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All right So check this out before we get to the podcast Maps prime maps prime pro and the prime bundle all of those are 50% off Go check them out go to maps fitness products calm Just use the code June prime with no space for that discount. All right. Here we go. Let's do this podcast So dr. Allo, I met you recently I was on your podcast you interviewed me about the book that I wrote and you've been listening to the show for a little while you're cardiologist and When we started talking it was great because we had a lot of similar I guess opinions and understandings about health and longevity and you know I have a lot of friends that are doctors and oftentimes Sometimes read odds But a lot of stuff that you were we were talking about were very similar I'd like to talk about the changes in our Understandings of heart health and there have been a few I remember when We were dietary cholesterol for example was a big topic. We were told to avoid it for a while What is the current research say? What do you tell your patients about things like that? What is what does that look like so dietary cholesterol? It used to be a thing We used to tell me don't eat more than 300 milligrams a day and try to avoid it, you know, don't eat that many egg yolks But as it turns out dietary cholesterol in and of itself is not a problem They've done studies where they feed people tons of dietary cholesterol whether it's shrimp or egg yolks or you know, whatever it is Your total cholesterol is not going to go up that much nor nor your LDL LDL is obviously the bad cholesterol But saturated fat We found actually does raise your cholesterol saturated fats or fats are solid at room temperature butter bacon cheese Chicken skin steak fat and all the good stuff that actually does raise your cholesterol But don't worry about it. If you're the studies that they've done where people are leaner and fitter and healthier The effect of saturated fat is not as much on them where somebody's like really overweight obesity causes Inflammation there's a number one cause of heart disease strokes, you know peripheral heart disease all that stuff When you're obese your inflammation level is higher You know your IL-6 is higher. You know CRP all the you know all the stuff we measure To measure inflammation as much as we can I mean, it's not the best, you know It's not perfect, but the all the ways we have of measuring inflammation and blood tests are all higher when you're obese The more obese you are the higher it is So we found that people who are more overweight Things like LDL Or I mean saturated fat things like saturated fat affect them more. They're more like it have heart attacks more like it have strokes I mean it's common sense too But the more overweight you are the less fit you are the more likely that is to affect you when they've done studies large large population studies on people Eating Saturated fat and then check in their cholesterol levels they found when they corrected for BMI like Where where you know we looked at you know the lean, you know super lean people people kind of a little bit overweight more overweight Obese morbidly obese whatever They found that people with within the same BMI If your BMI was lower the less likely they are for that to make a difference So if you're lean and fit like you know probably most of your audience or maybe not I don't know but like if like you guys and and you know people are pretty lean and fit if you ate more Saturated fat it up to a certain degree It doesn't raise your LDL or cause cardiovascular mortality you can get away with it more. There's a lot you can get away with when you're actually leaner and more fit They've done studies where they looked at fitness versus fatness They looked at they they they use they would think that you know like like one study They did where they looked at normal weight people who are fit People who are either normal weight or overweight and unfit like they didn't exercise They didn't do anything had two times higher cardiovascular mortality Whereas if you took overweight people and made them fit like they would run a few miles a day or whatever whatever fitness is defined as They're they're active. They're doing things their Cardiovascular risk mortality went back down to what a normal weight fit person would be so you can be fat and fit It's not as good as being normal weight and fit, but it's not that far off Well, how now how much of an individual variance is there with a lot of this stuff because I for example for me I obviously I work out and do all that stuff my diet to be very high in saturated fat Whenever I get probably not as high as you think Like you know you said I mean we've talked about this you talk about on the podcast a lot of time you eat red meat Yeah, you're whole foods. Yeah, you're eating McDonald's. Yeah, you're not eating like Hamburg or you know or whatever it is But even if you did if you're fit and lean it's not gonna affect you as much and you're probably not eating as much saturated fat as before In Finland there was this area. They