimen and that exercise is vitally important to avoid the loss of muscle and bone mass, especially during Phase one of the diet.

Side effects

Despite Dr. Agatston's claims to the contrary, the South Beach diet is both a low carbohydrate and a low fat diet. For this reason, one main concern regarding the diet is the risk of ketosis, especially during Phase one. Ketosis can cause such symptoms as dehydration, dizziness , heart palpitations, fatigue , lightheadedness, and irritability. Hypoglycemia , low blood sugar, headaches, and excessive fluid loss are also commonly associated with this diet. Cramping and tired muscles can be incited by salt depletion. Kidney functions can be impaired, possibly leading to serious health issues. Kidney function can be further impaired by the diet's high protein requirements. These side effects typically lessen or fade at the beginning of Phase two, when a more balanced diet is undertaken.

Research & general acceptance

Unlike the majority of low-carbohydrate diets, the medical community generally accepts the South Beach diet. The South Beach diet contains all the major food groups, promotes ingestion of "good" fats for maintaining heart health, and is flexible enough to accommodate most dietary needs.

However, many clinicians and dietitians agree that the rapid initial weight loss results mostly from water loss. Much of this weight can return once the dieter rehydrates.

Another important criticism by medical and nutritional professionals is the lack of evidence to support Dr. Agatston's claims connecting the consumption of low-GI foods and weight loss. They assert that as of the early 2000s, there is no scientific proof that eating low-GI foods will have any more weight loss effect than eating a normal, calorie-reduced diet that includes carbohydrates; that Dr. Agatston also fails to take into account the interaction of different foods when eaten together, which can dramatically alter glucose metabolism; and that this failure means that utilizing the Glycemic Index as a gauge for what foods to eat is not only confusing but also slightly misleading.

Resources

BOOKS

Agatston, Arthur. The South Beach Diet: The Delicious, Doctor–designed, Foolproof Plan for Fast and Healthy Weight Loss. New York:Rodale Press, 2003.

PERIODICALS

Abel, Lee. "Somewhere on South Beach." The Journal of the Arkansas Medical Journal. (February, 2004): 255–256.

Center for Science in the Public Interest. "Weighing the Diet Books (Cover Story)." Nutrition Action Healthletter. (January/February, 2004):3–8.

Goodnough, Abby. "New Doctor, New Diet, but Still No Cookies." New York Times. (October 7, 2003): F1.

Harvard Medical School. "Sizing up South Beach." Harvard Health Letter. (November, 2003): 5.

Schnirring, Lisa. "The South Beach Diet." Physician & Sports Medicine. (January, 2004): 9–10.

OTHER

Keefe, Sarah. "The Lowdown on the South Beach Diet." Askmen.com [cited May 22, 2004] <http://www.askmen.com/sports/foodcourt_100/102_eating_well.html>.

"The South Beach Diet." DietSurf.com. <http://www.dietsurf.com/diet/south_beach_diet.htm>.

"The South Beach Diet." South Beach Diet Online. <http://www.southbeachdiet.com>.

" WebMD Interview with Arthur Agatston, MD." WebMD. <http://my.webmd.com/content/article/71/81355.htm>.

Lee Ann Paradise

South Beach diet

Definition

Origins

Description

Function

Benefits

Precautions

Risks

Research and general acceptance

Resources

Definition

The South Beach diet is a popular short-term fast-weight-loss diet combined with a long-term calorie-controlled diet. The South Beach diet sets itself apart form several other popular diets by differentiating between ‘‘good carbohydrates’’ and ‘‘bad carbohydrates’’ based on their glycemic index and ‘‘good fats‘‘ and ‘‘bad fats’’ based on their degree of saturation.

Origins

Arthur Agatston, the originator of the South Beach diet, is a medical doctor. He is has a cardiology practice that emphasizes disease prevention and is an associate professor at the University of Miami Miller School of Medicine in Miami, Florida.

