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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.

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.

In the initial phase, lasting a few weeks, dieters attempt to eliminate cravings for "bad carbohydrates" by eating no grains or fruits. After this phase, grain-based foods and fruits are gradually returned to the diet, although in smaller amounts than were likely eaten before beginning the diet, and with a concentration on foods with a low glycemic index, such as whole grains instead of refined flour. By the time the dieter has lost the desired weight, they should be having three servings of whole grains and three servings of fruit a day. The more strict Phase 1 may be reinstituted if the person feels they have developed cravings for foods they shouldn't have.