Taking Preventative Measures: Heart Health with Dr. Mohammed Alo

In all the work that I do within the arena of metabolic healthcare and education, I always stress the importance of a comprehensive approach. This is why I work to provide you with a variety of resources and different perspectives, like the amazing discussion I’m bringing to you today.

Dr. Alo is a cardiologist who focuses especially on preventive cardiovascular healthcare. He is an amazing resource, and I am so honored to have him as a guest on The Obesity Guide. In this episode we hear a very unique and medically significant perspective on metabolic health and obesity, and how this affects our cardiovascular health.

We were able to really dive deep and have a well rounded, evidence-based discussion on whether or not the “calories in vs. calories out” method stands, what it really means for your heart health when you lose weight, practical milestones that Dr. Alo looks for in both cardiovascular and metabolic health, realistic fitness expectations and where to start to improve heart health, and so much more!

Connect with Dr. Alo:

Website
YouTube
Instagram
TikTok

More Resources:

Fitness And Weight Loss For Busy Physicians: Medical Conference Lecture(includes information on The Matador Study)

The Matador Study


Quotes

“The number one thing I would tell people in terms of lifestyle modifications is to find some kind of activity that you enjoy and that you can do forever” - Dr. Alo

“One of the things that we've found with diet and weight loss is regardless of how you do it, if weight comes off, you improve almost all of your cardiovascular markers and inflammatory markers no matter how you measure it. Even if you only eat twinkies.”  - Dr. Alo

“One of the biggest things I see with patients is they have diet culture trauma that has been there for a very long time, that’s very difficult to overcome. They're afraid of food and haven't been given the tools to deal with that properly. So mindset when it comes to food is absolutely the number one step.” - Dr. Alo

“We have unbelievable tools now that work, like Ozempic, and even at the lowest, microscopic doses, they’re amazing. I think there's a lot we're still learning about these medications, and I'm not saying it's a cheat code or it's magic, but it is a tool we can use.” - Dr. Alo

