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Old 01-23-2004, 10:55 PM   #1  
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Smile South Beach -- the Diet for You?

Thought that you all may be interested in this


South Beach -- the Diet for You?-- Arthur Agatston, MD-- 01/08/04
Updated 1/12/2004 6:32:58 PM

By Arthur Agatston

The South Beach diet has quickly become the next big thing in weight loss. How does it work, and is it right for you? We looked at the foods you can eat, and what results to expect when the diet's developer, cardiologist Arthur Agatston, MD, was our guest.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome back to WebMD Live Dr. Agatston.

Agatston: Hi. It's great to be back on WebMD, one of my favorite sites. With the New Year I am joining you all in beginning a crusade to stay on my own diet. I cheated a little bit over the holidays, but now I intend to start over.

Member question: At the beginning in Phase 1, is it mostly water weight you lose?

Agatston: No, it's not, it's mainly belly fat that you lose by lowering your insulin levels. If you restrict all carbohydrates, as is done in the Atkins diet, where you deplete your sugar stores and begin to burn fat or energy, you will develop ketosis, which is due to breakdown products of fat that are associated with significant water loss.

When on the South Beach diet you include the good vegetables and carbohydrates from the beginning, you avoid ketosis while still losing your cravings, and this results in much less water loss.

Member question: I'm in day four. My main problem is fatigue. What do you suggest for that, or worse, for the shakes?

Agatston: If you are fatigued early in Phase 1, this may be due to a fall in blood sugar. Make sure you are getting enough good carbohydrate in the form of salads and vegetables and that you are getting enough fluids. Usually when there is weakness it resolves in several days and is associated with good weight loss and loss of cravings. It is also helpful to make sure you are snacking in midmorning, midafternoon, and in the evening.

Member question: Thanks for developing this way of eating! It's fabulous, but Phase 1 is quite boring actually. I have heard of some people staying on Phase 1 for weeks and even months. Can this be healthy? How long is the maximum at a time that you would recommend anyone staying on Phase 1?

Agatston: For those with a lot of weight to lose, particularly with large bellies, Phase 1 can be extended to at least one month. The problem with persistent rapid weight loss is you can begin to lose muscle and bone weight, which results in a lowered metabolism, which can lead to yo-yo dieting. Regular exercise helps to maintain muscle and bone mass and maintain a good metabolism.

The problem with many diets is once rapid weight loss -- once early rapid weight loss ends, dieters go back to their usual way of eating, which leads to a return of the weight they lost. Our Phase 2 and Phase 3 are designed to turn the South Beach diet into a lifestyle that can be associated with years of maintaining your optimal weight.

So except for those who are extremely overweight we suggest adding back whole fruits and whole grains after a few weeks.

Member question: I'm on day six, and I still haven't seen much weight loss. I've lost 2 pounds so far. Is this normal?

Agatston: The amount of weight loss depends on the amount of weight you have to lose as well as several metabolic factors. Those who have had significant adult weight gain and/or who have a family history of diabetes and/or have predominant central obesity, as well as those with elevated triglycerides, have the most predictable and the fastest weight loss. Often we find those with slower weight loss have much less weight to lose.

We believe the principles of the South Beach diet of consuming good fats and good carbohydrate are the best way to eat, even for those who have no weight to lose. It is the healthiest way to eat, even for those with no weight to lose.

Member question: Can I drink low-carb beer after the first two weeks?

Agatston: The problem with low-carb beer is it still contains maltose, which is a very high-glycemic sugar. If you are at a good weight and consume the beer in moderation with a meal, you may well be able to get away with it.

When returning foods in Phase 2 or Phase 3, the bottom line is, is it causing a return of craving? If cravings return, it's best to go with another food or beverage. In general, we prefer wine or even vodka to beer, but if beer is your great love and you can do it in moderation, then give it a try.

Member question: Would I be better off to eat whole-wheat pasta or low-carb pasta?

Agatston: Whole-wheat pasta is what we recommend.

Member question: I'm confused about dairy products in Phase 1. What's good and what's not?

Agatston: The South Beach diet is always in evolution as more scientific studies are done. It is becoming clear that many dairy products are actually associated with weight loss and with a decreased chance of developing pre-diabetes. We have, therefore, added low-fat and skim and 1% milk, as well as fat-free yogurt, up to 2 cups a day in Phase 1. This is appearing on our web site,

Member question: In Phase 1, as long as it's fat free, does it need to be plain or can it be flavored?

Agatston: In Phase 1 either plain or vanilla-flavored, fat-free yogurt, with aspartame, is appropriate. Fruit yogurt should be avoided in Phase 1.

