The South Beach Diet

What is the South Beach Diet ?

The South Beach Diet ¹, which is named after a glamorous area of Miami, is sometimes called a Glycemic index diet or Modified low-carbohydrate diet, similar to Sugar Busters and the Zone Diet. The South Beach Diet is a popular weight-loss diet created in 2003 by cardiologist Arthur Agatston and outlined in his best-selling book, “The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss” ²). The South Beach Diet is lower in carbs (carbohydrates): low-carbohydrate diet initially <20 g/day carbohydrate without formal prescribed energy restriction but realized energy deficitand higher in protein and healthy fats than is a typical eating plan. But it’s not a strict low-carb diet, and you don’t have to count carbs.

The South Beach plan recommends certain types of carbohydrates and fats. The South Beach plan is organized into three phases ¹. But the South Beach Diet has evolved over time and now recommends exercise as an important part of your lifestyle. The South Beach Diet says that regular exercise will boost your metabolism and help prevent weight-loss plateaus.

South Beach Diet Phase 1, Weight Loss

The first 2 weeks restricts consumption of particular foods (eg, bread, rice, potatoes, pasta, baked goods, alcohol, fruit, or sugar products). This two-week phase is designed to eliminate cravings for foods high in sugar and refined starches to jump-start weight loss. You cut out almost all carbohydrates from your diet, including pasta, rice, bread and fruit. You can’t drink fruit juice or any alcohol. You focus on eating lean protein, such as seafood, skinless poultry, lean beef and soy products. You can also eat high-fiber vegetables, low-fat dairy and foods with healthy, unsaturated fats, including avocados, nuts and seeds.

The South Beach Diet says that you’ll lose 8 to 13 pounds (3.6 to 5.9 kilograms) in the two-week period that you’re in phase 1. It also says that most of the weight will be shed from your midsection. In phase 2, it says that you’ll likely lose 1 to 2 pounds (0.5 to 1 kilogram) a week.

The plan is liberalized in the second (continued weight loss) and third (maintenance) phases.

South Beach Diet Phase 2, Continued Weight Loss

In phase 2, dieters are instructed to have lean protein and low-fat dairy, and gradually reintroduce whole-grain carbohydrates and fruit. You begin adding back some of the foods that were prohibited in phase 1, such as whole-grain breads, whole-wheat pasta, brown rice, fruits and more vegetables. You stay in this phase until you reach your goal weight.

South Beach Diet Phase 3, Maintenance

Subjects expand the quantity and selection of whole grains and particular fruits and vegetables. This is a maintenance phase meant to be a healthy way to eat for life. You continue to follow the lifestyle principles you learned in the two previous phases. You can eat all types of foods in moderation.

The South Beach Diet allows carbohydrate consumption as long as they have a low Glycemic Index (GI). The Glycemic Index (GI) is a measure of the blood glucose response to intake of a particular carbohydrate ³. The higher the peak in postprandial blood glucose levels, the higher the GI value. The glycemic load (GL) is the product of dietary GI and total dietary carbohydrate, providing a useful measure of the total glycemic effect ⁴. Table 1 shows a list of common foods and their associated Glycemic Index (GI) and Glycemic load (GL). A high-GI diet has been proposed to increase hunger and elevate free fatty acid levels, leading to an increased risk of obesity, diabetes, and cardiovascular disease ⁵. Several in vitro experiments indicate that elevated postprandial blood glucose levels cause oxidative stress, leading to endothelial damage and activation of coagulation ⁶.

Table 1 shows the glycemic index and glycemic load of various foods compared with glucose. Adapted from data in reference ⁵.

The framework of the South Beach Diet includes an initial two-week period of extreme carbohydrate restriction followed by gradual re-introduction of low-GI carbohydrates. The maintenance phase encourages intake of fruits, vegetables, whole grains, mono- and polyunsaturated fats, omega-3 fatty acids, nuts, and moderate dairy products. Unlike the Atkins’ Diet, the South Beach Diet encourages lean protein, such as fish and poultry, and allows olive oil as a source of mono- and polyunsaturated fat.

The longest interventional study conducted in humans related to Glycemic Index (GI) was a crossover study lasting 12 weeks ⁷. Thirty women were randomized to a low-GI or high-GI diet. Those on a high-GI diet lost 7.4 kg, whereas those on a low-GI diet lost 9.4 kg. In 16 women who participated in a 12-week follow-up, crossover study, those on a low-GI diet lost 7.4 kg, compared with 4.5 kg on a high-GI diet. However, the results from other interventional studies, although shorter in duration and with smaller populations, have been inconsistent ⁸.