Audio Stamps

03:06 - Dr. Al

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Transcript

4:13

Welcome back to another episode of the podcast. Today. I have a special guest board certified cardiologist, Dr. Alo today it's a really great interview. If you want to hear all about what is it that he hears daily from his patients that they say, I wish I'd met you 40 years ago. What is the advice that he would give to someone now to prevent cardiac problems from happening? There's this concept within cardiology, preventive cardiology. I have heard this term used a lot more recently. I actually asked Dr. Allo about it. I'm not really sure when it started to take off, but the point is they don't want to be sitting there and putting a stent in the heart or having to treat a very sick heart. They want to prevent these things from happening. What are the things that you need to know now so that we potentially can avoid these things from happening in the future? Really interesting conversation. We talk about how GLP 1s affect the heart or the cardiovascular risk profile. And then the other thing that we really dig into are... What are realistic expectations based on where you're starting in your weight management journey? And Dr. Allo is someone that has written multiple books and has a lot of social media presence and education that he's done. I'm gonna make sure to link all this in the show notes because I think that a lot of these resources are honestly phenomenal. One of them that he really talks about is that in the back of his book, he kind of mentions based on where you're starting weight wise, what could be realistic as far as exercise. And something that I really appreciate in this conversation today is that you could really hear from decades of him having worked in weight management with patients, with helping them from a cardiac standpoint, that he's very realistic that depending on where you're starting with your weight, it might not be entirely realistic at. All for you to do any movement and to just start with the nutrition side of things to help get weight off. If you want to hear a really well rounded conversation that has lots of evidence base to what he's talking about, I think today will be a great conversation. I want to remind you again, we have such amazing guests on and we are able to spread the word, but only if we're able to get the podcast out to more people. So if you are loving this, I want to ask that you can please leave a review. ever you are listening and specifically if this episode really resonates, go ahead, take a screenshot of it, share it on social tag me, tag Dr. Allo and let us know what you loved about the episode. All right, let's get to today's interview. Thank you, Dr. Alo. So much for coming on. Can you start out with just introducing yourself to my audience, telling people who you are and how you help people as a physician. And I know you actually have a lot of unique things that you do. So if you can kind of tell us about all of it. Okay, so my name is Mohamed Allo. I'm a board certified internal medicine and cardiology. I'm a certified personal trainer as well I'm super passionate about exercise weight loss nutrition diet. I've written multiple books on weight loss I've written a cookbook. That's heart healthy plus geared towards weight loss it's a calorie counting book almost but it's heart healthy. So You would, for example, do the calculations in the first chapter, go to the 1800 calorie chapter, make those foods, their Mediterranean style diet, which is the most validated, nutritionally type diet. And I'm sure people on here maybe do different kinds of diets, but Mediterranean in terms of cardiovascular risk. reduces the risk the most, over time. That's what we found. It's a Mediterranean style diet, no saturated fat, no salt. And it, the calories add up to 1, 800 calories for that chapter. There's a 2, It just keeps, it starts at 2, 400 and every 200 it goes down. All the way down to 1200 very few people should end up that low, but there are some that do and every because i'm a bodybuilder and a certified personal trainer every chapter includes enough protein that you don't lose muscle mass as you know When people lose weight quickly or in there in a calorie deficit, you could lose muscle You might not mitigate it completely Especially if you're using losing weight quickly, you're going to lose more lean body mass But if you eat enough muscle, if you have protein, well, it is muscle being a protein, you will help, help mitigate that and not lose as much muscle, especially if you lift weights. My books come with that too. And I'm not here to promote my books at all, but just give me some background information. I've been doing obesity and weight loss medicine. I'm a professor of medicine at two different medical schools, Ohio university here. In midwestern university in Chicago, been teaching weight loss and obesity and, you know, the medications and the lifestyles and the science behind it since the beginning of time before there was even an obesity medicine. I didn't even know that they eventually came up with something called obesity medicine, that you could get boards in, been publishing my videos on YouTube, teaching obesity, weight loss, nutrition. The whole mindset around developing a healthy relationship with food and, exercise, all that stuff for a very long time. You can go to YouTube, watch my stuff all the way back from even 2010. I coach sports. I coach and play football. Well, I don't play now. Football, I play basketball, but I coach football currently as well as soccer and basketball. So I'm super involved in the community. I love giving back. I love teaching and mentoring young people. We have residents, we have fellows, we have medical students, you know, I love giving lectures. I mean, they're like one of my advanced lipid lecture, for example, with the fellows is four parts. And it's like an hour each one. And I keep adding more to it. Which is why I decided to write a cholesterol book, because everyone's like, you know, the only book on Amazon is actually written by people who are anti cholesterol. They don't believe in cholesterol. They deny the science. They just wanted to sell a book on denying cholesterol. So it's called The Cholesterol Myth. So I'm writing a book that's going to be called The Cholesterol Truths. And it's going to be like, what does medicine and science actually say? About cholesterol. One of the things that we've that we found with diet and weight loss and for example cardiovascular disease is that regardless of what? Diet you follow if you actually lose weight regardless of which macronutrients you emphasize regardless of how you want to do it if weight comes off You actually improve almost all of your cardiovascular markers and inflammatory markers no matter how you measure it even if you ate just twinkies Believe it or not, the head of Kansas State University's nutrition department, Dr. Mark Haub, and I'm sure you're probably familiar with this. He, he was sitting with his colleagues one day in the lunchroom eating a Twinkie and they looked at him and they said, we thought you were on a diet and you tell us you wanted to lose weight. He's like, yeah, I'm, I'm going to lose weight. You know, you can eat a Twinkie. It's not a big deal. Not that I'm recommending this, but just to give you an example of like what, you know, science is out there. It's very difficult to stick to a calorie count or be compliant or what have you. But I also don't want people to completely label foods as evil or, you know, completely out of the picture. But just as an example, head of nutrition, Kansas State University was eating a Twinkie. They're like, oh, what are you doing eating a Twinkie? He's like, I can, you can eat just Twinkies and lose weight. What do you mean? They're