Agatston first developed the South Beach diet for his obese cardiac patients who were having trouble staying on the standard low-fat diet recommended by the American Heart Association. After these patients had success with his diet, Agatston began promoting the diet to the public, shifting the emphasis away from heart health and toward rapid weight loss. In 2003, he published The South Beach Diet: The Delicious, Doctor-designed, Foolproof Plan for Fast and Healthy Weight Loss.. Television coverage boosted the popularity of the South Beach diet, and in 2004, Kraft Foods entered into an agreement that allowed it to use the South Beach diet name on line of foods that were nutritionally compatible with the diet.

Description

The South Beach diet is part a fast-weight-loss diet and part a calorie-restricted, portion-controlled long-term diet. Agatston says that the South Beach

South Beach Diet products

(Illustration by GGS Information Services/Thomson Gale.)

diet is neither a low-carbohydrate nor a low-fat diet, although it restricts both these food groups.

The South Beach diet is divided into three phases. Phase 1 lasts the first two weeks of the diet. During this time Agatston claims that people can lose up to 13 lb (6 kg) on the diet, and that they will lose mainly belly fat. Phase 1 eliminates all carbohydrates, both ‘‘good’’ and ‘‘bad’’ from the diet. This means that the dieter eats no bread, pasta, rice, potatoes, fruit, milk, baked goods, ice cream, alcohol, anything containing sugar or flour, and any fatty meats. Portion size is not strictly controlled. The total calorie intake during phase 1 is usually between 1,200 and 1,400 per day spread out over three meals and two or three snacks.

Some permitted foods in phase 1 include:

• meat: veal and lean cuts of beef; low fat or fat-free lunchmeat
• poultry: skinless chicken and turkey breast and Cornish hen
• seafood: any kind of fish or shellfish
• cheese: many types, low-fat and fat-free only, excluding any type of cream cheese except dairy-free cream cheese substitute
• tofu: soft low-fat or calorie-reduced types only
• eggs: whole eggs, egg substitute, egg whites
• vegetables: non-starchy such as salad vegetables excluding tomato, artichokes, asparagus, broccoli, cauliflower, collard greens, eggplant, mushrooms, turnips, and zucchini
• fats: olive oil and canola oil
• spices: any seasoning that does not contain sugar
• artificial sweetened treats and artificial sweetener: sugar free only and limited in amount

After two weeks on the very rigorous phase 1 diet, the dieter is permitted to start adding back a limited amount of ‘‘good’’ carbohydrates that have a low

KEY TERMS

B-complex vitamins —A group of water-soluble vitamins that often work together in the body. These include thiamine (B₁), riboflavin (B₂), niacin (B₃), pantothenic acid (B₅), pyridoxine (B₆), biotin (B₇ or vitamin H), folate/folic acid (B₉), and coba-lamin (B₁₂).

Dietary fiber —Also known as roughage or bulk. Insoluble fiber moves through the digestive system almost undigested and gives bulk to stools. Soluble fiber dissolves in water and helps keep stools soft.

Glucose —A simple sugar that results from the breakdown of carbohydrates. Glucose circulates in the blood and is the main source of energy for the body.

Glycemic index —A ranking from 1–100 of how much carbohydrate-containing foods raise blood sugar levels within two hours after being eaten. Foods with a glycemic index of 50 or lower are considered ‘‘good.’’

Glycogen —A compound made when the level of glucose (sugar) in the blood is too high. Glycogen is stored in the liver and muscles for release when blood glucose levels are too low.

Hormone —A chemical messenger that is produced by one type of cell and travels through the bloodstream to change the metabolism of a different type of cell.

Insulin —A hormone made by the pancreas that controls blood glucose (sugar) levels by moving excess glucose into muscle, liver, and other cells for storage.