did a study on saturated fat There was this area called North Karelia in the northern part of Finland was a rural town farm town All they ate was eggs and milk and cheese and lots of dairy lots of saturated fat Their cardiovascular mortality was the highest in the world They had about 700 people die for every hundred thousand which at that time in 1972. It was the highest mortality On earth for people so they the country said hey, you know, we got to reduce this is crazy So they put in a lot of public health measures They wanted to reduce smoking about 60% of men used to smoke at the time 12% of women smoked at the time There was some obesity. They got people to lose weight and they followed that out about the 2007 and then again up to 2014 and 18 they found that That at the time when it started people would 23% of their calories were coming from saturated fat I'm sure not your you know, you're not eating 23% of your calories from saturated found thought No, I don't follow you around so I don't know But they reduced it down to about 10% and they've and and they did lose weight Not not a whole lot and then in some people actually gained weight But they did reduce smoking in men from 60% down to about 16 Women's smoking rate stayed about the same They bumped up a little in the 90s because it was cool to smoke You know women start saying feeling like you know They want to smoke and then it did back down again But they found that they reduced cardiovascular mortality to only a hundred out of a hundred thousand was 84% reduction in Cardiovascular mortality and they attribute the majority of that to the reduction in saturated fat intake They went from 23% down to about 10 Slightly more and then when they when they did a subgroup analysis where they looked at just the women Because their weight didn't change a whole lot and their smoking didn't change and their smoking went up But at one point and then back down they found that even they reduce their cardiovascular mortality That much so there is a huge difference now that the number one thing I was telling my patients or when I'm giving talks The top ten things you can do to reduce cardiovascular mortality or like the top ten things you can do to improve your heart health Number one would be to quit smoking Can you guess number two exercise? Number two would be to quit smoking The first time the first ten things you can do to improve your cardiovascular mortality or your heart health would be to quit Smoking wow after that the next biggest one is to get to as close as your ideal body Weight as possible not that many people smoke in the US anymore It's about 18 and 19 percent the biggest problem now is obesity. We have According to CDC's latest about 80 percent of our country is overweight 42 percent is considered obese and even in children now the obesity rates are approaching 20 percent in some ages You know five to seven years old. It's about 12 percent up to about 17 18s We have even like rates of 20 percent or even more and they're almost adults at that point But obesity would be the next thing so smoking gives you a 20 20 times risk of if we took your exact twin and He smoked and you didn't his rates of heart attack and stroke will be 20 times higher than yours if we took your exact twin and he was overweight and you weren't his rates of heart attacks will be 10 times higher so those are the two Main things we want to reduce and there's no doubt about it. Sanctuary fat raises your LDL There's like millions of studies on this and there's no doubt that high LDL May not be what's causing the heart attacks or strokes in and of itself But it highly correlates with it because we know an LDL below 57 There's zero cardiovascular mortality if we got your LDL down to 57 There's zero cardiovascular mortality and you will not die. We have something cardiology We call the 60 60 60 guarantee if your LDL is below 60 and your HDL is above 60 Which is a good cholesterol and your triglycerides are below 60 triglycerides kind of measure your metabolic overall health You know how insulin resistant you are the kinds of things you eat You know how overweight you are those kind of things if you're triglycerides below 60, you know those three sixties line up You will not die of a heart attack or stroke. There's zero cardiovascular. Oh interesting. That is very interesting And when we talk about obesity being one of the one of the next to smoking Is it more is it more that the the client is obese and carrying X amount of body fat on them Or is it that they're probably taking an assault of being in a calorie surplus 90% of the time That's why they're they're that way Do you can we tease that out in the studies to know like which one is what what do you mean? So like when you when you say that they're they're a higher risk because they're obese versus somebody who is leaner Is it because the body they have excess body fat. Yeah, or is it more of the Constant assault of calorie surplus that is the stress or the constant assault of calorie surplus leads to the obesity It's not like they got obese because they're born that way. That's