like, no, you can't. What are you talking about? You're crazy. He's like, follow me around. So they looked at his logs and they followed him around and literally he ate Doritos, Little Debbie snack cakes, Twinkies, Oreos, all the, quote unquote bad stuff. But he did eat a drink, a hundred grams, protein shake, a hundred grams of protein every day, because he didn't want to lose muscle. He was eating 2, 600 calories a day, dropped it down to 1, 800 in 10 weeks. He lost 28 pounds. Now, obviously this is an end of one, one single person, but we have huge studies, with people that ate a isocaloric diet, meaning same amount of calories, but they varied the macronutrients. One of them was 90% protein. One of them was 90% carbs. One of them was, what have you all different kinds of diets, regardless of which macronutrients you emphasize. You will lose weight. So one of the things I always teach my patients, look, pick the diet that you enjoy. Don't pick something crazy that's overly restrictive. If you love carbs, why are you trying to limit carbs? If you love fat, why are you trying to limit fat? If you love what have you, pizza, ice cream, pop, whatever. I'm not telling you eat that all day and all night because it gets very difficult like if you're eating, you know, if you're drinking like sugar pop and this is zero calories, by the way, but if you're drinking like 250 calories of sugar every day, you don't get the satiety signaling, and the hunger signaling where if you ate like, a hundred grams of broccoli, you're going to feel full and stuffed and that hunger signaling satiety signaling will be completely different with that, but don't limit yourself and say, I'm never going to touch pop again. One of the biggest things I see with patients is, yeah. They're afraid of food. They have food phobias, like diet culture, diet trauma has been there for a very long time and mom used to always say, or dad, whoever it is, like, Oh my God, you know, are you really going to eat that? And you know, because Johnny's a hundred pounds overweight or what have you, and then people develop these food phobias over time and it affects them. And we've got all this dry diet trauma built up over time. And it's very difficult to overcome that you're good. You're going to go to a pizza party or a birthday party, let's say, and you're afraid to go. Ooh. Because you know, it's just going to be pizza, ice cream and pop. And you're like, Oh my God, what am I going to do? I can't take, you know, little Jenny to, the birthday party because it's just going to be this and it's going to be ice cream. And I don't know what, I don't know how to handle it. Like people are afraid of food and they haven't been given the tools to deal with that properly. So I think that's a huge factor that the mental, the mindset is huge. And I've heard you talk about this a lot too. In a lot of your videos on social media. So mindset when it comes to around food is. Absolutely the number one step because I have a lot of patients and you've seen them too. You haven't seen them in six months, at least in my case. They come back and, Oh my God, what happened? You lost like 70 pounds. What'd you do? He's like, Oh, I finally decided to do what you told me. I'm like, Oh, okay. So, but there's like this flip, this switch that needs to flip, and they just decide to get their act together, be compliant. And I'm not saying it's easy. I'm not saying you just flip a switch and suddenly you like lose weight. No, it's complicated. There's genetics, there's epigenetics, there's food environment, there's social determinants of health. There's, the diet. culture that you've been brought up in. I mean, it's a lot of things. And, and now we have medications, thank God, that are incredibly effective. I mean, like for me personally, back when I started doing this, people are like, what on earth is diethylpropion? What on earth is phentermine? What are you, what is that? It's not a weight loss medicine. I'm like, Oh my God, we've been using this for like 70 years for weight loss. Like, where have you been? Like the 1980s was the whole fen phen thing. That's part of the fen. That was one of the fens. The other part we got rid of because it caused, cardiac problems, cardiologist. So a lot of funny things like questions I get back to me. Is the primary doctors will call me up like, hey, this guy has a hypertension and a fib. Are you sure you're gonna put him on phentermine? Like don't worry, you know, I got this. This is literally what I do every day I'm the heart guy, you know, don't worry if I'm not worried about it, you know We need that stamp of approval though from cardiology, right? But I like okay So, you know, of course it said you just said listen as long as people lose weight a lot of these cardiac parameters are going to improve. I mean, I always am telling people about, you know, that five, 10% weight loss, depending on what they're trying to do, that they'll see metabolic benefit from it. Do you see a certain magic number in cardiology where you see blood pressure go down, cardiac risks improve? Is there a number you're looking for? So yeah, it's about right around that anywhere between five and fifteen percent depending on the person's genetics. Some people lose five percent and their blood pressure drops by five ten points. What have you their insulin resistance improves? They can breathe better. I mean that's like one thing like okay They don't really care if their blood sugar got better or their hypertension got better But they care that they can breathe more because that's something they can it's tangible they can feel it They can get up out of a chair now they can walk to the mailbox, those are like really tangible like when you tell someone to quit smoking So you don't get cancer in 80 years They're gonna be like what I mean why but like those like teenagers kids 20 years old But if you tell them your hair won't look yellow Your fingertips won't dry up here. You won't get wrinkles. Your skin won't look horrible Your teeth won't smell like, if you tell them things are super tangible They're way more likely to be compliant than saying 50, 60 years from now, you may not have cancer, but what do I care about cancer? It's like, it sounds great, but that fear based kind of future health risk is usually not enough to motivate people. What do you think would be like the top one or two tips that you wish you could tell people like 20 years before they ever come to see you with heart disease? Like, what do you think if they were to hear these things and implement them and do them, that their life would actually change because of it? So I think that there's two things that are definitely associated with longevity, like I'm a preventative cardiology, like you said, most of my patients come to me and they say, I wish I would have met you 40 years ago, because now they have problems and when they were in their 20s, they could have prevented most of these things, not everything, obviously I'm not naive. There are some people that have horrific genetics and we have to treat them when they're teenagers with, you know, familial hypercholesterolemia. These are people with genetically six, 700 cholesterols, what have you, and some people with genetically incredibly high, tumors, secreting certain things that give you incredibly high blood pressures and what have you. So the, the number one thing I would tell people is. In terms of lifestyle modifications, you want to do some kind of activity that you enjoy that you can do forever. Don't start running if you cannot maintain it. A lot of people want to create a calorie deficit with exercise, which is incredibly hard to do. I mean, you could do it, but it's incredibly hard to maintain. Maybe that's a better word for it. If you're eating 2000 calories a day and you're