Although I don’t generally recommend dietary supplements (I prefer that you get your nutrients from whole foods), I make an exception when it comes to omega-3s. In fact, to make up the shortfall, I recommend a fish-oil supplement for most people, especially those who don’t eat fish at least twice weekly.
The two active ingredients to look for in omega-3 or fish-oil supplements are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). If you read the supplement label, you will see the amount of these nutrients listed in milligrams (mg). You should take between 1,000 and 2,000 milligrams of EPA and DHA daily, with the approval of your doctor. For some conditions, such as a severe elevation in triglycerides, higher doses are recommended. Interestingly, DHA is present in large quantities in the brain and has been added to many brands of infant formula since 2002.
We do need to be a little careful, however, even with the good fats. As good as they are, they are also calorie dense and should be consumed judiciously during all phases of the South Beach Diet. I suggest that you limit added oils to approximately 2 tablespoons per day (no, you don’t have to eat your salads dry!) and limit nuts to about ¼ cup a day. While many nuts do contain good fats, it’s too easy to unconsciously eat way too many.
Avoid the Bad Fats
Bad fats include saturated fats (often referred to as animal fats), which are found primarily in fatty cuts of beef, lamb, and pork; in poultry with the skin; and in full-fat dairy products. There are also plant sources of saturated fats, including coconut, palm, and palm kernel oils, but the jury is still out on how bad they are. In fact, research suggests that some of these plant oils may have health benefits. The really bad fats are trans fats, which are created when manufacturers add hydrogen to vegetable oil—a process called hydrogenation—to increase the shelf life and stability of foods. Trans fats can be found in stick margarines (but not in most soft tub or liquid margarines), vegetable shortenings, foods fried in hydrogenated oils, and many packaged snack foods containing hydrogenated or partially hydrogenated oils.
Most bad fats, especially the trans fats, deserve their bad reputation. We’ve known for some time that a high intake of saturated fats from animal sources is linked to a greater risk of heart attack or stroke because these saturated fats raise bad LDL (low-density lipoprotein) cholesterol. And we now know that trans fats not only increase LDL, they also reduce good HDL (high-density lipoprotein) cholesterol and may even play a role in metabolic problems, obesity, infertility, and many other health problems of the Western world. For these reasons, in January 2006, the FDA started requiring food manufacturers to list the amount of trans fats on packaging.
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5 YEARS of SUCCESS
DANNY S., age 42: My Insurance Policy against
Weight Gain
I was one of the first people to go on the South Beach Diet; in fact, I was a story in Dr. Agatston’s first book. I’m delighted to be able to share my continued success.
I actually went to Dr. Agatston about 8 years ago because I had to lose weight—I was 6-foot-1 and weighed over 260. I was 35, and although my health was okay, I realized that if I didn’t do something about my weight, I could easily develop a problem down the road. I lost 60 pounds, and I’ve kept it off. The diet is my fallback, my insurance policy against weight gain. It definitely saves me from ever going back to that high weight. If I do put on a few pounds or find that my cravings have returned, I go right back on Phase 1 for a few days, take the pounds off, and reinforce my healthy eating principles.
Once I began taking off weight, I began to work out. I had never done any regular exercise before. I suddenly felt so much better, so much more alive and limber, that I no longer thought it would be a challenge to go to the gym. Now I weight train three times a week and do cardio five times a week.
The diet taught me what triggers my overeating. I know that bread is a huge problem for me, so I’ve learned to moderate it. I’ll only eat bread—mostly whole-wheat—in the morning. I rarely eat white bread. And there are a lot of other things besides a sandwich that I can have for lunch. If you’re really addicted to something, the desire doesn’t go away immediately, but you can learn how to control it. The good thing about the South Beach Diet is that you don’t have to give up any foods completely once you’ve reached your goal weight. It doesn’t make sense to deny yourself something for the rest of your life. The diet showed me that it’s possible to take off the weight you need to take off and then maintain it. If you do put a few pounds back on, it’s not the end of the world. You can go back on the right phase and take them off.
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Choose Lean Protein
Protein foods are digested slowly and do not produce the spike in blood sugar that stimulates hunger and overeating. They also satisfy you, so you won’t be walking around feeling hungry all the time. On the South Beach Diet, you can eat lean cuts of beef, lamb, and pork; skinless white meat chicken and turkey; game meats; fish and shellfish; soy products; beans and other legumes; eggs; and fat-free and low-fat dairy products. The amount of protein you require varies, depending on your age, activity level, and any illness you may have. Young athletes, for example, need a lot of protein, while older, sedentary individuals require less. For people with kidney problems, protein may have to be severely limited.
Some people have asked me how a cardiologist can recommend that people eat red meat even though it contains saturated fat. I’m not advising anyone to eat a steady diet of high-fat cuts, such as brisket or rib steak, or to eat red meat daily. Lean cuts of meat, however, are excellent sources of protein, iron, zinc, and B vitamins. And, in terms of maintaining a healthy weight, it’s far more preferable to eat lean meat than to gorge on highly processed refined carbs.
