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Doctor, doctor: Two south Florida physicians are also authors

Matters of the Heart

Arthur Agatston was already known for cardiology when his notions about carbohydrate intake became the basis for a diet phenomenon.

Miami Beach cardiologist and researcher Dr. Arthur Agatston invented a way of scoring the amount of plaque in coronary arteries, a sign of heart disease and a predictor of heart attacks. It’s known in medical circles as the “Agatston score” and is used the world over.

Having an illness or test named for you is big stuff in medical circles. But it was another Agatston innovation that brought him a much wider audience. In the 1990s, as director of cardiac rehab at Mount Sinai Medical Center in Miami Beach, Agatston was putting patients on what he called a modified carbohydrate diet. The people in rehab did so well on it that he brought it into his practice. He presented the diet at an American College of Cardiology meeting.

Good results, dry stuff. That changed in 1998, when WPLG, the ABC affiliate in Miami, decided to do a series of stories on trendy diets from around the country. It reached out locally, found Agatston and featured the diet. “Obviously, modified carbohydrate diet was not too sexy,” recalls anchor Kristi Krueger, who doubled as the station’s health care reporter. The reporting team tossed out ideas for a better nickname. “I don’t remember which one of us said, ‘South Beach’ first.”

The relatively short report sparked such interest that a few months later the station, Krueger, Mount Sinai and Agatston collaborated on a lengthy series spotlighting the “South Beach Diet.” Reports featured Agatston, nutritionists, cooking demonstrations from Krueger’s home and menu plans.

A phenom was born. Agatston had to write a book — and then another and an- other. Not counting foreign language translations, there now are 13 “South Beach” books — “The South Beach Diet Quick & Easy Cookbook,” “The South Beach Diet Gluten Solution,” among others — authored or co-authored by Agatston. He has 23 million books in print, plus audio programs, a DVD workout and 11 PBS broadcasts. He’s appeared on national TV shows and in the heart care documentary, “The Widowmaker.”

Agatston says that when his first book came out in 2003, there was a feeling that “serious academic” and “popular author” were mutually exclusive. That’s changed, he says. “I feel very strongly that to help change the way America eats and change the way cardiac prevention is practiced, you have to go to the public,” he says.

As medical director of wellness and prevention at Baptist Health since 2013, Agatston remains a serious academic. He keeps a full-time practice. He’s working on a “virtual medical center.” He proudly points to a recent academic study, led by an associate in which Agatston participated, that questioned the need for widespread statin prescriptions for people with a zero — normal — Agatston score. He says his score has saved lots of lives and needs to be better appreciated by clinicians.

But his popular writing also has opened doors and “definitely has given me financial security, which is good. We like to be philanthropic.” Indeed, aside from the 23 million books already out there, Pennsylvania- based Nutrisystem in December paid $15 million for the brand to SBD Holdings Group, a partnership of Agatston and MidOcean Partners, a private equity firm. Agatston joined Nutrisystem’s science advisory board. Nutrisystem plans to spend $3 million this year preparing to relaunch the brand in 2017 with a South Beach Diet delivery meal program.

Agatston’s practice and writing pursuits these days focus on “optimal health.” He concerns himself with the health consequences of sitting all day at a computer, staying connected all the time, the use and overuse of antibiotics and other considerations. Says Agatston, “Even though you’re not sick, it doesn’t mean you’re functioning optimally.” He points to the sheer numbers of anti-depressants and tranquilizers people take and the percentage of college students, who should be feeling good, with health issues.

He says the South Beach Diet principles haven’t changed: Good fats, good carbs, plenty of fiber. Almost everyone, he says, should try going gluten free. He says be wary of “iPosture” from hunching over devices all day and the similar “sitting disease.” Exercise at day’s end doesn’t make up for a day of sitting. Get away from devices in the evening to help sleep. Interval exercise and functional exercise are important.

Now in his “later 60s,” he says, “I will never retire. I see people retire and unless they have new projects, I think they go down hill quickly. What stimulates me is, I always have new projects.”

Anatomy Lesson

Naples neurologist David Perlmutter went from writing prescriptions to writing best-sellers.

Like a lot of overnight successes, Dr. David Perlmutter’s was decades in the making. But his breakout year came in 2013. His first No. 1 best-seller was published, and he offered a TV show based on the book to PBS stations looking for free programming for their pledge weeks, hiring a production company to coach him and edit the script for the 90-minute show.