running off another 200, so you're at 1800 losing weight. Great. But can you do that for the next 70 years? probably not. You're going to lose motivation. It's not going to be as exciting. Your knees are going to ache. Your body's going to get hurt. And then what? Right. So I would say there's, there's the two things that are the most associated with longevity are muscle mass. So I usually tell my patients, especially the elderly, look, if you lift weights and I'm not telling you go buck wild and deadlift 600 pounds or anything excessive. But if you just start with some kind of weightlifting to build up some strength, your quality of life improves. You could get up out of your chair and actually walk to the bathroom without a Walker, that's huge. But muscle mass correlates definitely with longevity. So does aerobic exercise or VO two max, the more you can do for the, for a sustained period of time, the better, you will do. So those two things in terms of the activity portion. Definitely contribute to longevity. The other biggest thing is the preventative stuff. Please see your doctors before you a lot of my patients need, need me, and I'm sure the same with you. They come to us when they have to. They don't come to us for well checks. They don't come to us to like, Hey, doc, am I doing okay? And, and, and then they, and then a lot of times these people on social media blame the doctors. You guys in Western medicine, you only fix the problems. Because, because you guys come to us when you have problems. You didn't come to me when you were... 15, 20, 30 years old, healthy as a horse, what have you, and you want me to help you not ever need me. Like, I mean, that's my number one thing. I love for people to never need us, but they don't come when they, when they're super healthy. They come after they've had a heart attack, after they've had a stroke, once they've been diagnosed with XYZ, now that some of these things are a little bit irreversible, now they have to see us. I think that's part of the problem. So I'd say Treat things earlier. And treatment doesn't necessarily mean medications. Don't you know, a lot of people think, Oh, you guys just push pills. No, we don't. We mean like lose the weight, get active, eat healthier, change your diet, all that preventative stuff so that you don't eventually need medications at least as much as possible for as long as possible. All of those things make a huge difference. So everything you're saying, this is all I feel like it's simple, actionable stuff, right? And obviously, sometimes it takes massive like overhaul to make this all happen. But I had a question you because you were talking about being a preventive cardiologist, part of what you do. How do people know that it's even appropriate for them to see a preventive cardiologist? Because I feel like I've only more recently been hearing this term. Like it wasn't that term wasn't used as much before. Am I wrong? Or is it something I just wasn't hip to hearing it before? Yeah, I mean, I think we. You're right. It's probably a newer term. It's definitely more of a buzzword. I think people are starting to put that in front of their name a lot. And, and I don't know when that started. But I, I feel like all cardiologists at heart want to be preventative cardiac. Like I don't want to put stents in people's hearts. I don't want to put in a pacemaker or drain fluid around your heart or what have you. I don't, don't think so. So for the longest time, we haven't been able to prevent atherosclerosis. For the longest time, we used to think LDLs of 130 are okay, and over 100 is okay. For the longest time, we didn't have the tools that could drop someone's cholesterol LDL down to like 15, 5, 6, 20. Now that we have those tools, so I use the example of, you can't set the speed limit on the highway to 250 miles an hour when no car can go 250 miles an hour. What's the point? So the guidelines for the longest time, cholesterol 130 is fine. You know, LDL, we can't really get it down that much lower with what we have. Then Rosuvastatin came along, Crestor. Which could actually drop endotorvastatin, which could actually drop most people's cholesterols by like 50 to 60 percent, kind of depending on the person. So once we, the Jupiter trial came out in 2003 or 4 maybe, once we saw LDL can get below 57, Completely got rid of atherosclerosis and the longer you're below 55, we dropped it to 55 now for certain people. 55 and below for the longest period, it's lifelong exposure to cholesterol, to a high LDL that causes atherosclerosis. So the longer you are below the cutoffs for the longer period of time, the more likely you are to not have atherosclerosis. So. It's super important to get that point right now that we have drugs that can get you under the speed limit under 55 or Under 40 for some people we're able to do it now So we've been lowering the guidelines because why not eliminate atherosclerosis if we can now we have a medication called Inclisarin That's a twice a year injection that drops your LDL cholesterol by about 55% as well So even if you didn't take a statin, but if you stack it on top of a statin and Zettia and other things We can get like an 80 to 90% drop in your LDL cholesterol. We could absolutely wipe out atherosclerosis. Like no one for the rest of eternity needs to have a heart attack or stroke if we choose to do that. But there's all these people that think we're big pharma shields and we're just trying to make the pharmaceutical companies money. And why do you keep lowering the guidelines? And you're just trying to make money for the pharmaceuticals, which is not true, but you know, this is how the system is set up. We're just working with it. The system is set up. That the third party payers pay the insurance and the government. And I mean, it's just the whole system is kind of upside down, but either way, we have to do what we can do within it. And we can eliminate atherosclerosis if we choose to do it. But the problem is, like I said, people, it's only recently that we have these new medications, the PCSK9 inhibitors. We've had statins since 1987. And now we have bempedoic acid, which is more recent too. A lot of these things now, they're no longer statins. Stacked on top of a statin even if you lower the statin dose you get tremendous outcomes and tremendous lipid lowering So I feel like that's the direction we should be going in so that you don't need cardiologists I think if you can prevent cardiology, why not prevent it so you don't actually need our services down the road now There's always going to be the difficult to control hypertensives and you know, what have you atrial fibrillation, whatever So cardiologists are not going to like go away, but we could eliminate the number one killer, which is still atherosclerosis, right? I mean, it's way down to what it used to be, but we could still eliminate that to almost zero if we wanted to, but we have to decide as a society that this is what we want to do. So I have a question. This is just from a standpoint of either the patient or a primary care doctors trying to refer. What do they need to say? So the cardiologist will see them because I'm used to being in systems where if there's not already massive things wrong, they won't see the patient. So what needs to be said on that consult form or what needs to happen so that the cardiologist will see them without there being already all these other things wrong. So it kind of depends on the system you're working with. I usually put like for those patients usually come see me for cardiovascular risk modification. I have a high LDL, I have metabolic syndrome, hypertension, let me see the cardiologist and make sure that I never need them ever again. I'll see them once a year and I'm happy to, but I don't want to ever have a heart attack or stroke and