the other thing a lot of my patients. Well, my family is all overweight It's genetic. No, it's not you inherited bad eating habits from your family You grew up with your family and they eat more food than they should mom tells you got to finish your play Whatever your habits are that you grew up with you're overweight because of what you eat now There are some people who genetically have to be obese They're very small percentage of people with short stature syndrome. They're like three maybe four feet tall or they come dwarfs But short stature syndrome. They have to be obese. There's almost no way they can't be Their genetics are such now if you're not one of those You're mostly obese because you're eating too many calories So yeah, the calories lead to the obesity which leads to the inflammation men who are obese The adipose tissue stores and gives off estrogen Which causes more clots And and can lead to strokes and heart attacks, but and you notice that men who are more overweight Are like feminized almost they have breast and boobs and you know acne facial hair redness, you know all that kind of stuff Lines in their belly like like almost like stretch marks not from actually being overweight But the kind of stretch marks people get when they have like diabetes or you know metabolic disorders So so definitely it's a it's a now. There's a I'm not trying to explain that doc a little bit I've actually never heard anyone say that the difference in the stretch marks. What do you mean by that? So people who are diabetic with their uncontrolled or or going into diabetes like a lot of times you see this in kids They have like really dark skin on their neck. They and you know moms like I've been trying to wash it off for years Yeah, and it won't go away. It's like, you know, it's dark skin in the creases. It's in their armpits, too That's a sign. It's it's called acanthosis nigra cans It's a sign of being diabetic or uncontrolled diabetes and they also get these white lines in their belly You see these in kids or or you know, other people who are pretty diabetic Even though they never gave birth never gained a ton of weight and lost it You see these white striations they call them they they go up and down their belly They get these dark marks under their armpits or in their neck creases Like I you know, you'll see a kid like this kid is diabetic There's no way he's not and then you ask the mom like yeah, you know The doctor did say his blood sugar is a little bit elevated last time and we need to keep an eye on it But being overweight in and of itself You know, obviously to do to access calories is definitely More athrogenic it the inflammation causes all this now people say well my cholesterol is 300 I'm not having a stroke or heart attack. Well, I mean it's a matter of time It might not be what causes it. It's the inflammation high blood pressure That's the other thing they found with the Finland study the majority of the reduction in mortality was due to the lowering of the saturated fat The second most was lowering blood pressure men in that study had blood pressures well over 180 some of them over 200 Yeah, they got those down into 130s And then that made a huge difference because the blood pressure and the diabetes Assaults the inside of your organs and arteries from the inside out your pounding Damaging the arteries a cholesterol just comes in like plaster and patches it up now. Can you explain to me? Basically how plaque forms in the arteries like, you know, they're genetic factors to that like what how does that all come about? So the genetic factor there are some people who have genetically high cholesterol They're called it's called familial which like family hypercholesterolemia super high cholesterol these people have cholesterol like four five six hundred the highest I've ever seen It's like almost a thousand one of my patients had a cholesterol of 998 like literally two points away from a thousand That's really genetic But the damage in the arteries happens from all the other stuff it cholesterol doesn't damage your arteries It actually patches it up the blood pressure the high blood sugars those kind of things cause shearing stress Especially the hypertension it shears the arteries You get little traumas and little damage in there and then the cholesterol comes in the LDL Especially to patch it up. So it's like scar tissueing in the sense imagine like I poke a hole Hole in your plaster your walls and you patch it up with plaster and then you paint it That's kind of what happens is somebody damages your artery or the blood pressure and then the cholesterol like patches So the cholesterol plaques are essentially your body's attempt at repair repair and trying to make best with what's going on So then in that case would lower in cholesterol or lower Maybe through statins or whatnot or lowering the body's ability to repair itself Could that also potentially cause more problems or is it like a risk versus reward thing? No, so when you when you lower LDL or increase HDL What happens is the HDL the good cholesterol goes in and scavenges back out the LDL