About the Author
Arthur Agatston, MD, is the medical director of Wellness and Prevention for Baptist Health South Florida and a clinical professor of medicine at the Florida International University Herbert Wertheim College of Medicine. Creator of the bestselling South Beach Diet series, he has also authored numerous scientific articles and is frequently quoted in the media on diet and health. Dr. Agatston lives and practices in Miami Beach.
Natalie Geary, MD, is executive vice president of the Diabetes Research Institute Foundation in Miami. An integrative physician with an expertise in treating wheat allergy and gluten sensitivity in both adults and children, she lives and works in Miami and New York.
Excerpt. © Reprinted by permission. All rights reserved.
CHAPTER 1
THE ACCIDENTAL GLUTEN DOCTOR
CONFUSED BY THE LATEST DIET CRAZE—GLUTEN FREE?
You're not alone.
The New Yorker cartoon below captures the current state of the nation when it comes to gluten. Many of us have heard about the phenomenon but really don't understand what gluten is or what, if anything, we should be doing about it. Yet millions of us are turning our lives upside down trying to avoid it.
Relax. We are here to help. You won't be confused about gluten after reading this book. And you won't be changing life as you know it. As a matter of fact, life is about to get a whole lot better.
"I have no idea what gluten is, either, but I'm avoiding it, just to be safe."
The South Beach Diet Gluten Solution doesn't necessarily mean gluten free forever or that gluten is not a problem. What this program does do is teach you to become gluten aware, not gluten phobic, and how to make the changes in your diet that are right for you.
As you come to understand the real story about gluten, you may discover that you don't have to say good-bye for good to your favorite pasta dish or your grandma's homemade bread. You won't be walking around cranky and hungry. And yes, you will lose weight quickly and easily without feeling deprived.
On our program, you will be giving up gluten for 4 weeks, but it won't be hard. You'll eat a wide variety of foods, including lots of gluten-free whole grains and other good carbohydrates to satisfy your need for that slice of pizza or piece of rye toast. If it turns out that gluten is a problem for you, you are going to feel a lot better--fast. I know this because so many of my patients have seen positive results within days of starting the Gluten Solution Program. Not only do they have much more energy and fewer aches and pains, they no longer complain about bloat, digestive problems, or brain fog.
So what exactly is gluten?
Gluten is the major protein found in some grains. These include all forms of wheat (bulgur, durum, semolina, spelt, farro) as well as barley and rye and a wheat-rye cross called triticale. It's also a common additive in many prepared foods, cosmetics, and even medicines.
It can make some people very sick. But not everyone.
In fact, many people obsessed with avoiding gluten don't have anything to worry about. These are individuals who don't have to eliminate whole-wheat, barley, and rye products from their lives and who should enjoy them, because these whole grains are good sources of vitamins, minerals, and fiber.
At the same time, there are countless others who should be avoiding or at least limiting their intake of foods containing gluten. The vast majority of these people haven't the faintest idea that gluten is at the root of many of their health problems.
A STEALTH DISEASE
For some people--about 1 percent of the population--gluten can be a matter of life or death. These people have a condition known as celiac disease. True celiacs, as they are called, are so sensitive to gluten that even a small amount--really just a trace--can make them very sick. Because gluten damages the lining of the small intestine, it can lead to a host of health problems ranging from chronic fatigue and skin rashes to severe abdominal cramping and osteoporosis. And people with celiac disease are at higher risk for some cancers as well.
Until a decade ago, celiac disease was thought to be extremely rare, affecting 1 in 10,000 people in North America. But in 2003, Dr. Alessio Fasano, one of the world's leading researchers in the field, reported a surprising finding: The rate was actually 1 in 133. That's 100 times more common than was previously believed. Today, Dr. Fasano and other celiac experts suggest that this estimate is probably low and that the disease may be present in 1 in 100 people. To make matters worse, the great majority of these people don't realize they have it. These "silent celiacs" suffer symptoms, sometimes debilitating, without knowing why, and they continue to unwittingly eat gluten, making their condition worse.
