Prediabetes typically occurs in individuals with a genetic predisposition to accumulating belly fat. In fact, you can recognize people with prediabetes on the street. They’re the ones walking around with large bellies and relatively thin arms and legs. They also tend to have high blood pressure, low levels of good HDL (high-density lipoprotein) cholesterol, and high levels of triglycerides (a fat-storage molecule found in blood and fat cells).
But how does prediabetes lead to type 2 diabetes? Over time, your pancreas tends to burn out from the stress of producing extra insulin to overcome the insulin resistance of your tissues and clear sugar and fat from your blood in a timely manner. It is at this point that your sugar remains high for many hours after a meal and type 2 diabetes is diagnosed.
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IT WASN’T STRESS THAT MADE US FAT
Many overweight individuals, including many of my patients, believe that their food cravings have to do with stress rather than blood sugar swings. They’re embarrassed by their lack of willpower and assure me that it’s the fight with the boss or the spouse, the 2-hour wait in traffic, or the kids’ bad report cards that made them wolf down that giant muffin, handful of candy, or piece of coffee cake. Even some scientists have suggested that our obesity epidemic is due to the psychological stresses of living in modern times.
While I acknowledge that some people do overeat to compensate in times of stress, I take issue with those who believe it’s the cause of our obesity epidemic. I like to point out that stress didn’t begin 30 years ago, and we didn’t start getting really fat as a nation until the 1990s—after the fall of the Berlin Wall that marked the end of the Cold War and before 9/11. The US economy was booming at the time. It’s also important to note that this was a period when the character of our food supply had changed and our physical activity was rapidly declining, largely due to increased use of the personal computer and other labor-saving gadgets.
The point is, it was in the midst of peace and prosperity that America became so fat. With what we know today, it’s clear that it was not our psychological state but what we ate and how sedentary we became that was the primary cause.
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During the prediabetes phase, most people’s fasting blood sugar is borderline, normal, or even low. For this reason, many of my patients initially believe that their risk of heart attack and stroke increases only if they become diabetic. This belief is wrong! During the prediabetes phase, when fasting blood sugar is still normal, insulin resistance is present and it takes longer to clear fats and sugar from the bloodstream. It’s that extra fat hanging around after a meal that often penetrates the walls of the blood vessels supplying the heart muscle, brain, and other organs. This is the origin of the atherosclerotic plaque that clogs these vessels and eventually leads to a heart attack or stroke. And, yes, this can and does occur during prediabetes, well before type 2 diabetes is diagnosed.
Again, this is relatively recent information. Prediabetes was first described in 1988 by Gerald Reaven, MD, of Stanford, and we’re still learning about the havoc it wreaks on our blood vessels and overall health. I talk more about the origins and the health implications of prediabetes in Chapter 6, “Bye-Bye Belly Fat.”
Creating the South Beach Diet
Armed with the conviction that our problem was not too much fat or too many carbohydrates in our diet but the wrong fats and the wrong carbs, I decided to try a good-fats, good-carbs diet on myself and on my patients. I also chose to recommend lean sources of protein that didn’t have excess saturated animal fat.
I decided on a three-phase approach, with each phase having a distinct purpose. The first phase would be strict and last just 2 weeks. It would jump-start the diet and get rid of cravings. While studies had shown the positive psychological effects of early rapid weight loss, we intentionally did not want this rapid weight loss to continue for too long. Not only would dieters miss out on key nutrients in fruits and whole grains but, over time, rapid weight loss would become counterproductive. For this reason, we designed the second phase for slower weight loss, so that my patients could learn how they reacted to whole grains and whole fruits as they gradually reintroduced them. It would be an educational stage and a transition from diet to lifestyle. The third phase, or maintenance phase, would become a permanent, healthy lifestyle and a guide for the way we should all eat, whether or not we need to lose weight or improve our blood sugar and cholesterol levels. Because studies showed that well-timed snacks help prevent the sugar lows that can bring on cravings in the late morning, late afternoon, and/or evening, I included what I called strategic snacking on all the phases, but especially the first phase, of the diet.
I felt that this approach was not only a true departure from the nationally recommended low-fat, high-carb diet at the time but also from the then-popular low-carb, high-fat diet and severely fat-restricted diets. I didn’t want to give my heart patients a high-fat diet that included liberal amounts of saturated fat that might accelerate their heart disease, nor did I want to severely restrict total fat. First, in my experience, patients had great difficulty adhering to such a diet. Second, with a low-fat, high-carb diet, I had seen patients’ good cholesterol decrease and their triglycerides and blood sugar shoot up. Third, I wanted my patients to have the benefit of good fats; studies had convinced me that they were good for both the heart and general health. In addition, having a certain amount of good fat in the diet made the food taste better and improved satiety and compliance.
The First South Beach Dieter—Me!
My interest in finding the ideal diet went beyond concern for my patients, however. In fact, it was a little bit selfish. I had had my own bad experience with the low-fat, high-carb approach and had gained weight due to what I now realize were very poor choices when it came to carbohydrates. I had even developed my own middle-age fat-storage depot where my once-trim belly used to be. Furthermore, I found I was running out of steam in the late afternoon, which often led me to a mad dash to the doctors’ lounge, where I would inhale a low-fat (but sugary) muffin and a cup of coffee to help me make it through the rest of the day. I now realize that this was a sign of reactive hypoglycemia due to insulin resistance and that the refined carbs and sugar I was eating only exacerbated the problem.