actually need to have stents placed anywhere. So I think cardiovascular risk modification will be a huge one. Okay, that's perfect. I was just looking for the language because I know we have a lot of health care people that listen and then we have a lot of people that are on the patient side that they, they want this, they know the family history, they know their personal risk factors, and they, they don't want these things to happen. So that's just good language to hear. And kind of along those lines of this preventive aspect, you know, GLP 1s, can you tell me sort of what their effect on the heart is? Is it cardioprotective? Does it reduce risk? Can we just lay that out sort of from the cardiac standpoint, what GLP 1s are doing? So there's, there's a lot of medications that are cardioprotective. Metformin was the first one. Metformin, without question, is cardioprotective. It's been like that since the diabetes prevention trial from the 1960s and 70s. And it prevents the progression to Full blown diabetes when you put pre diabetics on it, super fantastic. Now, same thing with the Jardians and Farsigas, the GLP 1s, all of these have some type of cardioprotective mechanism. We don't know always what the mechanism is, but also, part of it is if it causes weight loss, like the GLP 1s. Just as a side note, do you know where GLP 1s came from? Yeah, but can you tell people if, yeah, so a lot of cardiac meds, and this is the other thing that I find fascinating that all, a lot of these people criticize us for not using supplements. Well, let me just tell you the number one. Supplement I prescribe it's oil of wintergreen. It's also called salicylic acid, which is aspirin It prevents heart attacks and strokes, but we need to be able to dose it I cannot tell people go find the bark of a willow tree suck on a piece of it every day And you get your oil of wintergreen dose for the day That just doesn't work and then the other one there's a bunch of them The next one would be the would be viper venom lysine april comes from viper venom. Literally ace inhibitors are viper venom Purified so you can dose it so we're not killing people. I cannot tell my patients buy a viper, keep it in your house, have it bite you every morning, because one time you're gonna die, right? That's kind of the point. Sweet clover is Coumadin. Foxglove plant leaves are Digoxin. The Gila monster, the venom of a Gila monster, which is the only lizard in the United States that's venomous. It's in Arizona, is where ozempic comes from. It was actually exenatide, which is the first one by it in 2005. That came out, was taken off the market. I think they eventually brought it back. But all of these, somaglutide, loraglutide, all of them that came out. We're from that, Exenatide, Dr. Ina, I think his last name was Ina, he was going around since the 1990s trying to find somebody to take this molecule and turn it into something, they all ignored him, and then finally, you know, they, one company did, amylin, amylin, something like that, and they're out of business now. But either way, that's where those medications come from. There's so many other examples in cardiology, at least, like statins. Statins come from yeast. They're fungus. Now, the newer ones are semi synthetic, like atorvastatin and rosuvastatin and pitavastatin. But the older ones, like lovastatin, pravastatin, simvastatin, were all... Yeast, like literally exactly yeast. So people are like, why don't you use supplements? We do. If they work, we purify it so we can dose it. That's literally what we're doing. No one is going to go out there and prescribe you or tell you to take a supplement that has no data, no benefit. You know, why would you take it? You're paying for like 60 a month or 100 a month of whatever. Has no outcomes, you know, doctors are not stupid. You got the farm reps that come to your office daily, or they're, you know, at the conferences we present data on, well, we tried, I don't know, niacin and it failed three, you know, cardiovascular outcomes, it actually turned out to be toxic to humans, they cause, you know, acanthosis nigricans, people became diabetic, it actually changed the protein structure of HDL to make it less protective and more atherogenic. And even though it raised HDL through the roof, it actually had Retinitilization. No benefit. So there's going to be like, you know, people are going to, doctors aren't dumb where, you know, you can't just tell me, Oh, we made a new supplement. Let's prescribe like fish oil. Like, why are people on vasepa? It literally has no data to, to, that shows that it does anything. And all the data shows that it's either not beneficial, it's neutral, or even causes harm. All the fish oils, you know, and it's a long story, but you don't treat triglycerides with fish oil. You give them, you get them on metformin. Their triglycerides are high because they're. They're diabetic and it's not well controlled. Literally, I, you know, I've never put anybody on phenylfibrate or vasepa or any of these visuals for high triglycerides. You put them on metformin, all of a sudden you actually are preventing cardiology. You've improved their cardiometabolic health, and they're no longer as insulin resistant as they were before. So, I think a lot of it is just understanding, cardiology, and I forgot what your original question was. I apologize. I went off on a is good. We were, we were talking about kind of the GLP ones, and really you're saying, look, it's the weight loss, basically, that's happening. I didn't know if there was some mechanism I was unaware of when we're talking about it. They may, they may discover a mechanism. I think I saw a few recent, articles all showing that all the, you know, the trulicities and semaglutides and everything, even, the old Bayetta, all have cardiovascular benefit. I don't know that we've figure out the mechanism, but definitely when people lose 30, 40, 50% of their body weight, it's very similar to what happens with people with gastric bypass surgery. You lose about 30% very quickly. All your cardiovascular risk factors suddenly improve and, and, inflammatory markers go down. I always tell patients, like, well, it's the inflammation. Like, I know it's the inflammation, but do you know, the top three ways to reduce inflammation? Number one is... Reduce your body weight. Number two is reduce your body weight. Number three is reduce your body weight. Those are the top three ways to reduce inflammation and it correlates with BMI and tracks with it directly And we know the higher the inflammation the higher almost everything so we know that just reducing body weight in and of itself If you're overweight not every I mean if you're thin that's a different story But if you're overweight losing weight clearly reduces inflammation Yeah. So, I mean, the case is clear here for losing weight and reducing risk factors. One thing I'm wondering if you could speak to is sort of a random question, but I think people have a really hard time getting moving initially. And with this history with training and how passionate you are with movement, How do you explain to patients, I feel like a lot of patients get scared at the idea of moving because they get a little bit sweaty, they get a little bit feeling like their heart's pumping fast, and how do you, help explain to them sort of how they're going to build up conditioning or how do you phrase that conversation with them to help them start to get active? So this is a really good question. When I go to medical conferences and I lecture about this, I say doctors, it's your fault because we always tell patients the only way to lose weight is diet and exercise. You need to take the exercise part out because a 400 pound person is not going to exercise. I don't care how much you tell them to exercise. They can barely sit in a