A Safer Alternative to the Atkins Diet

The high-protein, high-fat, and low-carbohydrate Atkins diet has been receiving some positive press lately with a few studies finding that cholesterol levels are not affected negatively, at least in the short term, in spite of the high amounts of saturated fat that is recommended by the diet.

However, scientists know that weight loss from any type of diet will initially lower cholesterol in overweight and obese people, so the question remains whether followers of the diet will be able to sustain normal cholesterol when they have reached their optimum weight and are on the maintenance phase of the diet.

There is also the issue of an increased risk of colon cancer, which is associated with a diet rich in red meat. Still controversial is the long-term effect of a high-protein intake on the kidneys and the bones. And scientists can't just disregard hundreds of studies linking saturated fat with heart disease based on the results of a handful of short-term experiments.

The US National Institute of Health is currently conducting a five-year large-scale study on the Atkins diet but the results will not be known for quite some time yet. So the jury is still out on the safety of following the Atkins way of eating for life.

I have a client who recently discovered she had elevated cholesterol and a kidney stone after following the Atkins for a year. She isn't the only one I know who has had this experience. Registered dietician Sanirose Orbeta has had many patients referred to her by cardiologists because of the same results from following the Atkins for a prolonged period.

And yet I can understand the love affair many people have with the Atkins. They have had more success at losing weight with it compared to the traditional low-fat, high-carbohydrate diet.

The reason for their success is that they don't feel hungry with the Atkins. Upon closer analysis, they were also doing the traditional route the wrong way by eating refined and processed sources of carbohydrates like white bread and pasta and low-fat products with lots of sugar like fat-free cookies. Refined carbohydrates plus a low consumption of protein will lead to cravings and constant hunger.

The problem is that, since the Atkins is so carb-restrictive that even in its maintenance phase only 40 to 60 grams of carbohydrates are recommended, you can end up missing out on the cancer-fighting potential of the five to nine servings of fruits and vegetables recommended by the American Institute of Cancer Research and other such organizations.

Well, for those of you who like eating low-carb because it controls your sugar cravings and helps you lose weight but are concerned about the long-term effects of eating mostly steak and pork chops and hardly any fruits, there may be a solution to your dilemma.

I first heard about the South Beach Diet, or SBD as its fans affectionately call it, when Prevention Magazine published an article last year written by cardiologist Arthur Agatston.

In it, Agatston explained that he created the SBD because he became disillusioned with low-fat, high-carbohydrate diets since they did not work for his patients over the long haul. He said he was not concerned about the appearance of his patients, but he wanted to find a diet that would help prevent or reverse heart disease.

The SBD has been receiving a lot of attention lately and is the diet darling of the year. According to the publishers, Agatston's book, "The South Beach Diet," is fast approaching the sales of Dr. Atkins' "New Diet Revolution."

The SBD has been called an Atkins clone, but Agatston is quick to point out that his diet is not low-carb. Unlike the Atkins which restricts most carbohydrates and allows an unlimited quantity of food high in saturated fat, the SBD teaches people how to choose the right carbohydrates and the right fats "to lose weight, lower your cholesterol, reduce your risk of heart disease and diabetes, and get rid of cravings without feeling hungry."

In an interview with WebMD, Agatston explained the cornerstone of his diet.

"The key elements are using the good fats--Mediterranean oils, olive oil, canola oil, the omega-3 fish oils and the oils found in almost all nuts, along with the good carbohydrates, which are the vegetables, the whole-grain breads, and whole fruits. That, combined with strategic snacking, controls hunger and prevents the cravings that occur to so many Americans shortly after they finish a meal.

"The saturated fats cause blood to be sticky, they cause vessels to constrict, and they have negative effects on long term on insulin and sugar metabolism. The good fats that we talked about actually help prevent heart attack and stroke and they also improve insulin and sugar metabolism long-term. This helps the diet to become a lifestyle with long-term weight loss and improvement in blood chemistries, rather than just a short-term fix."

The SBD has three phases, while the Atkins has four. In both diets, the first phase lasts for two weeks and is the strictest part.

In phase one of the Atkins diet, called the "induction phase," only 15 to 20 grams of carbohydrates are allowed (equivalent to three cups of lettuce) but unlimited amounts of protein and fat (no matter the source) are encouraged.