The program on preventing, treating and reversing brain-related disorders, based on his best-selling “Grain Brain” book, was a “huge public television blockbuster,” according to the distributor, Executive Program Services, a Virginia company that specializes in pledge week programming for PBS stations. The program raised nearly $7 million for PBS stations, Perlmutter says.

It’s been a hit for the Naples neurologist, too. In addition to publicity, Perlmutter gets a cut of the proceeds from “pledge packages” of his books, DVDs and other materials that viewers receive in return for certain levels of donations.

Perlmutter, 61, is a Coral Gables native. His father was the first neurosurgery chair at the University of Miami’s med school. The youngest of five, Perlmutter spent a year at the University of Florida as a young micro-neurosurgery researcher before going to med school at UM. He left “too busy” Miami for Naples in 1986 to go into private neurology practice.

Early on, he gravitated to mass media. He wrote books on health and had local radio and TV programs. In his practice, meanwhile, he grew dissatisfied. Some of the most troubling neurological conditions — Alzheimer’s, for instance — have no effective treatment. “We weren’t doing a heck of a lot of good. I was not thinking I was really helping a lot of people by simply writing prescriptions day in and day out to manage symptoms,” he says, “so I knew there had to be more.”

He left a group practice — and mainstream neurology — to apply insights from researchers looking at the role of inflammation in other bodily ills to neurology. He says his patients showed improvement and he saw potential for a program to slow or prevent disease.

In 2013, his seventh book, “Grain Brain,” became a hit. Focused on the role of wheat, gluten, sugar and carbs in ADHD, dementia and other maladies, it’s been translated into 27 languages. A promo sums up his provocative claim: “Carbs are destroying your brain.”

These days, Perlmutter’s life is a welter of personal appearances, speaking engagements and business activity. Palm Beach Gardens-based supplements company Garden of Life pursued a business collaboration with Perlmutter for years before landing him in 2014 as a science adviser. He helps formulate products, writes and blogs for the company and speaks at its events.

In March 2015, he closed his practice shortly before the official release of what became his second best-seller, “Brain Maker, The Power of Gut Microbes to Heal and Protect Your Brain — for Life.” As of November, “Grain Brain” had sold 450,000 copies and “Brain Maker” 92,000, according to Nielsen BookScan. Nielsen says its research wouldn’t capture PBS sales. Perlmutter says there are 1 million copies of “Grain Brain” in print

A few months after “Brain Maker” came out, he released another TV program, by the same name, gratis for PBS pledge drives, again sharing the proceeds from pledge packages.

A business staff of about a half-dozen, headed by Yale grad James Murphy and Andrew Luer, handles everything from scheduling to social media for Perlmutter, who remains a prolific blogger and is ubiquitous on the web.

Meanwhile, as his ideas draw attention, they also generate controversy. Some viewers saw the PBS program as essentially an infomercial for junk science. Meanwhile, The Atlantic in 2013 and New York magazine in 2015 published long critiques (available online) of his work. Of the “Grain Brain” author’s contentions, “I say this, pun intentionally, like a lot of these things, there is a grain of truth,” says David Morgan, CEO of the University of South Florida’s Byrd Alzheimer Institute. A diet healthy for the heart and anything that slows aging, the major risk factor for Alzheimer’s, also is good for the brain. But, Morgan says, “the evidence isn’t there” for some of Perlmutter’s assertions, including the belief that diet will cut Alzheimer’s risk. “That link is where I see the weakness.”

Perlmutter is aware of the criticism. “I run into it all the time,” he says. “Have I been wrong in the past? You bet,” he says. “When you step out, you can be wrong or right, and if you’re right you’ll help advance medicine. I think that’s really important — to be not part of the crowd. If people weren’t confronting me and I didn’t have my detractors, I wouldn’t be doing my appointed job.”

Dr. David Perlmutter’s Five Brain Health Tips

1 Aerobic exercise, five days a week, a minimum of 20 minutes in your target heart range (check with your doctor) of 180 minus your age.

2 Eat at the most 60 to 80 grams of total carbs a day.

3 Eat prebiotic foods such as jicama, dandelion greens, asparagus, onions, leeks, garlic. Prebiotic fiber nurtures the growth of good gut bacteria.

4 Review medications, especially non-steroid anti-inflammatories, acid-blocking drugs and antibiotics, which “specifically and directly threaten your body’s microbiome.”

5 Welcome fat back to the table. Eat more unprocessed, natural fat such as extra virgin olive oil, coconut oil, nuts and seeds, grass-fed beef, wild fish.