Agatston on “insulin resistance” and his discoveries.

South Beach Diet - Supercharged - buy from Amazon

South Beach Diet - Supercharged - buy from Amazon

This is an extract from “The South Beach Diet” by Arthur Agatston, MD

I asked the most respected cardiologist I knew this question: ‘What is the best way to prevent heart disease?’ His answer: ‘Pick the right parents.’ If you inherited the gene for cardiac longevity, you were likely to live to a ripe old age. If heart disease struck early in your family, there was not much you could do to change your destiny.

Then, in 1984, I attended a course at the Heart House in Bethesda, Maryland, the national headquarters of the American College of Cardiology. There, I heard a lecture by a brilliant researcher and charismatic teacher, Bill Castelli, who headed the world-famous Framingham Heart Study. Dr Castelli told us about the results of the recently completed National Institutes of Health (NIH)-sponsored Lipid Research Clinics Primary Prevention Trial (LRCPPT). This was the very first study to prove that lowering cholesterol via diet could reduce heart attacks. At the time, the only known treatment for high cholesterol was an unpleasant, grainy powder known as a resin, which was taken several times a day before meals. Therefore, we were all very excited when Dr Castelli told the conference that if we put patients on the very first American Heart Association diet, we could lower their cholesterol and end the scourge of heart disease in America.

We physicians all returned home filled with fervour, ready to guide our patients to restored cardiac health and dietary wisdom. I came back to Miami confident in my newfound knowledge of how to save my patients’ lives. My wife and I even joked that with heart disease out of the picture, I might be better off switching to a growth speciality, like plastic surgery. It wasn’t long before I learned that unemployment as a cardiologist was going to be unlikely.

I began counselling my patients on the low-fat, high-carbohydrate diet advocated by the American Heart Association, but the results fell far below my expectations. Often, there was an initial modest improvement in total cholesterol with mild weight loss. This invariably was followed by a return of cholesterol to its previous level or higher, along with a return of the lost weight. This scenario was not only my experience but also that of my colleagues. It was reflected in the many diet-cholesterol trials documented in the literature that showed our inability to sustain cholesterol and/or weight reductions using low-fat, high-carbohydrate diets. There were no convincing studies showing that the American Heart Association diet saved lives.

Over the years I had suggested most of the highly respected diets out there — going back to Pritikin (see chapter three) and then through the various, more recent, heart-healthy low-fat regimes, including the Ornish plan and several American Heart Association diets – and seen each of them, for different reasons, fail miserably. Either the diets were too difficult to stick with, or the promise of improved blood chemistry and cardiac health remained just that – a promise. Discouraged, I had all but given up on advising my patients about nutrition, because I was unable to suggest anything that actually helped. Like most cardiologists in that period, I turned instead to the statin drugs that were just coming on the market, medications that had proved extremely effective in lowering total cholesterol, if not weight.

But I also decided, as a last-ditch effort, that I would devote some serious study of my own to diet and obesity. Like most physicians, I was not particularly knowledgeable in the science of nutrition. So my first task was to research all the weight-loss programmes out there, the serious scientific ones as well as the trendy attempts that topped the best-seller lists. As I acquired that education, I was also reading in the cardiology literature about the prevalence of something called the insulin resistance syndrome and its effect on obesity and heart health.

The science of success

One side effect of excess weight, we now know, is an impairment of the hormone insulin’s ability to do its job of processing fuel, or fats and sugars, properly. This condition is commonly called insulin resistance. As a result, the body stores more fat than it should, especially in the mid-section. We’ve been genetically conditioned to store fat since the dawn of homo sapiens, as a survival strategy to see us through times of famine.

The problem now, of course, is that we never experience the famine end of that equation, only the feast. As a result, we store fat but never require our bodies to burn it off. Much of our excess weight comes from the carbohydrates we eat, especially the highly processed ones found in baked goods, breads, snacks, and other convenient favourites. Modern industrial processing removes the fibre from these foods, and once that’s gone their very nature – and how we metabolize them – changes significantly, and for the worse.