So I designated myself as the first candidate for my new diet. I was amazed to observe my belly fat start to disappear in just 2 weeks, and I quickly felt energized. I no longer needed to make those late-afternoon dashes to the doctors’ lounge to hike up my falling blood sugar.
With the confidence and excitement that resulted from my own experience, I recruited Marie Almon, MS, RD, at that time the chief clinical dietitian at Mount Sinai Medical Center in Miami Beach, to help me develop meal plans for each phase of the diet, based on the principles of nutrient-dense, fiber-rich carbohydrates; healthy fats; and lean sources of protein. When this was accomplished, we began counseling patients, explaining the three phases and handing out photocopies of the Foods to Enjoy and Foods to Avoid lists and the meal plans.
I was amazed by my patients’ success. After years of frustration with the low-fat diet, I was now witnessing wonderful results as their belly fat seemed to melt away and their cholesterol improved, triglycerides dropped, and prediabetes and early type 2 diabetes reversed. I was also surprised and gratified to learn that my patients were mailing and faxing their photocopied diet guidelines to friends and relatives around the country. (Of course, this was before e-mail!)
The South Beach Diet Goes Prime Time
Because of the diet’s success, we began sharing our results at national meetings. First we reported consecutive cases, and then we undertook a small clinical trial. We compared our good-fat, good-carb approach to what was then called the American Heart Association (AHA) Step II Diet, which was very low in fat and high in carbohydrates (it has since been supplanted).
Of a group of 60 overweight participants, half went on our diet and the other half went on the AHA Step II Diet. After 12 weeks, five o
f the low-fat dieters had dropped out, but only one of the South Beach dieters had quit the program. In the end, the South Beach dieters lost nearly twice as much weight as the low-fat dieters and actually had greater improvements in their blood fats. Notably, their blood triglycerides improved dramatically. Just as I had, they lost a lot of belly fat (which was significant when measured by their waist-to-hip ratios; see “Why Your BMI Can Be Misleading” on Chapter 6). The low-fat dieters did not have the same success.
In spring 1999, after we presented our results at a national meeting of the American College of Cardiology in New Orleans, a Miami TV station asked me if they could offer the South Beach Diet to their viewers. I said fine, and hundreds of South Floridians went on the diet and lost weight. The response was incredible, and the South Beach Diet series became an annual event for the station for 3 years running. I continued to prescribe the diet to my patients, and people urged us to write a book. Its publication in 2003 seems like yesterday.
Scientific Support: The Diet Debates Are Over
In the 5 years that have passed since the publication of the original book, we have received thousands of testimonials documenting people’s good results on the diet. You will find stories like Jen P.’s (above) throughout this book. There have also been numerous scientific studies reaffirming our healthy eating principles, including, notably, the importance of good fats and good carbohydrates. In fact, the latest USDA Food Pyramid, released in January 2005, reflects these same principles.
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living THE SOUTH BEACH DIET
Jen P., age 43: Now I Love Life and All the People in It
I have found a new life with the South Beach Diet. In April 2006, I was 41 years old, 5-foot-6, and 156 pounds. I weighed 30 pounds more than I had before I got married in 1997. I was smoking two packs a day and drinking a whole pot of coffee before 10:00 a.m. for an energy boost. I never ate breakfast, and I never exercised. My meals consisted of fast food and anything processed that I could eat on the run. My total cholesterol was 287, and that was with medication. But I didn’t care.
Then two things happened that made me take stock of my life. First, my grandmother died. She had been living with my mother with the help of hospice care, but I helped take care of her the last week of her life. I had been very close to my grandmother, and this was very difficult for me. Then, just 3 weeks later, my father died suddenly of a stroke. His death was shocking so soon after the loss of my beloved grandmother.
Following the funerals, I felt a strong, overwhelming need to live and cherish every moment of every day, I decided I needed a complete overhaul of my lifestyle. My supervisor at work told me that she was on the South Beach Diet, and it was working really well for her, so I decided to give it a try. I bought the book and followed the Phase 1 guidelines to a T. I lost 8 pounds during those initial 2 weeks and had more energy than I’d had in years. I started walking outside. I could go only a mile or so at first, but I did it every day until I had the strength to walk 3 to 5 miles on some days. My speed increased, too.
I knew it was time to quit smoking. Being on the diet made it easy because I already had a fridge packed with raw vegetables to munch on. Also, I could always walk when I felt the urge to smoke. I did it—I quit smoking and never gained back an ounce. I continued to lose 1 to 2 pounds a week while on Phase 2 and tried another type of exercise. I bought a bike and rode it on a bike trail we have in town. I hadn’t been on a bike in more than 20 years, and now I can ride the whole trail (22 miles). I also bought a kayak and some dumbbells, exercise videos, and a treadmill so I could walk when the weather got cold.