A possible association between a high-GI diet and diabetes has been observed. Studies that investigated this relationship include the Nurses’ Health Study ⁹, which followed over 65,000 U.S. women for six years, the Health Professionals’ Survey ¹⁰, which followed 42,750 U.S. men for six years, and the Iowa Women’s Health Study, which followed 36,000 women for six years ¹¹. All of these prospective cohort studies showed an association between diabetes and high GL. A recent meta-analysis of 14 randomized, controlled trials comparing low- and high-GI diets in diabetes management showed that glycated proteins were reduced 7.4% on a low-GI diet ¹². Multiple cohort studies have been inconclusive as to whether a high-GI diet may also be linked to CVD risk factors ¹³, ¹⁴, ¹⁵, ¹⁶, ¹⁷. Cohort studies are a type of medical research used to investigate the causes of disease, establishing links between risk factors and health outcomes. Cohort studies are usually forward-looking, that is, they are “prospective” studies, or planned in advance and carried out over a future period of time.

High-GI diets may alter HDL metabolism. A survey of 1,420 British adults ¹⁶ evaluated GI through a seven-day diet survey and showed an inverse relationship between GI and HDL cholesterol. The Third National Health and Nutrition Examination Survey (NHANES III) ¹⁷, which followed 13,907 subjects older than 20 years old, demonstrated that for every 15-U increase in GI, there was a 0.06-mmol/l decrease in HDL cholesterol.

Many of these prospective cohort studies contain confounding variables. Most of these studies based their GI and GL calculations on self-reporting. Portion size and recall bias could result in inaccurate reporting ¹⁸. Also, the GI of a food can change depending on the method of food preparation and different types of the same food (i.e., different grains of rice). Despite suggestive evidence, no trials have shown that low-GI diets prevent cardiovascular disease. Longer studies with more participants are needed before low-GI diets can be definitively recommended ¹⁹.

In a study ²⁰ comparing the dietary quality of popular weight-loss plans (their status on the New York Times Bestseller list) – the New Glucose Revolution, Weight Watchers, Atkins Diet, South Beach Diet, Zone Diet, Ornish Diet, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans. The Dietary quality was estimated using the Alternate Healthy Eating Index (AHEI), a measure that isolates dietary components that are most strongly linked to cardiovascular disease risk reduction ²¹,²². The Alternate Healthy Eating Index (AHEI) was developed to measured adherence to the 1995 US Department of Agriculture Food Guide Pyramid dietary guidelines and the quality within food groups and acknowledged health benefits of unsaturated oils ²³. The score was then used to predict development of cardiovascular disease, cancer or other causes of death in the same population previously tested. Men and women with AHEI scores in the top vs. bottom quintile had a significant 20% and 11% reduction in overall major chronic disease, respectively. Reductions were stronger for cardiovascular disease risk in men than in women. The score did not predict cancer risk. The AHEI was twice as strong at predicting major chronic disease and cardiovascular disease risk compared to the original Healthy Eating Index (HEI) ²⁴, suggesting that AHEI may be a better proxy of dietary quality ²⁵, ²⁶.

The AHEI incorporates several aspects of the original HEI ²⁴, and therefore some components correspond to existing dietary guidelines (eg, to increase fruit and vegetable intakes). The AHEI has nine components for evaluating and determining dietary quality, including fruit, vegetables, nuts and soy, ratio of white to red meat, cereal fiber, trans fat, ratio of polyunsaturated fat to saturated fat, alcohol, and duration of multivitamin use ²⁷. Seven of the nine AHEI components were used to calculate the AHEI score for each plan ²⁷. Duration of multivitamin use and daily alcohol intake were not used because neither were addressed in the diet book meal plans.

The AHEI also provides quantitative scoring for qualitative dietary guidance (eg, choose more fish, poultry, and whole grains, and if you drink alcohol, do so in moderation). AHEI variables were chosen and scoring decisions were made a priori, on the basis of discussions with nutrition researchers. AHEI sought to capture specific dietary patterns and eating behaviors that have been associated consistently with lower risk for chronic disease in clinical and epidemiologic investigations. AHEI score of 10 indicates that the recommendations were fully met, whereas a score of 0 represents the least healthy dietary behavior. Intermediate intakes were scored proportionately between 0 (worst) and 10 (best). For example, zero vegetable servings per day was given the score of 0, and five servings per day or more was given a 10. For meat, when no red meat was consumed, the component score was set to 10. The multivitamin component was dichotomous, contributing either 2.5 points (for nonuse) or 7.5 points (for use). All component scores were summed to obtain a total AHEI score  ²⁷ ranging from 2.5 (worst) to 87.5 (best).