chair. and not be short of breath. They cannot get out of a chair without being short of breath. They cannot walk to the bathroom without being short of breath. So telling patients that they need exercise, that those two are together is the problem. You cannot keep telling people it's our fault. And we're always, we're always talking about that here, that the two are not linked because they've done many studies that show even if you're doing over five hours a week, it's actually not clinically significant weight loss at the end of the year. We know from that standpoint, but from the heart standpoint, kind of helping out that aspect and improving VO two max, things like that. Right. So I usually, I want to show you a chart because I feel like it's super important. And I know this may or may not, and you know, end up being a video, but there's a really cool chart that I have in my weight loss book. So this is the two models of exercise we used to think that there was a linear model that the more you exercise, the more weight you lost or the more calories you burned. We don't believe that anymore. It's constrained. Your body takes, calories or, you know, total daily inexpensure from somewhere else. So it's not, It's not a linear model anymore. You can exercise. If you exercise for the first hour, whether it's just walking on a treadmill or what have you, you're going to burn about 80% of the calories you're going to burn. For every hour after that, you're burning a little bit more. It's not linear anymore. Your body takes away from your non exercise activity thermogenesis, which is, other ways that you could burn calories or use calories throughout the day. So that's not helpful. I think the most important thing I tell my really overweight patients, Number one thing, just get your calories down. If you're eating 5, 000 calories a day, drop it to 4, 500. You also don't want patients to just drive their calories to 1, 200, because that's insane. You're taking a, let's say, 360 pound person who's used to eating 4, 500 calories a day, and you're saying, oh, just eat 1, 200 calories, you'll be fine. That's insane. Okay, let's say they eat 1, 200 calories, they lose 60 pounds, now they're 260. Now what? You're, you're stuck at 1, 200. That's like what a child eats that's sort of athletic that's like 8 years old. That's super low. You're, you're going to have something called metabolic adaptation. You want to lose, you want to tell people to eat the most amount of calories they can while still losing weight. So what I usually tell my patients is track your calories for a week or two. Do not change what you eat now that you're tracking. Because a lot of people subconsciously will. Eat like you normally do. Show me your logs. What are you actually eating? If it's 4, 500 calories a day, take off 000 calories a day. You don't feel like we're starving you and you're still losing weight and I don't care if you change your diet. Just, just subtract out that 500. Shave off a piece of your sandwich, a piece of your Twinkie, whatever it is, cookies. I don't even care what it is. Take off that little five, 10% of what you were eating. Now you're at 4, 000 calories instead of 4, 500. You will absolutely lose weight when you plateau or get stuck. We can drop it again, drop it to 37, 38, what have you. You're still eating the most amount of calories you can while still losing weight. There's also these things called diet breaks. We have found, in the sciences, the El Matador study, for example, found that if you diet for 12 weeks, straight, let's say eating 1800 calories for 12 weeks straight and then we put you on a diet break another 12 weeks and, and, and we say you should do it at least the same amount of time or twice as much. So if you diet for 3 months, go back up to maintenance level for 3 months or 6 months, that diet break actually helps you not lose lean body mass. Helps you mentally stay in it. Cause like, if you're always dieting, you're eating 1800 calories a day, it becomes exhausting. You're like, Oh, more lettuce, more salmon, more, whatever. It becomes exhausting to do that. So you go back up to maintenance calories, you up it to 2200. Now you feel like you're eating a lot more food. You're doing fantastic. Do that for three months, four months, five months, and then go back to 1, 800 instead of, instead of cutting it to 1, 600 when you plateau or you kind of get stuck or bored out of your mind, you, you up it up to 2, 200, do that for five, six months, reset, be mentally ready again, drop it back down to 18 or 2000, even at that point. And you'll start losing weight again. The weight starts coming off again without losing as much lean body mass. Plus the diet break really helps mentally like diet fatigue. Mental diet fatigue is taxing. I mean, it is hard. Like all these people that are angry. This is from this, you're like always. Thinking about, Oh my God, I got, am I at 1800, my 1700, where am I? Like what happened? I talk about like that, when you're losing weight, it's this push energy that you're in, where you're having to change things. You're having to look at what you're doing. You're having to really like work through a lot. It's a heavy mental load. And so this makes sense. I mean, I always say there's weight loss sprints and then we pause, we maintain, but I like this kind of the diet break, like the break part almost makes me think, Oh, it's like something nice. That's happening instead of this. Unintentional plateau that's happening. We're always out of my control and sort of feeling like they can sort of never get a handle on it I didn't realize though that the that holding on to muscle is higher So I need to look into the study of what you were talking about. It's called the l matador e l m a t a d o r There was a 16 week study. They, they, they did, they did calorie deficit for one, for one group was like 16 weeks straight. The other groups, they would switch every two weeks. So it took twice as long, but they lost less lean body mass. It's in my weight loss lecture. If you go to drallo. tv, D R A L L O. TV takes you to my YouTube channel. If you go to the ultimate weight loss playlist, it's one of the top lectures there, you know, at the very. You know, more recent part of the list. It's a medical conference lecture. It's towards the end. But either way, the other thing that's also important about that, kind of like you said, just like from a mental standpoint, patients are going to gain weight when they increase their calories back up to maintenance. So if you're eating 1, 800 calories a day, you got 260 pounds. You really want to get to 130. You take your break. You bump your calories back up to 2200, you are going to gain five to seven, maybe 10 pounds right off the bat, your body, your muscles take up glycogen. Every gram of glycogen takes up three ounces of water. So you are absolutely going to bump your weight. You're going to go from one 60 to one 67 and be like, ah, you know, but if you warn them ahead of time and say, listen, this is what's going to happen, you might get up to one 70 in two or three days. Don't worry about it. It plateaus though. You stay at 170 for the next three, four or five, six months. Then when you're ready again to go back to weight loss, you drop your calories again to, you know, 1800 or whatever, whatever it was. And then weight will start coming off again and it'll seem like a breeze. You took that mental break, that calorie break, you went up to maintenance. You can actually build some muscle in that time. You can lift weights. You won't be in a calorie deficit. Cause it's kind of tricky, to lift, to build muscle while in the deficit. So if they go back up to maintenance, they can, and, and that helps so that, and, and the building, the muscle actually does increase your total daily energy