Atkins claims the induction phase will put the body into a state of "ketosis" where the body will burn stored fats because of the virtual absence of carbohydrates.

Phase one of the SBD also lasts for two weeks and also restricts carbohydrates, but not as strictly as Atkins. It does not tell you how many grams of carbohydrates to eat, but gives a list of foods that are allowed and not allowed during this phase.

Foods allowed are low-fat sources of meat like chicken and fish and less fatty cuts of pork and beef, low-fat or fat-free cheeses, nuts, eggs, low-fat tofu, vegetables and beans. Foods that are not allowed during this phase are high-fat sources of meat, full-fat cheeses, starchy vegetables like potatoes, all fruits and fruit juices, all breads and grains (even the whole grain type), all kinds of dairy and alcohol.

Agatston told WebMD, "We are not so strict in the first phase that we put patients into ketosis. Ketosis often causes excessive water loss early. We found it is unnecessary for significant early weight loss. We teach our dieters to use the glycemic index, which is a measure of how fast a carbohydrate raises your blood sugar, and if you consume low glycemic index carbohydrates, you can do very well on a high carbohydrate diet."

Even though the SBD has a healthier approach to phase one because it allows more types of vegetables and legumes (kidney beans, black beans, green beans) and does not encourage meat high in saturated fat, it is the first phase of both diets that I believe causes false expectations of quick weight loss.

Much of the weight that is lost is in fact water, which is why weight loss slows down to one or two pounds a week or even plateaus for a while in the succeeding phases.

This leads many people to continually go back to phase one in an attempt to jump-start weight loss again. I know someone who continuously follows a cycle of three weeks of phase one of the Atkins and one week of eating all the carbohydrates she wants. She has been able to lose and maintain her weight using this method, but how healthy can it be to eat this way for life?

Even Agatston warns that a person should not stay in phase one for a long time. "Phase 1 is to get rid of carbohydrate cravings. Once this is accomplished, it is fine to begin Phase 2. For those who are quite overweight, they often are doing very well on Phase 1, they are not hungry and do not want to leave it. The rapid weight loss in Phase 1 also gives a very positive feedback.

"The problem with staying in Phase 1 and losing too much weight too rapidly is that you lose muscle and bone mass, which is very metabolically active. If you lose muscle and bone mass, you will be burning fewer calories while you are sleeping. For this reason we recommend exercise, which helps to maintain muscle and bone mass and therefore a higher metabolism or higher metabolic rate. We recommend moving to Phase 2 at least by the third or fourth week. The more there is to lose, the longer it is okay to stay on Phase 1, but we still like to see movement to Phase 2 at least by the third or fourth week."

The other phases are basically a progression of gradually introducing carbohydrate foods back into the diet. The dieter is supposed to find the appropriate amount of carbohydrates that he or she can eat while still continuing to lose weight and eventually to maintain the weight loss.

Like I mentioned above, the Atkins is still quite carb-restrictive even in the maintenance phase. The SBD, on the other hand, does not tell you how many carbohydrate grams to eat but instead advises people to choose fiber-rich carbohydrates instead of refined carbs, which have been stripped of most of the fiber.

So even in phase two of the SBD, whole grain breads, brown rice, oatmeal, milk and most fruits are allowed. What is still prohibited and for good reason are refined carbs.

The third phase of the SBD is the maintenance phase where you can "cheat" once in a while on ice cream, cake and cookies but still maintain your weight by eating mostly lean protein, high-fiber carbohydrates, and healthy fats like monounsaturated fat and omega-3 fatty acids.

The second and third phase of the SBD look and sound suspiciously like the Health Eating Pyramid of Walter Willet of the Harvard School of Public Health that recommends eating the same types of healthy food and avoiding the refined carbohydrates.

This is probably why registered dieticians like Lynn Grieger of ivillage.com have called the SBD the "best low-carb diet." The SBD also gets a thumbs-up from the nutrition advisory board of Prevention Magazine, which is composed of top dieticians and scientists from some of the best universities.

With its emphasis on healthy sources of carbohydrates and fats, the SBD is by far a safer alternative to the Atkins. However, if you have a family history of kidney disease, get yourself checked first because even though the SBD isn't as high in protein as the Atkins, you may still be at risk for kidney stones and other kidney problems.

Next week: Understanding the glycemic index

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