This doesn’t mean that the South Beach Diet isn’t for vegetarians. Many vegetable sources of protein, such as soy and legumes (beans, lentils, chickpeas, and so on), are very satisfying. Vegetarians will also benefit from eating good monounsaturated and polyunsaturated fats, as well as good carbohydrates, from the wide variety of fruits, vegetables, legumes, and whole grains we recommend.
Go High Fiber
I’ve already talked a bit about fiber, but I can’t say enough about it. That’s because one of my goals as a cardiologist is to get people to eat more fiber-rich foods. I have no doubt that if they did, there would be far fewer cases of obesity in this country and around the world. Why? As I noted earlier, high-fiber foods slow the rate of digestion of starches and sugars, which blunts the swings in blood sugar that lead to cravings. It’s not surprising, then, that people who consume higher amounts of fiber gain less weight when followed over a period of years. They just aren’t hungry all the time!
In addition to helping people maintain a healthy weight, fiber also plays an important role in combating a number of diseases. At one time, people were advised to load up on fiber as a means of preventing colon cancer. This belief was based on research that showed that countries with the highest rates of dietary fiber consumption had the lowest rates of colon cancer. While later studies put this theory into doubt, fiber does appear to protect against heart disease and type 2 diabetes. A major Harvard study of more than 40,000 male health professionals found that those who ate lots of dietary fiber—especially cereal fiber—had a 40 percent lower risk of coronary heart disease, compared with men who ate the least fiber. A study of female nurses, also conducted at Harvard, found that fiber had the same heart-healthy effects on women. And numerous studies have linked fiber consumption to a reduced risk for diabetes (see Chapter 7 for one example).
Today, the American Heart Association recommends eating 15 grams of fiber for every 1,000 calories consumed daily. That adds up to about 25 to 35 grams per day, depending on how many calories you take in. But most Americans don’t get anywhere close to this amount. In fact, the average daily intake is a total of 15 grams of fiber. That’s why I always remind people to keep eating plenty of fiber-rich whole fruits and vegetables, legumes, and whole grains.
You now have the tools to eat great food, look great, and feel great. You’ll find it easier than ever to follow a healthy diet as a lifestyle.
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A Diet You Can Live With…For Life
When we originally published the South Beach Diet in 2003, some people asked me about long-term studies documenting its value. Others questioned whether anyone can successfully stick to a diet. And over the ensuing years, some articles were written claiming simply that “diets don’t work.” This can certainly be true, unless the diet teaches you how to make better food choices and evolves into a healthy and sustainable lifestyle.
In that regard, I like to point out a diet and lifestyle experiment that lasted hundreds of years with remarkable success. It involves the inhabitants of the Mediterranean island of Crete. Of course, the people of Crete didn’t know they were part of an experiment. They didn’t know they were on a diet or participating in an exercise program. They didn’t weigh their food or count calories, carbs, or fats (in fact, their diet was relatively high in fat). They didn’t go to the gym. And they certainly weren’t walking around hungry. In fact, they were quite satisfied with a wonderful range of food choices. Yet even with this seeming lack of regard for diet and exercise, they were not overweight, and they enjoyed low rates of heart disease, diabetes, cancer, and other diseases.
How did they accomplish this? They were simply surrounded by a wide variety of fruits, vegetables, and whole grains. There were ample quantities of lean meats and fish. They consumed plenty of fat, but it was predominantly healthy Mediterranean oils, in particular olive oil. And there was, in fact, a great deal of exercise in the form of long walks and vigorous exertion as part of their daily routine. They were happy and healthy without working at it or even thinking about it. Unfortunately, today the Western lifestyle has found its way to Crete, and its men and women are looking more like Americans in both their abdominal girth and their health profile.
Why Is America So Fat?
In this country, our epidemic of obesity and diabetes really took off over the past 3 decades and has continued at a fast clip right up to the present. Coincidentally, the 1980s was when the federal government, along with medical groups such as the American Heart Association, began to aggressively promote the benefits of a low-fat, high-carbohydrate diet. This was eventually reflected by the first USDA Food Pyramid, published in 1992, which emphasized bread, rice, pasta, and cereals as the basis of a healthy diet. Fats and oils were to be used sparingly. Was this the wrong advice? Did it have a role in the fattening of America? I believe the answers to these two questions are yes and yes.
The national recommendations were based on what was felt to be the best scientific evidence at the time. Much, if not most, of the nutritional research we have today was simply not available back then. The rationale for the low-fat, high-carb approach was largely predicated upon population studies performed after World War II. The most influential were those conducted by Ancel Keys, PhD, a physiologist at the University of Minnesota. Dr. Keys looked at the relationship between diet, cholesterol, and heart disease in industrialized and nonindustrialized countries. Industrialized countries, such as the United States, had a high fat intake associated with high cholesterol levels and heart attack. Nonindustrialized countries had low-fat diets, low cholesterol levels, and low rates of heart attack.