the problem when we patch it up Is it soft? It's not Hard it doesn't kind of heal properly. So you've got these little patches of like Balloons or like bubbles of cholesterol hiding in there and if a plant one of those plaques ruptures, which eventually it does all that LDL comes out goes down with the artery plugs it up with platelets and all kinds of stuff And then you have a heart attack or if it happens in your brain. It's a stroke So the LDL builds up in there and then the HDL if you have good HDL And the only way you can raise that release with exercise or a B vitamin called niacin It goes in and takes out the LDL so that then it heals up and it's like natural You know artery tissue But if you don't do that or there's more damage being done and you're still inflammatory and you're still, you know Overweight and all that eventually those do rupture and that's how you end up with these massive heart attacks Yeah, so okay, let's let's talk more about statins because it's a bit of a controversial Drug in the I guess in the health and fitness space. I would say now I used to train a lot of doctors and surgeons and I remember one of my Clients was a vascular surgeon. Now. This was about 10 years ago and I remember him saying Boy if they could put statins in the water, it would be amazing. It would solve it would help so many things I remember thinking like is it really that Great, or is it more nuanced than that? Like what is their value? Is it something that if you have just high cholesterol you should just take or is it is it, you know much more complicated? So it depends statins are definitely one of the greatest inventions ever like I always tell my patients to say Oh, I don't want to take stands. I want to take something natural. Well statins came from red yeast rice I mean that it's lovastatin. That's what's in it. That's why those work. You can buy it over the counter I tell my patients all the time like, you know, if it if you know the for supplements, for example I want to take something natural like all the drugs we have came from something natural like aspirin is Willow tree bark or oil of wintergreen salicylic acid Coumadin is sweet clover Digoxin is comes from the digitalis flower running on the leaves of it Lysinopril is a blood pressure medicine. It's one of the most common blood pressure medications Guess where that came from. Where just guess. It's Lysinopril. I'm trying to put the name It's viper venom. Oh, yeah, yeah, we would have never guessed When a viper bites a human it injects a ton of this medicine called an ACE inhibitor like Lysinopril and allopril all the Prills it injects a ton of this into your blood pressure drops so low that you're not getting blood anymore Organs and then you die. So obviously we don't give it such a high dose. It's microscopic doses But we've taken all this stuff from nature and turned it into You know therapeutic medication like people come up to you say well, shouldn't I be taking fish oil? We have that it's called lovaza if it works we turn it into a medication turns out lovaza, which is EPA and DHA Raised your bad cholesterol too much. So then they split it and now it's only the EPA Portion and now it's a drug called vasipa. So there's actually prescription drug called vasipa Which lowers your cardiovascular mortality and all-cause mortality. So The fish oil that's unseparated is not as good as the one that's just EPA So I don't know so we I mean pay we tell that to patients all and I'm back to Staten So yeah, even answer your question. Yeah, no worries. So Staten's Of all the medications we've ever invented other than aspirin Staten's have the the best number needed to treat in Statistics and medicine we talk about this number needed to treat It's the number of patients you need to treat to prevent one death So most of these medications the number needed to treat is like twenty thousand three thousand You know really high numbers in the thousands the number needed to treat for Staten's is forty For every 40 people on a Staten you save one life. So they're they're very very good Now there are some people that have Familiar really high genetic cholesterol that Staten's aren't gonna be enough and you need to put them on You know a bunch of other stuff too, but for the average patient like 99% of my patients Staten by itself will reduce cardiovascular mortality Prevent them from dying almost and you know at least not from a heart attack and they work very very well. There was a there was a Concern at one point in the time maybe like ten ten years ago probably when your patient talked to you that they caused some Neurocognitive Alterations like memory issues, but then they went back and looked at an over two hundred thousand Patients in all these databases and they found that Staten's did not Have anything to do with that people the people on Staten's are older and they're more likely They're not more likely than the general population to develop that if they were on a Staten or not They they just that's what you know, so why wouldn't we all supplement with Staten's then like a fish oil? I wouldn't be a