The Cardiologist Behind  The South Beach Diet

Dr. Arthur Agatston, the creator of the world-famous South Beach Diet, is not just another celebrity. Although he is well known for his mega-famous eating plan, it’s easy to overlook the fact that he is also the same doctor who developed the “Agatston Score,” a method of screening for coronary calcium as an indicator of atherosclerosis that is considered by most experts to be the best single predictor of a future heart attack.

“People who don’t know that I am a cardiologist think, ‘Well, he’s just a diet doctor.’ When I go into hospitals to give a cardiology lecture and the doctors realize that I’m the same person who created the South Beach Diet, they don’t always know what to make of it,” says Dr. Agatston.

Such contradictions don’t ruffle him. His passion is preventing heart disease and it doesn’t matter to him whether he’s doing it in the clinic or in America’s kitchens. Either way is fine, and in helping people become heart-healthy, he’s achieved two remarkable accomplishments, both of which have put him on the map.

Dr. Agatston began his work with coronary calcium, which led to the development of the Agatston Score, in the early 1990s when statin drugs had just come on the scene. “Statin drugs were relatively new then and we knew that they were very effective at lowering cholesterol. But the problem was that we didn’t know which patients to use them for,” he recalls. The problem is that not all people with high cholesterol develop coronary artery disease. “Although heart attacks occur in people with high cholesterol, they strike people with average cholesterol as well,” he says.

Cholesterol is a substance that is consumed in food but is also manufactured by the body. It is a structural component of each of our cells and is essential for their healthy functioning. But cholesterol deposits, or plaques, may build up in the walls of the coronary arteries, resulting in coronary artery disease. These plaques, like little cholesterol pimples, can rupture, injuring the lining of the artery and causing blood to clot at the site of the injury. If the clot is very large, it might block the vessel, prevent blood from reaching the heart and cause a heart attack. But these ruptures often occur without blocking the vessel and the site is healed over with a calcium deposit. These calcium deposits (calcifications) become markers for the extent of atherosclerosis in the heart’s arteries. They can be easily viewed with a CT scan to help determine the patient’s risk for a future heart attack.

Working with radiologist Dr. Warren Janowitz, Dr. Agatston developed a method to screen for and evaluate coronary calcium. This became known as the “Agatston Score,” “Agatston Method,” or “Calcium Score,” and today it is utilized by cardiologists throughout the world.

Although the development of the Calcium Score was a major achievement, Dr. Agatston was not satisfied. “Now that we could identify which people were developing heart disease, I knew that we needed to find out how to prevent it,” he says.

In the meantime, Dr. Dean Ornish was demonstrating that diet was a key to heart disease reversal. But Dr. Agatston was finding that most of his patients could not stick to Ornish’s very strict low-fat approach. In addition, Dr. Robert Atkins’ low-carb diet was gaining popularity, but, recalls Dr. Agatston, “I simply couldn’t give my patients a diet high in saturated fat and low in fiber and other nutrients.” And so, after convincing his nutritionist to help with the program, Dr. Agatston devised his own diet that focuses on “good carbs” (which are those found in nutrient-dense, high-fiber vegetables, fruits and whole grains) along with lean sources of protein and healthy fats, like olive oil and omega-3-rich fish oil.

Dr. Agatston christened his plan the “Modified Carbohydrate Diet” and gave it to his patients. He found that although his intention was to lower their cholesterol, they were also losing weight easily. What’s more, they loved the diet. By accident he had discovered the ideal eating plan that his patients would stick to. And, after learning the fundamentals of healthy eating and how to make better food choices, they kept off the weight.

Along the way, Dr. Agatston’s “Modified Carbohydrate Diet” became known as “The South Beach Diet.” According to Dr. Agatston, “A few people take credit for that but I have to credit my wife, Sari.” With a boost from Miami’s ABC-TV affiliate, which ran spots on the diet, Dr. Agatston’s 2003 book, The South Beach Diet, shot to the top of the bestseller list the moment it was published. Over the years this has led to a series of South Beach Diet–themed books and cookbooks along with The South Beach Heart Health Revolution, a readable book about how to prevent heart disease. In Dr. Agatston’s recent book, The South Beach Diet Wake-Up Call: 7 Real-Life Strategies for Living Your Healthiest Life Ever, he broadened his approach beyond diet and exercise, laying out a plan for revamping the American lifestyle, including seven strategies, from getting organized to getting better sleep. “Would the first book have sold as well if it didn’t have ‘South Beach’ in the title? Well, probably not. But I’ve never made any apologies about that because if you want to help change the way that Americans eat, you have to get their attention. If you just present data at cardiology meetings, the average American isn’t going to hear about it and little will change,” says Dr. Agatston.

In 2004, he founded the nonprofit Agatston Research Foundation for the purpose of conducting and funding original research on diet, cardiac health and disease prevention. One of the foundation’s goals is changing the way America’s children eat in order to stem the growing problem of childhood obesity. The foundation implemented the Healthier Options for Public Schoolchildren (HOPS) initiative to provide nutrition and healthy lifestyle education programming, including daily physical activity, to more than 50,000 elementary school children nationally. The findings, which have been published in major medical journals and presented at national conferences, including those of the American College of Cardiology and the American Heart Association, show that children in HOPS schools improved their weight, blood pressures and academic test scores compared to children in non-HOPS schools. Today, the foundation is working with the University of Pennsylvania to further pursue better nutrition in public schools.

When he’s not seeing patients, lecturing or working on prevention, Dr. Agatston can be found on the golf course or tennis court, often with one of his sons, Adam, 24, or Evan, 28. He also works closely with his wife on his books and other content for the general public. He’s a devotee of exercise, especially Pilates, and a solid golfer with a sense of humor. (A silver golf trophy in his office, inscribed “Most Chandeliers 2005-2006,” was a gift from his brother-in-law. The trophy commemorates the year Dr. Agatston took some practice swings indoors, smashing not records but lighting fixtures.)

He’s also about to enter the gluten debate with his forthcoming book, The South Beach Diet Gluten Solution, which will be published by Rodale in April. Dr. Agatston ended the high carb-low carb diet debates and taught people the difference between good carbs and bad carbs and how to monitor their own responses to starchy foods in The South Beach Diet. With this new book he hopes to end the current state of gluten confusion by giving people a real understanding of the role gluten plays in their diet and health. The book will help people learn how much, if any, gluten is right for them and will provide a detailed, effective eating plan that can help people transform their weight and their lives. “I think it’s going to be a paradigm-changer,” he says.

Get ready for another Agatston bestseller.

By Charlotte Libov