The South Beach Diet

The Danger Of Ketosis Generated By South Beach Diet Phase One

by Joel Fuhrman M.D.

(PEERtrainer Editorial Note: This is a footnoted article with medical references at the end.  PEERtrainer does not represent the viewpoint in this article.)

While I realize PEERtrainer is dietary agnostic, I am sure many dieters will appreciate guidance directing them to potential risks of certain diets. South Beach is one that I and others have voiced concerns about over the years. In my view the dangers are potentially life threatening.

Some people change diets as each new celebrity comes on the screen championing the latest popular fad.  A few years back, the South Beach Diet became a hot, trendy diet, topping the best seller list.  Lose up to 13 pounds in two weeks, it claimed.  “Lose belly fat first”, was touted on the books cover. 

While making such a claim may sell books, many scientific studies have demonstrated that no diet can target a specific area of the body.  Where fat accumulates and where you lose it is based on genetics, not food choices.  As you turn the pages of the book, you find false and misleading claims on almost every page.

So many of his erroneous claims (like you are better off eating ice cream or a chocolate bar instead of a baked potato) because of the glycemic index of potatoes is higher) are simply wrong.  He also claims that eating a baked potato is less fattening topped with low-fat cheese or sour cream, compared to eating it plain.  He gives not one scientific reference to back up these his ridiculous claims.  When actresses give flawed information in their diet books, it is not as annoying as you don’t expect scientific integrity from an actress.    continue reading...

The amount of unscientific and false claims on this popular diet was remarkable, especially concerning, because the book was written and is promoted by a cardiologist, Arthur Agatston.

Bad advice and guidance about food and nutrition should not be taken lightly.  People die needlessly from inaccurate and improper advice, and this diet has a few features that make it one of the most dangerous ever, maybe even be more dangerous than Atkins’.  Even worse that he was a cardiologist, promoting it to heart patients.

The biggest risk is associated with Agatston’s advice is the ketosis promoting induction phase.  It is well established in the medical literature that carbohydrate restricted, high-protein diets can cause electrolytes deficiencies from enhanced urinary excretion, especially the loss of potassium that can lead to a cardiac arrthymia and sudden cardiac death. (Footnote 1)  

The risk of death is heightened the first few weeks of beginning such a diet. (Footnote 2)   Medical journal articles have documented such deaths from people following ketogenic diets, including the death of a healthy 16 year old girl starting the diet with her mother two weeks before her death. (Footnote 3)  continue reading...

The US Center for Disease Control (CDC) noted a 30 percent increase in sudden cardiac death in young women which they could not explain at first, killing over 3000 women (aged 15 – 34) during the time when the high protein ketogenic diets became popular in the last 10 years. (Footnote 4)

In the 1960’s and 70’s liquid protein diets were associated with similar deaths and finally fell out of favor.  Now, evidence also suggests that ketogenic diets not only create metabolic derangement conducive to cardiac conduction abnormalities but have also been shown in the medical literature to cause a pathological enlargement of the heart called cardiomyopathy. (Footnote 5) 

The South Beach diet is so irresponsible because it has three phases and Agatston encourages the readers to go on and off the induction phase multiple times as a means of controlling their weight as they start to gain weight back on stage two and stage three.  This not only repeatedly  increases the risk of potassium loss, electrolyte shifts and a life-threatening irregular heart beat but it also increases the risk of having a standard heart attack.  continue reading...

People forget that not only is temporary weight loss of no benefit, but it is actually more dangerous than not losing weight at all.  Permanent weight loss only occurs as a result of changes one makes permanently.  It is true that a ketogenic diet (one that severely restricts carbohydrates) will cause some dehydration and initial weight loss, but as soon as carbohydrate-rich foods are reintroduced in the diet, steak, cheese, bacon and other animal products become fattening again. 

Ketogenic diets are dangerous if maintained long-term; if done for a short-time as recommended in the South Beach plan, the weight benefits are quickly lost.  Yo-yoing your weight is not health promoting and increases the soft, most dangerous type of coronary deposits leading to heart attacks.

Heart attacks are not generally caused by obstructive atherosclerosis, but by blood clots promoted by vulnerable or juvenile plaque. Every time a person loses weight and regains some back again, softer, more vulnerable plaque, more likely to rupture and cause a blood clot is built up. 

