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The South Beach diet is frequently confusingly compared to the Atkins diet, which is a low-carbohydrate diet. The South Beach Diet emphasizes the consumption of so-called "good carbohydrates", mainly ones that are high in fiber or nutrition, and typically low in glycemic index. The South Beach diet was developed for cardiac patients to lose weight without risking ketosis. (There are studies of the effects of extended Ketosis on the average body, but they are at this time inconclusive.) Weight loss turned out to be a beneficial side effect; Dr. Agatson believes this is a positive thing, as it encourages many people to move to a heart-healthier diet than may otherwise make this choice.

The diet also emphasizes the difference between good and bad carbohydrates, combinations of foods, and good and bad fats. Good carbohydrates have a low glycemic index, that is, they are digested and absorbed slowly. Other preferred carbohydrates are ones that have more nutritional value than the alternatives (ie, brown rice is allowed in moderation, but white rice is discouraged). Eating fiber or fat with carbohydrates will slow their digestion. Good fats are monounsaturated and polyunsaturated fats. Saturated and trans fats are bad.

This diet emphasizes making a permanent change in one's way of eating. It suggests whole grains and large amounts of vegetables, along with adequate amounts of mono- and polyunsaturated fats, including Omega-3 oils. It discourages the eating of overly refined foods, particularly refined flours and sugars.