One thing I have done at home is adding some Splenda to plain yogurt and this tastes great. Just as we add flavoring to our ricotta desserts, such as almond extract, vanilla extract, mocha, lime zest, and lemon zest, you can also add these flavorings to plain yogurt. Enjoy.

Member question: What about portion control? The SBD recipes are SO GOOD!!

Agatston: We believe that the major cause of the epidemic of obesity and diabetes in the country is not oversizing but the high amount of processed carbohydrates and trans fats in our foods. When you're eating the good carbohydrates and good fat, portion control tends to take care of itself, but not always.

I was brought up with the admonition to always clean my plate, and I do find that often I continue to eat, even when I am full. We do not want anybody to leave a meal hungry because they have limited portion sizes, but it is not necessary to finish everything on your plate once you are satisfied.

Member question: Is red wine or white wine better?

Agatston: Red wine has theoretical advantages over white wine for vascular health, due to antioxidants it contains, but clinical studies that have shown decrease in heart disease and diabetes with moderate alcohol intake have failed to show a real advantage of red wine over white wine.

Wine with a meal, either red or white, does help slow stomach emptying, and therefore slows the rise and fall of blood sugar, which is our goal in the South Beach diet. Excess alcohol does turn into sugar and can be a diet buster.

Member question: My overall cholesterol is over 200 for the first time, and I have a history of heart disease in my family. However, my ratio of good to bad cholesterol is still good according to my doctor, but he wants me to lose 15 pounds. Is the South Beach diet appropriate, or do I risk raising my cholesterol?

Agatston: Losing weight on the South Beach diet consistently improves blood chemistries. We have shown in clinical studies that triglycerides fall substantially while the good cholesterol stays the same or increases.

The South Beach diet is the only diet that has been shown to increase the size of the bad cholesterol molecules (LDL). This makes the bad cholesterol particles less likely to enter the vessel wall and cause blockages.

Member question: My sister is newly diagnosed insulin dependent diabetic (three weeks) She is inspired by my 11-pound loss in a week, but concerned that this way of eating is not good for her at this time. Should she wait until her diabetes is more under control?

Agatston: The best way to control diabetes is the South Beach diet and exercise. This should be done in conjunction with your doctor, because falls in blood sugar on the diet make it necessary to adjust your diabetes medication, and this must be done in consultation with your doctor.

Member question: I'm curious to hear your take on saturated fats. For years I've heard they are the worst possible kind of food intake, but lately it sounds like the current research would tend to indicate they aren't so bad after all.

Agatston: Clearly the worst fat in our food supply are the trans fats. These are the hydrogenated and partially hydrogenated oils found in commercial baked goods. They increase our bad cholesterol and decrease our good cholesterol.

Saturated fats are not as bad as trans fats, but are still associated with some increase in risk of arteriosclerosis. But you are right, they are not as bad as initially thought. Some saturated fats, such as the saturated fats found in chocolate, do not increase our bad cholesterol.

We are also revisiting the tropical oils, coconut oil and palm oil, which were taken out of our food supply because they were so saturated, but studies have not, in fact, shown these fats to have adverse health effects.

The good news is that the good fats, the Mediterranean oils, are good for our vessels and appear to help long-term weight loss and help prevent diabetes.

Member question: I am currently 18 years old. When creating your diet you probably accounted for older adults, so bearing my age in mind is there any additional advice you'd give me regarding the South Beach diet?

Agatston: As you probably know, our epidemic of obesity and diabetes has reached into our teens, and even our preteens, and has become a huge national health problem. This is because our children are eating too much junk food, including the processed carbohydrates and the worst fats. The South Beach diet is ideal for teenagers who have gained weight on junk food.

We are, in fact, planning an initiative to bring healthier foods to our schools. We think this will not only improve waistlines, but will also improve academic performance and overall health.

Member question: Your reply signifies to me that the diet is meant for the "obese." Would you suggest the diet for a teenager that isn't medically classed as obese, but wants to achieve what popular society deems as a better figure?

Agatston: That is a difficult question because certainly among American teenagers eating disorders are common, where teenagers are actually too thin. So I am reluctant to recommend weight loss to an inappropriate level. Certainly the principles of the South Beach diet of consuming the good fats and the good carbohydrates are important for teenagers, even who have no weight to lose.

By choosing the good, helpful foods suggested in the South Beach diet you will tend to hit your optimal weight. Regular exercise is also important. By eating the right foods you can be satisfied with each meal, not hungry, yet still attain your optimal weight.