Insulin resistance —A condition in which the cells of the body do not respond to insulin to the degree they normally should. This creates a condition in which more and more insulin must be used to control glucose levels in the blood.

glycemic index. Weight loss in phase 2 is expected to be 1–2 lb (0.6–1 kg) per week. The permitted foods are the same as in phase one with the addition of whole grain cereals, oatmeal, whole-grain bread and whole-grain pasta, barley, low-fat milk, nuts, beans, starchy vegetables, wine, and most fruits. These items are portion-controlled. Watermelon, bananas, raisins, white bread, baked goods, and sugary foods are not allowed. Saturated fats and trans fats (animal fats, butter, cream, fatty meats, some solid-type margarines) are forbidden.

Dieters stay on the phase 2 diet until they have achieved their desired weight, at which time they move to phase 3, a maintenance phase. The list of restricted foods in phase 3 is quite similar to phase 2. Foods made with white flour and high levels of refined sugar are sill off limits. Individuals who get off track and violate the diet in phases 2 or 3 are instructed to go back to phase 1 and start again.

For a fee, the South Beach diet Website offers tools to help the dieter stay on track. These include as recipes, advice from dietitians, food journals, and meal planners. Daily moderate aerobic exercise and strength training are recommended for people on this diet.

Function

The South Beach diet is based on the idea that to lose weight, the dieter must replace ‘‘bad carbohydrates’’ with ‘‘good carbohydrates’’ and ‘‘bad fats‘‘ and ‘‘good fats’’. Good carbohydrates are defined as those that have a low glycemic index, while bad carbohydrates have a high glycemic index in order to reduce insulin resistance.

The glycemic index compares foods on a scale of 1–100 for how much they increase the level of glucose (sugar) in the blood. When people eat, the level of glucose in their blood increases. How much it increases depends on the foods they eat. ‘‘Good’’ foods witha low glycemic index (below 50) raise blood sugar less than ‘‘bad’’ foods with a high glycemic index (above 50 or above 65 depending on which authority is consulted). When blood glucose levels increase, cells in the pancreas release the hormone insulin. This signals cells in the body to convert some of the glucose into a compound called glycogen that is stored in the liver and muscles and some into fat, stored in fat cells. When blood glucose levels go down, different cells in the pancreas release the hormone glucagon. Glucagon signals cells in the liver and muscle to release glycogen, which is converted back into glucose and is burned by the body. If glucose levels continue to be low, fat is also burned for energy.

When people eat foods that contain a lot of sugar or carbohydrates that break down rapidly in the body into glucose (the ‘‘bad’’ carbohydrates of the South Beach diet) their insulin level spikes. When people eat carbohydrates that break down more slowly into glucose (the ‘‘good’’ carbohydrates of the South Beach diet), their insulin level rises more slowly and does not reach as high a level. When someone eats too many sugary foods too often, they secrete a lot of insulin, and eventually cells in the body may become insulin resistant. Insulin resistance is a factor in type 2 diabetes. By removing all carbohydrates from the diet for two weeks, the South Beach diet is claims to eliminate insulin resistance.

The fats that the South Beach diet calls ‘‘good’’ fats are unsaturated fats. Unsaturated refers to a certain part of their chemical structure. ‘‘Bad’’ fats are saturated fats that have a slightly different chemical structure. Saturated fats are thought to promote atherosclerosis or ‘‘hardening of the arteries.’’ In this condition, cholesterol and other materials build up on the walls of the arteries (blood vessels) blocking blood flow and causing the arteries to lose their elasticity.

Benefits

According to Agatston, benefits of the South Beach diet include:

• rapid weight loss followed by lifetime weight control
• loss of weight from the belly region
• fewer hunger pangs because of slower carbohydrate breakdown and frequent small meals
• a heart-healthy approach to fats
• decreased risk of developing cardiovascular disease.

Precautions

The South Beach diet is unlikely to meet the nutritional needs of growing children.