A glaring exception in the nonindustrialized category was the island of Crete, which, as I noted above, had a relatively high-fat diet yet a low rate of heart disease. But Crete was considered a fluke and ignored at the time. So the United States went on a low-fat, high-carbohydrate diet and got increasingly fatter.
How did we go so wrong?
At the time of the national recommendations, the thought was that the new American diet would mimic the diet composition of the nonindustrialized world, where there was almost no obesity or heart disease. The problem was that in the national recommendations, no distinction was drawn between good carbs and bad carbs or between good fats and bad fats. While sugar was not recommended, starches (the so-called complex carbohydrates) were. It was simply not known at the time that low-fiber starches, such as white bread and potatoes, raised blood sugar just about as fast as simple sugars did. As for fats, studies showing the overall health benefits of good fats (such as omega-3-rich oils), including their positive effects on the heart, had not yet been performed.
In response to the conventional—and misguided—wisdom of the time, the food industry began to produce low-fat, low-cholesterol baked goods, including cookies and pastries, made with refined white flour and varying amounts of sugar. Most commercial baked goods also included coconut and/or palm oil, which had replaced the highly saturated animal fats in these products when various groups complained about them. It was only when the American Medical Association published a position statement calling for clear disclosure to the public that tropical oils were just as highly saturated as animal fats that these plant oils began to be removed.
That’s when things got even worse. Tropical oils were replaced by hydrogenated or partially hydrogenated vegetable oils, the harmful trans fats I talked about on Chapter 2, which are directly associated with heart attack, stroke, diabetes, and other serious health problems. Ironically, trans fats were created as a healthier alternative to saturated fats, but they turned out to be worse. For years, most Americans (including yours truly) thought we could eat these starchy, trans fat-laden baked goods with impunity. We were mistaken. And we got fat.
How Eating Can Make You Hungry—And Fat
Thanks to ongoing research in the science of food, nutrition, and diabetes, by the early 1990s, I had a pretty good idea of where our diet had gone wrong. It became clear that as a society, in our attempt to limit fat, we were consuming ever-higher amounts of bad carbohydrates—in other words, more of the sugary sweets and refined starches that are essentially devoid of fiber and other nutrients. This was causing exaggerated swings in our blood sugar, which resulted in cravings for more refined carbs and the constant hunger that I described in Chapter 2.
The reason we were so hungry all the time also became clearer when I learned about the glycemic index, a measure of how the carbohydrates in an individual food can affect blood sugar. The foods that keep blood sugar nice and stable—the ones that don’t cause dramatic blood sugar swings—are those that are low on the glycemic index. These include whole grains, most vegetables, and low-sugar fruits (such as berries), which are digested slowly, making you feel full and satisfied for a longer period of time. Fiber is a major determinant in establishing a food’s glycemic index, but there are other factors as well, such as the degree to which a food is processed, how long it’s cooked, and its acidity. However, as useful as the glycemic index can be for guesstimating how certain foods will affect your blood sugar levels, it doesn’t tell the whole story. We have learned a great deal more about food and how it works in our bodies since the glycemic index was first identified. The expanded Foods to Enjoy and Foods to Avoid lists in this book reflect this growing body of knowledge.
It’s no wonder that back then my patients were getting fatter as they filled up on the high-glycemic carbs (the pastas, breads, and cereals made from white flour) that we were mistakenly recommending as a substitute for fatty meats and full-fat dairy. Once I understood more about the glycemic index, however, it didn’t take me long to see that these essentially fiberless, starch-laden foods were making our patients hungrier due to the swings in their blood sugar.
And, of course, the hungrier they got, the more they ate, and the more weight they gained. It was an endless cycle. And as they
got fatter, they also became prediabetic and diabetic. Because of new research in this area, I also began to understand that there were just as many misperceptions about these diseases as there were about what constitutes a good diet.
Misunderstood Prediabetes
Most people mistakenly associate all diabetes with a lack of insulin, the hormone produced by the pancreas that clears sugar (glucose) and fat out of the bloodstream and moves it into the cells after meals. Type 1 diabetes, formerly called juvenile diabetes, is characterized by the inability of the pancreas to make enough insulin. But in prediabetes, which often leads to type 2 diabetes, the problem is not too little insulin but the resistance of cells to the hormone’s effects. In fact, in prediabetes, blood insulin levels actually remain high after a meal until the excess insulin finally opens the floodgates, allowing glucose to move from the bloodstream into the cells. This results in a rapid fall in blood sugar, which is known as reactive hypoglycemia because the reaction, or blood sugar drop (hypoglycemia), comes sooner after a meal than a normal, gradual drop would. It’s why the insulin resistance associated with prediabetes only exacerbates the already exaggerated swings in blood sugar and consequent cravings caused by bad carbohydrates. And it’s why prediabetics are almost always hungry again soon after a meal and tend to gulp down their food to bring up their sagging blood sugar.
The South Beach Diet Super Charged Page 3