Losing, regaining some and losing again, as you cycle off ketosis and back on it again is the most heart attack promoting practice made worse because the diet is so rich in animal products too.  Doing the South Beach weight fluctuation dance can be more dangerous than not losing and remaining overweight.  continue reading...

A typical South Beach diet breakfast is two eggs and “lean bacon.”  Meat and cheese are allowed at every meal.  Yet Agatston claims his diet is better than Atkins because the Atkin’s diet is too high in saturated fats.  I wonder if Agatston really knows how much saturated fat is in “low fat” cheese and lean bacon?  

Lean bacon usually contains even more sodium than salt-rich regular bacon and is still high in saturated fat. Swift Premium Sizzling (lean bacon) has 3 grams of sat fat/strip and 230 mg of sodium per strip, Typical bacon contains 5 grams/ strip.  While Agatson mentions the value of eating less saturated fat, most of his menus contain over 20 grams of saturated fat daily and are also high in sodium.  These are menus very high in saturated fat, completely contrary to the recommendations of the American Heart Association.

Phase 2 is similar to the Zone or Sugar Busters as Agatson allows the addition of some fruit and beans to the diet that still gets over 60 percent of calories from animal products.   Then you may move into Phase 3 which essentially lets you eat almost anything you want, but when you start gaining weight again he instructs you to bounce back to phase 1 again.  Wow, hard to believe people fall for this.

No diet can promote consuming animal products three times a day, at every meal and claim to be healthy.  That is precisely the formula that begets 55% of our population dying of heart attacks and strokes and another 30% getting cancer. 

The world’s health experts are in agreement, in a March 2003 report from the World Health Organization compiling the evidence and opinion of the world’s foremost nutritional experts, concluded that the consumption of foods like oil, meat and cheese, the staples of the South Beach Diet, promote heart disease and cancer, and that fruits vegetables, beans, and nuts protect against premature death.  continue reading...

A diet program is valuable only if it results in you making healthful changes that you stick with forever.  For any diet to claim it is “heart healthy,” it must reduce both refined carbohydrate and animal products in favor of greens, vegetables, beans, seeds, nuts, whole grains and fresh fruit. 

Agatston and his South Beach Diet does a disservice to America.  He uses his credentials as a cardiologist to market the false promise that an unhealthy diet is heart healthy, while he displays a very superficial knowledge-base in nutrition and nutrition science.
Those who want true long-term weight reduction and cardiac protection must adopt a diet predominating in fruits, vegetables, beans, and nuts.  Nature’s high antioxidant and phytochemical rich foods show a remarkable ability to protect us against a wide range of chronic disease as well as lowering cholesterol and preventing heart disease. 

PEERtrainer Editorial Note: The views expressed by Dr. Joel Fuhrman are his own, and we work to present a wide variety of opinions and observations. Other MD's who provide input into this site have not yet expressed this concern. Above all we value healthy debate on these complicated issues. We would observe however that if someone is looking for a safe and structured diet program both the Weight Watchers Momentum Program and Eat For Health are getting good feedback from both users and experts. We have also looked into outside references from this view and have found other medical studies pointing to sudden cardiac death associated with a ketogenic diet.

Article Citations and Footnotes:

 1. Nichola JD, Cohen HW, Wylie-Rosett J, et al. Serum potassium changes with initiating low-carbohydrate compared to a low-fat weight loss diet in type 2 diabetes.  Southern Medical Journal 2008;101(1):46-49.
  2. Bank IM, Shemie SD, Rosenblatt B, et al. Sudden cardiac death in association with the ketogenic diet. Pediatric Neurology 2008;39(6).
  3. Stevens A, Robinson P,Turpin J, et al. Sudden Cardiac Death of an Adolescent During Dieting. South Med J 2002;95(9):1047-1049.
  4. Zheng AJ, Croft J, Giles WL. Et al. Sudden cardiac death jump among teens, young adults – biggest increase in women. American Heart Association Scientific Sessions 2000.
  5. Best TH, Franz DN, Gilbert DL, et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology 2000;54(12):2328-30.