expenditure. Every pound of muscle you put on, you gain about six to eight more calories a day that you could eat or burn or use. So your, your total daily energy expenditure, your BMR goes up by about six to eight calories for every pound of muscle you put on. Do you, do you do body composition testing at all with patients? I just wonder, I mean, I don't know in the cardiac plan, but no, I'm just, I'm just curious. I mean, like my, my patients are so overweight that it would make almost no difference. Like if I told someone, I mean, I could eyeball it cause I know, like I could tell them, but like, what difference would it make? We usually say above 35% body fat, you know, body fat percentage. There's no point in actually checking. Because first of all, like what, what point, what's the point? I mean, the person's still very overweight. I'm in your same category patients that come to me. They usually have almost a hundred plus pounds to lose. I'm, just not getting the patients that that words, vanity weight if you would, not that they would necessarily qualify for the medications and things but, there's this obsession I find with some physicians with like in body testing and like Just, and I think it doesn't change the protein goal. It doesn't change the speed at which we're not going to recommend you go over. So to me, clinically, it's not changing much, but I didn't know if you had a different thought on that. If you're a physique athlete, and I've had some people that really want to get lean. Absolutely. We could check with calipers and I have calipers and I have all that. I don't do the in body stuff. I don't feel like I could look at someone and eyeball. I know what you're, I mean, a guy, if you just. Takes a shirt off. I can tell you with absolute certainty within one percentage point what your body fat percentage is. I mean, that's not hard. Women, you could do the same thing. They have these pictures online where, you know, what a 25% body fat looks like 22, 21, all the way down to like six, five, four, three, super lean shredded for a bodybuilding show in our patient population, at least mine. That is going to be like nonsense. They're going to think I'm insane and they're going to Almost be insulted. Maybe that I'm even considering or thinking of this stuff Yeah, I don't know that that's that help but above 35% body fat percentage is not that helpful And there's no reason to check it and it's kind of cumbersome to do like body caliper testing with that I mean, I feel like it's not useful. Somebody lost a ton of weight. They know they lost a ton of weight. They're you know, clothes fit better. I mean, everything works really, really well. Yeah. So this has been a really good conversation because I feel like people understand sort of the importance of, when we talk about weight management, sort of what we're actually getting at, it's about long term longevity, health, benefits much bigger than what I always say, shapeshifting, right? Do you have any final words of wisdom that you would want to share with people that you think they need to understand hearing from a cardiologist? Yeah, so I think like what you just said is very important, in addition to what some concluding remarks might be. We're not, I don't try to tell people what they should look like. When a person comes to me, I don't tell them what their goals should be. I don't say, well, you should weigh 125 pounds. No, you pick what you want to look like. Tell me your goals. Maybe they want to put on muscle only and they don't really care how much fat they carry like a power lifter. Maybe they want to get to 170 pounds And they're at 160 now I don't know But we have no right to tell people What they should or shouldn't look like how they should dress or not dress like even all that stuff is related so I I think that's super important as clinicians, even as like a health coach if you're coaching people to Lose or gain or whatever, you know physique athletes or somebody just wants to lose weight To be healthy, like, you know, most of my patients, they're the furthest thing from wanting to be on stage doing a bodybuilding show. And I don't mean that in an insulting way, but they don't care about that at all. They would feel like I've insulted them or that I'm insane if I even mentioned that. So to them, they just want to be healthy. And like you said, these patients aren't, they don't care, they're not going to be able to exercise right off the bat, especially like, like in my book towards the end, like what is my exercise prescription? If you're over 200, if you're 200 pounds overweight, you're not going to exercise. If you're 99 pounds overweight, we can maybe walk. If you're this many pounds overweight, like I have this whole exercise prescription at the end of my book for depending on how overweight you are. What kind of things would work for those, but you cannot tell a 450 pound person that they need to start walking every day because they would probably die. I like that you bring this up though, because I feel like this is something where, I think doctors put really unrealistic expectations on people. And I think me and you are treating it all day long or helping manage, but. I think if other people are listening and you're new to this area as a clinician that's helping in this area, maybe you can buy his book and, and, you know, read through that. Cause I think it's really helpful that you've just laid it out so simply. Like I said, a 400 pound person, if you told them they need to walk. Two minutes a day. They're going to think you're crazy, because to them, even getting out of a chair is very difficult. But we can get the weight off first. Like I, I had this lady since January, since the end of January till now, she's lost 97 pounds. And, and she's, and she's one of these people and you've seen these, I'm sure she has tried everything, like literally everything. I became her friend on MyFitnessPal and I do this while I set it up for her and I did it with her like the week, the year before. I tracked everything she ate. She tracked it. We did it. She walked. You know, she could, she couldn't walk much, but she tried, you know, all that stuff. Nothing, nothing worked. We put her on Phentermine, 30 pounds in like a month or two. Kind of got stuck there a little bit. You know, I know how you couldn't be on it for that long, but they just changed the law so now you can be on it forever, which is nice. So then we added Metformin. Lost a few more pounds, and then added, Ozempic, and boom, the, the other 60 pounds just came right off. Adding Metformin first kind of helps, because you're making the case to the insurance company that, we've tried other diabetes medications, and this person's definitely metabolic syndrome, just look at all the other markers, it's not that hard to prove. And she she's down 97 pounds and she the last time I saw her was like a week ago and she's like, oh my god, dr. Allie. You don't believe this. I'm actually walking now. She's actually up walking outside every day She's like I couldn't do it before, you know, it was impossible But now I can I feel so good. I'm actually gonna hire a personal trainer I'm gonna start working out like now you can do those things So it makes no sense to tell patients you just need to walk more and eat less because like that first of all, it's Insulting. Like, don't you think they've tried that? They're looking at you like, really? That's like telling a poor person, you need to have more money in your bank account, spend less and make more. Like, really? One of my, one of my patients, the cardiologist literally said to her, cause she, I'm like for blood pressure meds, resistant, all this stuff. The cardiologist literally said, because she was going to come work with me and she said, Hey, I'm going to work with Dr. Ntia. And