The results of that study ²⁰ that compares the dietary quality of popular weight-loss plans (the New Glucose Revolution, Weight Watchers, Atkins Diet, South Beach Diet, Zone Diet, Ornish Diet, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans), ordered from the highest to the lowest plan were:

1. Ornish (score 64.6),
2. Weight Watchers high-carbohydrate (score 57.4),
3. the New Glucose Revolution (score 57.2),
4. South Beach/Phase 2 (score 50.7),
5. Zone (score 49.8),
6. 2005 Food Guide Pyramid (score 48.7),
7. Weight Watchers high-protein (score 47.3),
8. Atkins/100-g carbohydrate (score 46),
9. the South Beach/Phase 3 (score 45.6), and
10. Atkins/45-g carbohydrate (score 42.3).

The Zone plan was lowest in energy (mean 1,025±122 kcal per day), whereas the 2005 Food Guide Pyramid plan was highest (mean 1,946±200 kcal per day).

The Ornish plan, which is almost a completely vegetarian plan, scored high largely due to the amount of vegetables, fruit, cereal fiber intake, and low trans fat ²⁸, ²⁹, ³⁰, ³¹, ³², ³², ³²(28-34).

The Weight Watchers higher-carbohydrate and the New Glucose Revolution plans also fared well due to the emphasis on fruits and vegetables, higher whole-grain composition, and low trans fats.

In light of the study limitations, further investigations are warranted to observe what patients actually consume when following a popular weight-loss diet plan.

Purpose

According to Arthur Agatston, M.D., author of The South Beach Diet – the key to losing weight quickly and getting healthy isn’t cutting all carbohydrates and fats from your diet, it’s learning to choose the right carbs and the right fats.

The South Beach Diet says that you’ll lose 8 to 13 pounds (3.6 to 5.9 kilograms) in the two-week period that you’re in phase 1. It also says that most of the weight will be shed from your midsection. In phase 2, it says that you’ll likely lose 1 to 2 pounds (0.5 to 1 kilogram) a week.

Most people can lose weight on almost any diet, especially in the short term. Most important to weight loss is how many calories you take in and how many calories you burn off. A weight loss of 1 to 2 pounds a week is the typical recommendation. Although it may seem slow, it’s a pace that’s more likely to help you maintain your weight loss permanently.

The purpose of the South Beach Diet is to change the overall balance of the foods you eat to encourage weight loss and a healthy lifestyle. The South Beach Diet says it’s a healthy way of eating whether you want to lose weight or not.

This approach is part of a three-step program Dr. Agatston developed to help his heart patients lose weight and lower cholesterol.

Emphasizing foods that are loaded with fiber and nutrients, the South Beach Diet promises to help you kick your cravings, jump-start your weight loss, and keep those unwanted pounds off — for life.

In the first 2 weeks, Phase 1 of the diet, you can expect to lose between 8 and 13 pounds, Dr. Agatston says.  With Phase 1 the most restrictive: no bread, rice, potatoes, pasta, or fruit.

In Phase 2, you gradually add back in some of these foods. You move into Phase 3 when you hit your goal weight, and you stay there for life.

Why you might follow the South Beach Diet ?

You might choose to follow the South Beach Diet because:

• You like the related South Beach Diet products, such as cookbooks and diet foods.
• It’s a healthy approach to eating that can help you shed pounds. Nutrition experts warn against the restrictive first phase, though.
• You want a diet that restricts certain carbs and fats to help you lose weight.
• You want to change your overall eating habits.
• You want a diet you can stick with for life.

What You Can Eat and What You Can’t ?

That depends on the phase you’re in. Phase 1 is the strictest and includes:

• A lot of protein, such as beef, poultry, seafood, eggs, and cheese.
• Some fats, including canola oil, extra-virgin olive oil, and avocado.
• Carbs with the lowest glycemic index, including vegetables such as broccoli, tomatoes, spinach, and eggplant.

What’s off-limits in Phase 1: Fruit, fruit juices, starchy foods, dairy products, and alcohol.

In Phase 2, you slowly reintroduce healthy carbs into your diet — fruit, whole-grain bread, whole-grain rice, whole wheat pasta, and sweet potatoes. Expect weight loss to slow to 1 to 2 pounds a week, on average.

