From South Beach with 'Heart'

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From South Beach with 'Heart'
Updated 1/3/2007
By Nanci Hellmich, USA TODAY

One of the nation's top diet doctors has trimmed many waistlines with his best-selling The South Beach Diet. Now he's going for the heart with a new book out today.

Cardiologist Arthur Agatston, who calls himself an "accidental diet doctor," originally created his eating plan to help his patients lose weight, improve their cholesterol and avoid diabetes and heart disease. He says he never dreamed it would take off as it did.

His 2003 book evolved into one of the best-known diet programs. About 11 million copies are in print worldwide. It recommends eliminating most processed and fast foods and eating plenty of fish, vegetables and fruit. It also emphasizes whole grains and healthy oils.

Now he wants to trade on that fame to save hearts with his book, The South Beach Heart Program (Rodale, $25.95).

In this book, he explains how the way people live directly affects the heart and all its machinery: the arteries, the blood vessels, the heart muscle itself. He outlines the diagnostic tests for heart disease and urges people to learn the condition of their arteries and adopt heart-healthy living: eating better, exercising regularly, stopping smoking and reducing stress. The book offers a crash course on his diet with a few daily menus.

The Miami Beach doctor says he wants to "speed up the cardiac prevention revolution. One of the biggest secrets in medicine today is that cardiologists and internists who are practicing aggressive prevention are rarely seeing premature heart attacks and strokes in people under 70."

Early reactions from doctors and nutritionists who have read the book have been mostly positive, with some reservations.

"We need to reawaken people. Heart disease is a plane crash. We want to prevent the crash and the near-misses as well," says renowned New York heart surgeon Mehmet Oz, co-author of the best-selling YOU: On a Diet: The Owner's Manual for Waist Management.

Keith Ayoob, a registered dietitian at the Albert Einstein College of Medicine in New York, says Agatston's new book "won't appeal to fad dieters who are worried about getting into a bikini, but it will appeal to aging boomers who have realized they are not immortal."

Cardiovascular disease is the No. 1 killer in the USA, according to the American Heart Association. About 865,000 new and recurrent heart attacks strike each year, Agatston says.

He believes these grim statistics can be changed. He'd like to see more doctors working as "healers" to stop heart disease before it goes too far, instead of working as "plumbers" who go in after the damage is done to make repairs with scalpels, balloons and stents.

He says he treats mostly high-risk patients who have multiple risk factors, but he rarely has to use invasive procedures such as angioplasty or bypass surgery. These procedures are done far too often in the USA, he believes.

If patients had a clearer picture of what is going on in their arteries, they would be more motivated to clean up their lives, he says.

Oz says more doctors are moving toward prevention and agrees that knowledge may help inspire people to change. As a surgeon who does many bypass surgeries and heart transplants, when he opens his patients' chests, he sees all the "sludge" that's blocking their arteries. "This is not something they were born with. It's actually something they did to themselves."

He's often disappointed that the patient needed surgery. "It's like I'm bringing new pipes to your home when what I should have been doing is teaching you how to change the corrosive fluids that were rusting your pipes."

What's really going on inside

Agatston, an associate professor at the University of Miami Miller School of Medicine at Mount Sinai, says arteriosclerosis, or hardening of the arteries, is caused by a combination of genetics and environment. "Some people have fabulous genetics and can get away with almost anything Û smoking and eating whatever they want," he says. "Some people have horrible genetics and can do everything right and live a perfect life and still develop heart disease. But most of the rest of us are somewhere in between."

He writes that when he went to medical school in the 1970s, he was taught the "plumbing model" of heart disease. Doctors believed heart attacks resulted from a blockage of a major coronary artery caused by a gradual buildup of plaque. The idea was that as the artery became more clogged with plaque, it would narrow to the point at which blood flow to the heart would be cut off.

But this theory was wrong, he says. The biggest reason for heart attacks are what are called "vulnerable plaques." These plaques are like little pimples, but instead of being filled with pus, they are filled with cholesterol, Agatston says. When they pop, they cause tiny injuries to the vessel wall. To heal the injury, a blood clot forms.

If the blood clot is large enough, it will block the artery and cut off part of the heart's blood supply, he says. Blood-starved heart tissue dies. This is a heart attack.

The good news is that by improving their diet, exercising and possibly taking medications, most people can stop the plaques from growing and bursting. "In a sense, the plaques stabilize. They can regress."

When it comes to improving the condition of their arteries, most people need to begin with their diets because they "have horrible eating habits."

People are killing themselves with high-fat burgers, sugary milkshakes and trans-fat-laden fried foods, highly refined foods with little nutritional value, he writes in the book. "If we had deliberately set out to design a diet to make people fat, diabetic and candidates for heart attack or stroke, we couldn't have done a better job."

That can be changed, he says. Good eating and exercise habits produce weight loss, which improves cardiovascular health. Every pound of fat takes lots of tiny blood vessels to feed it, he says. When a person loses weight, there is less stress on the heart.

Plus, weight loss helps reduce waist circumference, which is key. Having a lot of belly fat increases the chance of type 2 diabetes and heart disease.

Agatston says that to improve heart health, people should:

ÔAvoid trans fats, hydrogenated and partially hydrogenated oils found in some commercial baked goods and fast-food fries.

ÔIncrease the intake of fruits and vegetables. Supplements won't give you all the micronutrients that these foods will.

ÔIncrease their intake of omega-3 fatty oils by eating flaxseed oil or fatty fish such as salmon or by taking supplements.

Agatston's South Beach diet program is divided into three phases. The first two-week portion is the most rigorous and eliminates such foods as fruits, carrots, bread, cereal, potatoes and pasta.

Dawn Jackson Blatner, a registered dietitian at Northwestern Memorial Wellness Institute in Chicago, doesn't like the first phase because, she says, "it eliminates healthy foods."

Phase 2 is much better because it "encourages people to eat a wide variety of healthy foods, such as colorful fruits and vegetables, fiber-rich whole grains and heart-smart fats," she says.

Robert Eckel, former president of the American Heart Association, says many of the dietary principles outlined by Agatston are consistent with those from the AHA. "But we have no science that the South Beach Diet is any better than some other evidence-based diets for weight control and prevention of heart disease."

A battery of tests

Agatston says people would eat better if they knew the condition of their arteries. He suggests a variety of diagnostic tests, including blood tests for cholesterol, triglycerides and other factors.

For men over 40 and postmenopausal women over 50 who have risk factors for heart disease, he recommends having a non-invasive heart scan, which indicates the amount of plaque that's present in the arteries. Some of his patients keep pictures of their arteries on the refrigerator.

"Before they open the refrigerator, they look at their arteries."

Eckel says Agatston does a good job outlining the principles of heart disease prevention and diagnosis, but he says Agatston is overly "zealous" in his advice for some tests, including heart scans.

The heart association calls the scan a "potential useful tool" for people who are at moderate risk but stops short of recommending it. "The decision should be made by the patient's physician," Eckel says.

Although Agatston is a passionate believer in the power of diet and exercise, some patients at high risk for heart disease should be taking statins and other drugs. "Millions of people who should be taking cholesterol-lowering drugs are not. That means that millions of Americans have an unnecessarily high risk of heart attacks, strokes or sudden death.

"The medications we have today have a fraction of the side effects that they used to have. They are lifesaving."

Copyright 2008 USA TODAY, a division of Gannett Co. Inc.