the cardiologist said, that's great, but I wish you would do it naturally. And I was just sitting there thinking, isn't that going to be helpful? And by the way, all of this has come true for her off like five medications. I think it's amazing what we've created, right. But, but saying that to her as though somehow, a blood pressure med is different than a med to treat chronic obesity. It's, it's quite interesting, actually. And, and the other thing that, that people don't realize, these new medications are absolutely life changing. Before we had Bietta, Trulicity, Victoza, Saxenda, before this class of medications, it is, I mean, we used the Naltrexones and Belviq, I don't know if you remember Belviq, but it was taken off the market. We used Contrave, all these off label, on label, however you want to call it. They worked. But not like this. I mean, Phentermine was still, without question, the number one ally. I mean, it kind of works, but like all of these medications really couldn't beat Phentermine. I mean, Phentermine still caused the most weight loss. Throw in a little, well, Butrin, maybe some people lost, you know, at least if you got them off Paroxetine and switched, it would definitely make a difference, because Paroxetine, of all the, Psych, depression, anxiety meds causes the most weight gain. But if you switch some people, added a few things here and there, stack some things on top of each other, you might get 10 to 12% weight loss. But if you just add a little bit of Ozempic and, you know, even at the lowest, microscopic doses. And, and back when we had sex and, you know, we still have it, but Victoza, all of these things literally it's like effortless, and I'm not saying like it's a cheat code or it's magic, but it is a tool to use a psychiatric bypass. You lose 30% of your body weight within the first year and your hormones change, your eating habits change, your satiety signaling, your insulin resistance, like the diabetes is gone. before you even lose one pound after gastric bypass. The next morning, your insulin resistance and sensitivity has, is gone. You haven't even, you haven't even lost one pound. All you have is gastric bypass. The real gastric bypass, the Roux en Y, not this new sleeve gastrectomy. They do that stuff first now, and then eventually they'll go to the Roux en Y if they need to. But literally the next morning, all that stuff is gone. So I think there's a lot we're still learning about these medications and I'm sure they're coming up with fancier ones Monjaro now and this new one, Rizazipatide. I don't know why the new one's called it's not fully approved yet, but maybe it will be soon But we have unbelievable tools now, that work and all, a lot of these things are generic. Like one of my patients once said, my insurance wouldn't improve diathelopropion. I started laughing. I was like, just go tell the pharmacy you'll pay cash. It was literally 25 bucks. Yeah. Yeah. And it was like, Oh, I didn't realize. I mean, it's been around forever. It's generic. The nice thing about that one is if they get the tachycardia or the anxiety or the mouth dryness, mouth sores from phentermine, you put them on that and that's all gone. So it is another tool that we can use and it causes very similar, weight loss. It's in the same class minus some of the weird. Tachycardia, mouth dryness type effects, and it doesn't wear, it doesn't, you don't have to take it in the morning and have it wear off by night. So you can actually fall asleep. You take it all throughout the day. It works fantastic. Yeah, I mean, this is just again, it's I'm, I'm liking that we're hitting home the fact that there are actually tools that can make this possible because I think people have really felt hopeless in the past. It's just like this chronic yo yoing, like they're constantly trying to do something. It boomerangs right back and you just never long term are able to figure it out. So you have mentioned a lot of really good things today, and I'm going to link in the show notes this, YouTube, you talking, what we were speaking about before with this, with this study. Can you tell people how they can find you? How can they find you on social? What's your book called? Can you just tell us all of it? Yeah, so if, I mean, I'm not here to sell anything. I honestly just love teaching. So, I mean, you could, you could easily Google me or find me, but if you want to find all my stuff, if you go to drallo. net slash links, just drallo. net slash links, all my social profiles are under there. Links to my books and courses and weight loss stuff is all under there. The Ultimate Weight Loss playlist is on there from YouTube. It's totally free. So if you don't want to like buy a book and I'm not encouraging you to, it's fun. It's a good gift to give to people. But your book was out because I wanted to purchase it before we talk. I don't want to put a plug for people to follow you on social. Cause I was following you on Tik TOK and you talked about, this little egg maker, you know, where it like boils, it like boils the egg in the morning, but you don't have to do like a pot of water. Okay. I bought that little baby. I was like, listen, if he can have this piece of toast with the egg on it, like I hate cold. Boiled eggs. And I was like, I can go do this. So you are influential and people do need to follow you because it's easy what you say. It's like fun little things, you know? I mean, I, love teaching. I always tell people like people in medicine, and I'm sure it's in every field, but people in medicine, we're always going to be teachers and we're always going to be students. Like when I talk to you or I read, you know, listen to like some of the other people on TikTok or social media. It's funny that it's tick tock now, but social media, when they're talking about weight loss, this, or weight loss, that cholesterol, this cholesterol, that you learn from other people who've also been doing it slightly differently. Like, I'm sure the way you treat your weight loss patients is somewhat different than I do different than Nadolski, different than someone else, but we're all, you know, doing the same thing and this field is developing obesity medicine and weight loss medicine is. Gradually improving and developing, and I think we'll know more of like, what to do first, what to do next, what to try, what not to try, what two things go together really well in these kind of patients, but not these kind of patients. So I think that's all developing and it's good to have these kind of conversations. I was hoping also to put together like a big weight loss symposium. Everyone's schedules have been crazy. I had like five or six. I know we try. I mean, you suggested it. I need to, I need to just put. put a date and just say, let's just go. Let's just do it. I think it would be fascinating just to see every the reason I want to do is to see everyone's different approaches to obesity in general. And then, where do they start with medications and how do they think about it? When do they think to, when do they decide to Accelerate treatment or reduce it or switch when would they stop like, what's their philosophy behind everything? But I think we'll still get that done maybe like in the in the fall or in the next few weeks here Everyone schedules everyone keeps side texting me. You know my schedule, but I think we'll figure it out. We'll get to that I mean it shouldn't be oh, we'll get that done. Don't worry But I just want to say thank you so much. I know all our listeners are going to learn so much We'll have everything linked down below and just thank you for sharing all this wisdom today. I know I really learned a lot All thanks for having me. I appreciate it. And yeah, just reach out. You know, your people can follow me. I can follow yours. We'll figure it out. Thanks.