Within 2 months, my cholesterol went from 287 to 155. My doctor couldn’t believe it. Six months later, with my doctor’s permission, I went off my cholesterol medication completely.
I also joined a gym for the first time and love all the exercise classes. I’m always telling people on the SouthBeachDiet.com message boards about my exercise routine. We also share recipes all the time. I actually learned how to cook from those wonderful people.
I met my goal of losing 30 pounds more than a year ago. It took about 7 months, and I have been working hard at maintaining it. Sometimes I’ll regain a few pounds, but then I just go back to eating like I did when I was on the first couple of weeks of Phase 2, and the weight comes right off. It’s very simple.
Another added benefit of the diet is that I’ve made new, healthy friends at work, at the gym, and in my neighborhood. I wasn’t a very pleasant person to be around before South Beach. Now I love life and all the people in it. I didn’t just find a new lifestyle with the South Beach Diet—I found life!
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And there’s much more going on. Food manufacturers are now required by law to list the amount of trans fats on their food labels, and many have simply removed these terrible fats altogether. In New York City, restaurants are currently banned from using most frying oils containing artificial trans fats and will have to basically eliminate artificial trans fats from all their foods by July 2008. Many more cities are sure to follow. When we watch TV today, we see more and more advertisements for whole-grain foods. And the terms good carbs, good fats, and glycemic index are now common in both the media and our daily conversations. These are all clear signs that the diet debates—and diet confusion—are over.
Here’s just a small sampling of the scientific studies that support our diet philosophy.
Low fat a failure. In 2006, the Women’s Health Initiative Dietary Modification Trial reported the results of a 7½-year study involving nearly 49,000 women between ages 50 and 79. One group followed a low-fat diet, decreasing their fat intake to 20 percent of calories. They were informed that the diet was not intended to promote weight loss and were encouraged to maintain their usual energy intake by replacing fat calories with calories from other sources. The other group, the control group, received diet-related education materials and continued to eat a normal, higher-fat diet. Researchers found no benefit to the low-fat diet in terms of cardiovascular health, nor did it reduce the occurrence of breast or colorectal cancer.
Mediterranean diet a winner. In 2006, a Spanish study (the PREDIMED Study) divided 772 adults at high risk for cardiovascular disease into three groups. One group ate a low-fat diet, while the other two ate a Mediterranean-style diet that, like the South Beach Diet, was rich in fruits, vegetables, whole grains, seafood, lean meats, and good fats. One of these two groups was allowed additional olive oil (1 liter—about a quart—per week), and the other was allowed additional nuts (30 grams—about 1 ounce—per day). The results: Both groups following the Mediterranean diet had better blood sugar, better blood pressure, and better ratios of good HDL to bad LDL cholesterol than those in the low-fat group. Those following the Mediterranean diet also had a reduction in C-reactive protein, a measure of inflammation, in their blood. (You can read about the health implications of inflammation in Chapter 6.)
Low-glycemic best against insulin resistance. Studies comparing the low-glycemic approach to other diets have confirmed our good results. In a 2007 study led by nutrition pioneer David S. Ludwig, MD, at Children’s Hospital Boston, 73 obese young adults were placed on either the standard low-fat diet or a low-glycemic diet. All the participants were tested before the study to determine whether they were high-insulin secretors, which would mean that they would be especially sensitive to high-glycemic foods. These same people would be likely candidates for prediabetes (metabolic syndrome). After 18 months on the diet, the high-insulin secretors lost more than 12 pounds on the low-glycemic diet. Those on the low-fat diet lost only 2.6 pounds. Those following the low-glycemic diet also lost more body fat and, remarkably, did not regain any weight. Both the high-insulin secretors and those with normal insulin response did better on the low-glycemic diet than on the low-fat diet in terms of two important numbers: Their HDL, or good cholesterol, went up, and their triglyceride levels went down.
Support from around the world. In a 2007 Australian study, researchers at Child
ren’s Hospital at Westmead in Sydney, Australia, reviewed six randomized control trials from Australia, France, South Africa, Denmark, and the United States, comparing low-glycemic diets with other diets. They found the low-glycemic diets to be more effective in terms of overall weight loss and a decrease in body fat. Furthermore, those on the low-glycemic diets had a greater reduction in overall cholesterol and bad LDL cholesterol.
I could cite many other studies, but they all tell the same story. Healthcare professionals universally agree that our focus should be on nutrient-dense, fiber-rich carbohydrates; healthy sources of unsaturated fats; low-fat dairy; and lean sources of protein. The principles of the South Beach Diet are here to stay.
Over the past decade, the South Beach Diet has helped millions of people lose weight. For many, following the diet was the first step toward adapting a healthy way of life. Many of them also went on to engage in some form of regular physical exercise, often for the first time in their lives. (I wish they all had.)
There’s no question that being active is key to maintaining a healthy weight. And the good news is that even the busiest individuals can fit exercise into a South Beach Diet lifestyle. Just as I have learned more about the nutritional value of certain foods in the last 5 years, I have also learned what type of exercise is best for revving up your metabolism and speeding weight loss. And working exercise into your life is a lot easier than you might think. Just turn to Chapter 4.
The South Beach Diet Super Charged Page 4