But the real focus of this book is on a much more common disorder--the recently recognized problem of gluten sensitivity, a condition with symptoms often similar to celiac disease but that may not require giving up gluten entirely.
With the significant increase in our gluten intake over the past 50 years due to the ubiquity and overconsumption of products made with highly refined wheat flour--along with other surprising factors that I'll tell you about later--we are just beginning to appreciate gluten's impact on our health. As a society, we are in a state of "gluten overload," and millions of people of all ages and all walks of life are suffering as a result.
In my cardiology practice, I have been amazed at the number of patients who have gluten sensitivity and who have gone undiagnosed for many years. When they eat foods containing gluten, it triggers unpleasant symptoms--stomach pains, diarrhea, heartburn, body aches, headache, skin rashes, fatigue, brain fog, and depression--and sometimes leads to or exacerbates chronic illnesses such as rheumatoid arthritis and fibromyalgia.
We now know that there is a relationship between this new epidemic of gluten sensitivity and the epidemics of obesity and diabetes, two related and reversible conditions that have been the principal focus of my earlier South Beach Diet books.
While there are specific diagnostic tests that can confirm celiac disease, this is not the case for gluten sensitivity. So, if you have symptoms and have tested negative for celiac disease, you may well be gluten sensitive. The only way you know whether gluten is a problem for you--and to what degree--is by observing whether your symptoms are relieved when gluten is sharply reduced or eliminated from your diet.
But I'm not advocating that we all become gluten phobic. My goal is to clear up the confusion and help you determine whether or not you are gluten sensitive--and if you are, just how sensitive. By following the South Beach Diet Gluten Solution Program in Part II, you will have the answers in just a few weeks.
The good news is that even if you are gluten sensitive, you don't have to give up all whole grains. There are many grains that do not contain gluten and that will not cause symptoms. And depending on your degree of sensitivity, you may be able to have some gluten-containing grains as well.
EAT WELL, FEEL WELL, STAY WELL
I am a history buff and find the evolution of the gluten story in this country and around the world fascinating. Wheat, and accordingly gluten, has been part of our diet for thousands of years. Throughout the book, I am going to touch on the pivotal changes that have made to the "staff of life" a problem for so many of us today.
But first let me tell you a bit about my own history and why I am so anxious to teach you about gluten--a topic that was barely covered when I attended medical school.
I am a preventive cardiologist. My entire career has been devoted to keeping people out of emergency rooms and coronary care units. I am best known in scientific circles for developing the Calcium Score (also known as the Agatston Score) along with my colleague Warren Janowitz. This is a method of screening for coronary atherosclerosis (hardening of the arteries) years before it leads to a heart attack or stroke. It is considered by most experts to be the single best predictor of heart disease, and it is used at medical centers throughout the world. I created the South Beach Diet to help my cardiac and diabetes patients lose weight and improve their blood chemistries in order to stop the progression of atherosclerosis and thus prevent heart attacks and strokes.
I never expected to write a best-selling diet book and thus have been referred to as an "accidental diet doctor." I was inadvertently pushed into the role when I noticed that the so-called heart healthy nationally recommended low-fat diet popular at that time was actually making my patients fatter and sicker. Once I switched my patients to our good fats, good carbs, lean protein, high-fiber strategy, I was amazed at how quickly their health improved and their waistlines shrank.
To apply these fundamentals easily to busy lives, we developed a three- phase approach that we still recommend today.
During Phase 1 of the South Beach Diet, which typically lasts for 2 weeks, all grains (including whole grains) and other starches, sugars (including fruits and fruit juices), and alcohol are excluded. This is the rapid but healthy weight-loss phase designed to eliminate cravings for sweet, sugary foods and refined starches. As a result, you gain control over what you eat and get quick, positive feedback from the many £ds shed. Phase 1 is tailored for people with greater than 10 £ds to lose and those who have difficulty controlling cravings. After 2 weeks most people move on to Phase 2.