Phase 3 is about maintaining your weight. There’s no food list to follow. By this time, you’ll know how to make good food choices and how to get back on track if you overindulge once in a while. If cravings return or your eating gets off track, the plan recommends going back to Phase 1 or 2.

South Beach Diet Details

• Carbohydrates
  The South Beach Diet is lower in carbohydrates than is a typical eating plan, but not as low as a true low-carb diet. On a typical eating plan, about 45 to 65 percent of your daily calories come from carbohydrates. Based on a 2,000-calorie-a-day diet, this amounts to about 225 to 325 grams of carbohydrates a day. In the final maintenance phase of the South Beach Diet, you can get as much as 28 percent of your daily calories from carbohydrates, or about 140 grams of carbohydrates a day. A true low-carb diet might restrict your carb intake to as little as 50 to 100 grams a day.
• Exercise
  The South Beach Diet has evolved over time and now recommends exercise as an important part of your lifestyle. The South Beach Diet says that regular exercise will boost your metabolism and help prevent weight-loss plateaus.

Phases of the South Beach Diet

The South Beach Diet has three phases:

• Phase 1. This two-week phase is designed to eliminate cravings for foods high in sugar and refined starches to jump-start weight loss. You cut out almost all carbohydrates from your diet, including pasta, rice, bread and fruit. You can’t drink fruit juice or any alcohol. You focus on eating lean protein, such as seafood, skinless poultry, lean beef and soy products. You also can eat high-fiber vegetables, low-fat dairy, and foods with healthy, unsaturated fats, including avocados, nuts and seeds.
• Phase 2. This is a long-term weight-loss phase. You begin adding back some of the foods that were prohibited in phase 1, such as whole-grain breads, whole-wheat pasta, brown rice, fruits and more vegetables. You stay in this phase until you reach your goal weight.
• Phase 3. This is a maintenance phase meant to be a healthy way to eat for life. You continue to follow the lifestyle principles you learned in the two previous phases. You can eat all types of foods in moderation.

A typical day’s menu on the South Beach Diet

Here’s a look at what you might eat during a typical day in phase 1 of the South Beach Diet:

• Breakfast. Breakfast might be an omelet with smoked salmon or baked eggs with spinach and ham, along with a cup of coffee or tea.
• Lunch. Lunch might be a vegetable salad with scallops or shrimp, along with iced tea or sparkling water.
• Dinner. Dinner may feature grilled tuna or pork paired with grilled vegetables and a salad.
• Dessert. The diet encourages you to enjoy a dessert, such as a ricotta cheesecake or chilled espresso custard, even in phase 1.
• Snacks. You can enjoy snacks during the day, too, such as a Muenster cheese and turkey roll-up or roasted chickpeas.

Health benefits

The South Beach Diet, while mainly directed at weight loss, may promote certain healthy changes. Research shows that following a long-term eating plan that’s rich in healthy carbohydrates and dietary fats can improve your health. For example, lower carbohydrate diets with healthy fats may improve your blood cholesterol levels.

On the other hand, no long-term, randomized controlled clinical trials have measured the health outcomes of the South Beach Diet. Nor have there been such studies of the overall health or cardiovascular benefits of following a low-glycemic-index diet. But eating such foods as whole grains, unsaturated fats, vegetables and fruits should help to promote good health.

Does It Work for Weight Loss ?

Yes. Besides the restrictive first phase, this is a healthy Mediterranean-style approach to eating that can help you shed pounds.

Most people can lose weight on almost any diet, especially in the short term. Most important to weight loss is how many calories you take in and how many calories you burn off. A weight loss of 1 to 2 pounds a week is the typical recommendation. Although it may seem slow, it’s a pace that’s more likely to help you maintain your weight loss permanently.

Losing a large amount of weight rapidly could indicate that you’re losing water weight or lean tissue, rather than fat. In some situations, however, faster weight loss can be safe if it’s done in a healthy way. For example, some diets include an initiation phase to help you jump-start your weight loss, including the South Beach Diet and the Mayo Clinic Diet.

For long-term success, get regular exercise as recommended in the South Beach Diet Supercharged plan.

Side Effects of South Beach Diet

The South Beach Diet is generally safe if you follow it as outlined in official South Beach Diet books and websites. However, if you severely restrict your carbohydrates, you may experience problems from ketosis. Ketosis occurs when you don’t have enough sugar (glucose) for energy, so your body breaks down stored fat, causing ketones to build up in your body. Side effects from ketosis can include nausea, headache, mental fatigue and bad breath, and sometimes dehydration and dizziness.

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