The South Beach Diet Doctor Can Save Your Life

(as Well as Your Waistline)!

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Arthur Agatston, M.D., may have become famous for his popular diet. But his interest in weight loss grew out of his work as a cardiologist treating patients with severe heart disease. An associate professor of medicine at the University of Miami School of Medicine, Dr. Agatston is also a prominent researcher in the field of heart scanning to detect blockages in the arteries. Here, he answers questions about weight and diet and their links to heart disease.

Just what is it that makes excess pounds so hard on the heart?
You need to look at where you're carrying the extra pounds to understand the risk to your heart. If the weight that you've gained in middle age is concentrated around your middle, you may have a health problem called the metabolic syndrome: Your body is slow to process sugars and fats; after a meal, fat and cholesterol are deposited in your blood vessels, setting the stage for heart disease.

So if a patient has a potbelly, do you worry about her heart?
Yes, even if she's generally slim. When you gain belly fat in middle age, you aren't adding new fat cells but swelling the size of those you already have — your fat cells are getting fatter, in other words. These super-fat cells make it hard for insulin to clear sugar from the bloodstream. So your pancreas begins to churn out more and more insulin, which can lead to diabetes. Your cholesterol level and blood pressure go up too. In contrast, women whose fat is concentrated on their hips and thighs often have perfectly healthy blood chemistries. There is some good news about belly fat, though: It's easier to lose than fat on the hips and thighs.

How would a diet like South Beach help?
My diet advice focuses on choosing good carbohydrates and good fats. The good carbs are the ones that are high in fiber and full of nutrients — foods like vegetables, fresh fruits, and whole grains. Unlike sugary items or highly processed foods made from white flour, good carbs cause your blood sugar to rise and fall slowly, so you don't produce as much insulin. Also, you feel full longer.

And the "good" fats?
They're the kind found in various nuts, such as almonds, and in olive and canola oils. The fats you want to avoid are the saturated ones — the type in butter, bacon, and other fatty meats — and the trans fats found in many commercial products, including cakes, cookies, and margarines. But low-fat dairy products, poultry, and lean meats are fine. And fish, especially oily varieties like salmon and tuna, is particularly good.

You're pretty low-key about exercise, right?
My approach is "less is more." If you walk for at least 20 minutes, three to five times a week, you will significantly cut your risk of future heart disease. A longer workout adds value, but the biggest benefit comes in the first 20 to 30 minutes. You do need to work up a sweat, though.

Is cholesterol testing important for women?
Total cholesterol is actually a very poor predictor of whether you're going to develop heart disease. This is especially true for women. They have higher HDLs — the good cholesterol — which could make their total number higher, and that's OK. Even LDL, the bad cholesterol, isn't a good predictor unless it's very, very elevated. What I'm interested in is the size of your LDL particles: The smaller they are, the more likely they are to get into blood vessel walls. So women might want to ask their doctor for a test to gauge the size of their LDL particles. Also, triglyceride levels are very important. Triglycerides carry fatty acids into your bloodstream after a meal and are a significant risk factor for females.

Should women be asking for heart scans?
Not all women. If your cholesterol and triglyceride levels are perfect and people in your family live to an old age, scanning is probably not necessary. But if you had early menopause or have lots of risk factors, I'd recommend an electron beam computed tomography scan, which can predict problems better than blood tests.

What advances in prevention do you see coming up?
Soon we'll have new drugs that will raise good cholesterol. Then, within not too many years, we'll have gene tests that will suggest which medications will work best for you. I've spent a big part of my career helping develop ways to look inside blood vessels. In the future, scans will be able to predict risk years before someone has a heart attack. Many of my patients fear that their children and grandchildren will experience the same problems they have. I tell them not to worry — that the most common heart problems will essentially be cured.
Susan Ince

DR. AGATSTON'S GOOD NEWS: "I am convinced that preventing most heart attacks and strokes is not a pipe dream but something that is feasible today, even if you have a family history. The important thing is to begin now."

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