Risks

Many nutritionists question whether this diet provides long-term balanced nutrition. Specific objections are that limiting milk may lead to calcium deficiency and limiting and whole grains even in the maintenance phase may lead to deficiencies in dietary fiber and B-complex vitamins. The initial rapid weight loss also is of concern to many weight-loss experts.

Research and general acceptance

The South Beach diet is relatively new, and no independent scholarly research has been done on it. A few small studies that report decreased blood fats and similar heart-protective effects have been sponsored by organizations with South Beach diet affiliations. However, nutritionists are in general agreement that replacing saturated fats with unsaturated fats in the diet is a healthy choice. Nutritionists also agree that whole grains tend to be more healthful than refined grains, but express concern about the small quantity of whole grains permitted on the diet.?

Of more concern is the rapid weight loss of phase 1. This rate of weight loss is not in line with generally accepted practices for healthy dieting and long-term weight control, and obesity experts find highly questionable the claim that dieters can control weight loss so that they preferentially lose belly fat. The public has

QUESTIONS TO ASK THE DOCTOR

• What are my current risk factors for heart disease?
• Is there another diet that might better meet my health goals
• Do I have any health conditions that might be worsened by the restrictions of this diet?
• Can my whole family follow this diet?
• Are there any sign or symptoms that might indicate a problem while on this diet?
• Do you have any experience with the long-term success of this diet?
• If one of your family members wanted to go on a diet, would you recommend this one?

enthusiastically embraced the South Beach Diet, but how many people can stay on this fairly rigorous diet and maintain long term weight-loss remains to be seen.

Resources

BOOKS

Agatston, Arthur. The South Beach Diet: The Delicious, Doctor-designed, Foolproof Plan for Fast and Healthy Weight Loss. Emmaus, PA: Rodale, 2003.

Agatston, Arthur. The South Beach Diet Quick & Easy Cookbook: 200 Delicious Recipes Ready in 30Minutes or Less. Emmaus, PA: Rodale, 2005.

Agatston, Arthur. The South Beach Heart Program: The 4-Step Plan That Can Save Your Life. Emmaus, PA: Rodale, 2006.

Bijlefeld, Marjolijn and Sharon K. Zoumbaris. Encyclopedia of Diet Fads. Westport, CT: Greenwood Press, 2003.

Icon Health Publications. Fad Diets: A Bibliography, Medical Dictionary, and Annotated Research Guide to Internet References. San Diego, CA: Icon Health Publications, 2004.

Scales, Mary Josephine. Diets in a Nutshell: A Definitive Guide on Diets from A to Z. Clifton, VA: Apex Publishers, 2005.

ORGANIZATIONS

American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, Illinois 60606-6995. Telephone: (800) 877-1600. Website: <http://www.eatright.org>

The South Beach Diet Online. (Official Website of South Beach Diet) <http://www.southbeachdiet.com>

OTHER

Harvard School of Public Health. ‘‘Interpreting News on Diet.’’ Harvard University, 2007. <http://www.hsph.harvard.edu/nutritionsource/media.html>

Kellow, Juliette. ‘‘South Beach Diet Under the Spotlight.’’ Weight Loss Resources, March 16, 2007. <http://www.weightlossresources.co.uk/diet/south_beach_review.htm>

Northwesternutrition ‘‘Nutrition Fact Sheet: The South Beach Diet.’’ Northwestern University. January 2007. <http://www.feinberg.northwestern.edu/nutrition/factsheets/southbeach.html> United States Department of Health and Human Services and the United States Department of Agriculture.

‘‘Dietary Guidelines for Americans 2005.’’ January 12,

2005. <http://www.healthierus.gov/dietaryguidelines>

WebMD. ‘‘The South Beach Diet.’’ June 2005. <http://www.webmd.com/content/pages/15/96038.htm>

Tish Davidson, A.M.

Southeast Asian diet see Asian diet

Southern African diet see African diet

South Beach diet Weight reducing diet based on high protein and low carbohydrate. See also Atkins diet.