Decrease the consumption of those ‘bad’ carbs, studies showed, and the insulin resistance starts clearing up on its
own. Weight begins a fairly rapid decrease, and you begin metabolizing carbs properly. Even the craving for carbs disappears once you cut down on their consumption. Finally, cutting out processed carbs improves blood chemistry, ultimately resulting in lowered triglycerides and cholesterol.

So my eating plan’s first principle was to permit good carbohydrates (fruits, vegetables, and whole grain) and curtail the intake of bad carbohydrates (the highly processed ones, for the most part, where all the fibre had been stripped away during manufacturing). We would thereby eliminate a prime cause of obesity. This was in marked contrast to the Atkins Diet, for instance, which bans virtually all carbohydrates and leaves the dieter to exist mostly on proteins. That regime also permits limitless saturated fats, the kind found in red meat and butter These are, as most people know, the bad fats — the ones that can lead to cardiovascular disease, heart attack, and stroke. That hasn’t stopped millions of dieters from adopting the plan. But from the moment I learned of it, the diet set off alarm bells in this cardiologist’s head. Even if you do lose weight and keep it off, your blood chemistry is bound to suffer from eating so much saturated fat.

My plan cut certain carbohydrates, but not all. In fact, it encouraged eating the good ones. For instance, I banished white flour and white sugar. But our diet permits wholegrain breads and cereals and wholemeal pasta. We also prescribe lots of vegetables and fruit. I had a practical reason, beyond their obvious nutritional value and the beneficial fibre they provide, for that decision. Not everyone wants to give up vegetables, fruit, bread, and pasta for ever even in exchange for a regime that allows a pound of bacon for breakfast, followed by a pound of hamburger (with no bun, of course) for lunch, topped by a thick steak for dinner And if people want bread, pasta, or rice, a humane eating plan should be able to accommodate that desire.

To make up for the overall cut in carbohydrates, my diet permitted ample fats and animal proteins.This decision flew in the face of the famous diets that had been developed specifically for people with heart problems, like Pritikin and Ornish. For a cardiologist, this was skating on thin ice. But my experience with patients showed that those so-called heart-healthy diets were nearly impossible to stick to, because they relied too heavily on the dieters’ ability to eat superlow fat over the long haul. The South Beach diet would permit lean beef, pork, veal, and lamb.

The low-fat regime’s severe restrictions on meat were unnecessary – the latest studies had showed that lean meat did not have a harmful effect on blood chemistry. Even egg yolks are good for you – they’re a source of natural vitamin E and have a neutral-to-favourable effect on our balance between good and bad cholesterol, contrary to what we once believed. Chicken, turkey, and fish (especially the oily ones such as salmon, tuna, and mackerel) were recommended on my diet, along with nuts and low-fat cheeses and yogurt. As a rule, low-fat prepared foods can be a bad idea -the fats are replaced with carbs, which are themselves fattening. But dairy products such as cheese, milk, and yogurt that are low fat are exceptions to this rule — they are nutritious and not fattening.

I also allowed plenty of healthy mono- and polyunsaturated fats, like the Mediterranean ones: olive oil, rapeseed oil, and peanut oil. These are the good fats. They can actually reduce the risk of heart attack or stroke. In addition to being beneficial, they taste good and make food palatable. They’re filling, too – a major consideration for a diet that promises you won’t have to go hungry.

Next, I found a suitable guinea pig for preliminary testing purposes, a middle-aged man who was having trouble keeping his growing paunch under control: me.

I went on the diet. I gave up bread, pasta, rice, potatoes. No beer. No fruit even, at least in the very beginning, because it contains high levels of fructose, or fruit sugar But otherwise I was determined to eat as normally as possible, meaning three meals a day plus snacks when I was hungry.

After just a week, I noticed a difference. I lost almost 8 pounds in those first seven days, and it was easy. I didn’t suffer any hunger pangs. No terrible cravings. No noticeable deprivation.

Almost sheepishly, I approached Marie Almon, MSRD, chief clinical dietitian at our hospital, Mount Sinai Medical Center in Miami Beach, and told her of my experiment. She conceded that the low-fat diet we had been recommending to cardiac patients wasn’t working. So we took the basic principles I had developed and expanded them into an agreeable eating plan…


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