Member question: I love to eat sushi, I really want to go while I'm still in Phase 1 and eliminate the rice. Is eating just the fish with the seaweed OK? Or is seaweed not allowed on this phase?

Agatston: Sushi without the rice and with just the seaweed is acceptable on Phase 1. You can also enjoy it with the wasabi and the soy sauce.

Member question: What happens if you break down and have one cookie or something that's not good for you?

Agatston: We all mess up on the diet from time to time. I certainly have, as I did over the holidays on several occasions. Once you have lost your cravings and have lost usually 5 to 10 pounds, isolated transgressions, such as cookies, have very little effect on the diet. If you eat cookies in the first phase before your cravings have disappeared, then they certainly can be a diet buster.

Member question: If your cholesterol is normal can your triglycerides spike from eating simple carbohydrates (such as sugar) and is this why SBD can reduce high triglycerides?

Agatston: Yes, absolutely. In the low-fat, high-carbohydrate diet advocated previously by the Heart Association, often sugar, as well as starches that made up the high-carbohydrate intake caused weight gain as well as big spike in triglycerides.

In those in the population with pre-diabetes, which includes most of our overweight population, both the bad cholesterol particles and the good cholesterol particles tend to be very small, and the good cholesterol level tends to be low. These factors often result in a normal to low total cholesterol, which is very misleading, since it hides several factors that can lead to heart attack and stroke.

Member question: What is the difference between good and bad carbs? Are carbs only bad because they break down into sugar?

Agatston: The good carbohydrates are those where the natural fiber, which is associated with most of the vitamins and nutrients being maintained in the food. The food in this form will still contain starch, which breaks down to sugar, but the important point is the breakdown is slow and you don't get swings in blood sugar, which leads to cravings and more eating.

In the bad carbs, such as white bread, the fiber, as well as vitamins and nutrients, have been removed, and the starch left behind is very rapidly digested, resulting in big swings in blood sugar. This is why Americans have been walking around hungry all the time.

Member question: What should we look for on ingredient labels, especially the less obvious things?

Agatston: Food labels can be misleading because just looking at total grams of fat or carbohydrates doesn't tell you whether the fat or carbohydrate is good or bad. It is best to read our book and go on our web site to learn the basic pecking order of the various food groups.

One helpful nutrient that is on food labels is the amount of fiber, and in general the higher the fiber content the more slowly the food is digested and the better it is. This is particularly helpful for breakfast cereals, where if there is 6 to 8 grams of fiber or more, it is generally an excellent choice. For breads we like to see at least 3 grams of fiber per serving, and we like to see the label say whole grain. Whole wheat breads are not necessarily high in fiber.

Member question: In Phase 1, can you switch the snacks or lunches for breakfast? I am getting a little sick of eggs.

Agatston: Yes, you can mix and match all you like, and hang in there, because in Phase 2 you can have oatmeal and a variety of high-fiber cereals for breakfast.

Member question: Can the South Beach diet work for someone who is vegetarian?

Agatston: Yes. We have always had a vegetarian form of the South Beach diet and you can find it on our web site, In this month's edition of the Vegetarian Times there is a story on the South Beach diet and advice for vegetarians who are on the South Beach diet.

Member question: Do you have to be a paid member to view the diet changes on your web site?

Agatston: Yes, there is some information on the web site that you can see as a nonmember, but to obtain the full use of the web site, it is necessary to join and pay a fee. Sorry about that.

Member question: Hello. Do you have advice for long-haul drivers, as we can't prepare meals and are at the mercy of fast-food chains and truck-stop diners? Is this woe for me?

Agatston: This is a very good question. Certainly for a truck driver it takes more planning to be successful on the South Beach diet. Having appropriate snacks along on the ride, including nuts and low-fat cheeses are good. Possibly carrying yogurt and other foods in a cooler would also be helpful.

The good news is that more and more restaurants, including fast-food restaurants, are putting good carb choices on their menus, and the food industry is coming out with more and more good carb products. I believe in a year or two it will be much easier to stay on the South Beach diet when you are on the road. Good luck.

Moderator: Do you have any final words on the South Beach diet for us, Dr. Agatston?

Agatston: I wish you all a happy and healthy New Year and successful weight loss. Please remember that the South Beach diet should not be just a diet, but a lifestyle, and by understanding its principles you can maintain an optimal weight without great sacrifices. Most of the self-discipline comes in planning the diet, instead of avoiding bad foods, once you have started the diet and lost your cravings. I enjoyed being with you. Good luck.

Moderator: Thanks to Arthur Agatston, MD, creator of the South Beach diet, for being with us today. South Beach -- the Diet for You?-- Arthur Agatston, MD-- 01/08/04
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