People with fewer than 10 £ds to lose and who aren't bothered by cravings can begin the diet on Phase 2. In this phase, whole grains and other healthy starches, most fruits, and even alcohol are gradually reintroduced. Each individual learns which foods--and how much of those foods--he or she can eat without rekindling cravings. This slow and steady weight-loss phase is continued until you achieve your weight-loss goal.
MY NEW SECRET WEIGHT-LOSS WEAPON
I have written a great deal about the epidemics of diabetes and obesity and their well-established relationship to heart disease and to most other chronic diseases. I have laid the blame squarely on our sedentary lifestyle and our poor diet filled with empty-calorie, low-fiber, nonnutritious foods- -especially in the form of refined carbohydrates.
Our addiction to highly processed starches has led us to consume more gluten than ever before. The irony here is that the more of these junk foods we eat, the more we crave them and the more we continue to eat them. It is a vicious cycle that leaves millions of people struggling with their weight, feeling exhausted and depressed, and suffering from a variety of health problems that are diminishing their quality of life.
I live in South Beach, so many of my patients have been happy to take my diet advice. While I was interested in making them healthier, their primary interest was in looking good. Whatever the motivation, weight was lost, blood chemistries improved, and success was achieved.
But some patients simply didn't care all that much about losing weight. The threat of diabetes and coronary artery disease sometime in the future was not "real" enough to induce them to make changes in the here and now. Interestingly, my new understanding of the Phase 1 gluten-free connection has led me to develop a different strategy for diagnosing and helping my patients. If these noncompliers have symptoms like joint pain, headaches, or difficulty concentrating that I think may be gluten related, I simply explain that relief may be at hand if they make some dietary changes and eliminate gluten for a few weeks. I stress the "feel better fast" part of the program to spark their enthusiasm and initial participation. Typically, if they only lose weight, this type of patient may fall off the wagon. But if they feel great and their troublesome symptoms disappear, they will remain faithful to our healthy eating principles for life.
Here's a real-life case in point:
I have followed my patient Tom, who is now 50 years old, for more than 20 years because of a problem with a heart valve. In the past few years, he has gained a middle-aged belly and developed an elevated hemoglobin A1C, which indicates high blood sugar and is a sign of prediabetes. He had never been compliant with my diet recommendations, and I didn't feel that scare tactics would work with him beyond the short term.
In addition to his prediabetes, Tom had a persistent complaint about ankle pain due to osteoarthritis from an old football injury. This actually bothered him more than the threat of future diabetes or heart attack. His ankle hurt--and it hurt now. He had tried all kinds of conventional and unconventional remedies to treat it. These included localized injections as well as "magic remedies" that he had seen on late-night infomercials. I told Tom that while I was certainly not sure, eliminating gluten for a month might improve his ankle pain, making it easier for him to exercise. I hoped that, like many of my other patients, he might feel so good limiting gluten (and by default so many refined carbohydrates) that he'd stick with the diet and that his belly fat would recede and his risk of diabetes would diminish along with his ankle pain.
I saw Tom a few months after he started the South Beach Diet Gluten Solution Program (he had been consulting with our nutritionist by phone in the meantime) and, as in so many other cases, his results exceeded my expectations. He reported that his ankle pain was much relieved after several weeks on the program. He had also lost 20 £ds, and the results of his bloodwork were better than they had been in years.
But even more impressive is that now, more than a year later, he remains committed to his gluten-aware diet (for him, this means eating some gluten- containing foods but not much and not often), not just because his ankle improved but because he "just feels so much better." He has trouble defining it more precisely than that. As a result, Tom has kept off the extra weight he was carrying, his waist circumference is down 2 inches, and his hemoglobin A1C is well below the diabetes zone. He also says that he has more energy now than ever--and this from a guy who didn't think he had a low energy level before.
And, by the way, his wife loves the new Tom.