more regular. It may not be a bad idea. Really depends on your cholesterol Like you know like I have patients that are they're like, you know 30 40 years old They're like my cholesterol is 210 220. I have a bad family history now if you're not a smoker and you're fit and You eat healthy. It's not an issue But if you're like a smoker and hypertensive and diabetic look I don't want to be that guy that my cholesterol is 198 and right on the border You know, why can't it be 110 or you know 120 or 98? You know, I not get it down How often do you have this conversation with people like that where they come to you? They're like I smoke I eat like shit I don't exercise Do you have this conversation with them or you're like what pill doing yet? We could give you this drug or you know Here's the thing. I have seen thousands of patients as you can imagine I Tell them every day they have to lose weight They have to quit smoking they have to do all this how many people listen and I give them resources I'm like listen. I'm here. I will help you like I've sat down with patients and set up my fitness pal for them Like literally set it up put their calories in increase their protein because the ratios it gives you is not good enough Did that with them and educate them for like an hour on they come back three months later Yeah, doc. I tracked for two days and I stopped and now okay like don't track Here's a way to do it without tracking clearly. That's not working for you. I give them ways to Reduce their calorie intake without tracking. I put them on stuff to help them quit smoking. I I mean, there's very there's a few patients Say, you know, I don't want to quit smoking. I actually enjoy it. Okay, fine We don't have to quit smoking But but they but the vast majority do want to get better and healthier I was to help people the two most addicting substances known to man are nicotine and it is it's harder to quit nicotine Then crack cocaine pain pills alcohol anything else they've ever tested nicotine is the hardest You talked about this Especially in cigarette you know because with the cigarette And you're doing it so often you're like conditioning yourself on top of it And I know you tried the lozenges and gums and whatnot, but that is these because it alters your mind You nicotinic receptors are in your brain. That's why I took it There's nicotinic receptors in your brain they're sort of in the same class as caffeine almost like it's really hard to quit caffeine I tried I had acid reflux and I had to quit for six weeks. I almost died But it's super hard to quit nicotine. The second one is food like calories The second hardest thing to make people give up not give up entirely just cut a little bit right his food and calories But those two things would make the biggest difference in your health. I forgot what the original question Well, I actually want to talk about because you you mentioned my fitness pal And I wasn't asked this earlier So it's a good transition of this if you let's pretend We actually have people that will track their food because there's a lot of people in our audience that will are there some Generic parameters like as far as what you would tell them to you know, stay your saturated fat under this or it should be only this No, it really doesn't even matter if you're total So here's the other thing if you're in a calorie deficit and you're losing weight Everything else makes no difference like all your cardiovascular risk factors that we can measure go down like they've done studies where people are in a calorie deficit regardless of the portions of Nutrients like they've tested where like 10% of your calories are fat 10% or carbs 10% or protein And then they play with all the other stuff then they switch it around if you're in a calorie deficit and weight is coming off It doesn't cholesterol goes down your inflammatory markers go down your insulin resistance improves your blood sugar goes down Hypertension goes down Diabetes goes down regardless of what on earth you're eating if it's in a calorie deficit and weight is coming off Not like I'm in a calorie deficit, but you're still gaining weight Yeah, if weight is coming off all that stuff gets bad. That's why I was asking that question earlier Is it sounds like I mean, I know you alluded to that obviously the the calorie surplus is what really leads to obesity But it sounds like the thing that is the most detrimental is the surplus of calories consistent Because even if you were an obese person if you immediately get into a calorie deficit all those factors We start improving right away right away like even even the studies where they've done only six weeks like alright Let's put you in a calorie deficit and it's not even like a huge deficit. They're not like 20% deficit 25 they're liking 10 maybe 15% deficit. They're just slightly losing weight even in six weeks We notice a huge huge difference in their Inflammatory markers and cardiovascular risk markers. This is why Every single diet has been shown to improve health. That's like, oh, you know vegan. No keto No, they have in common yet. They're all they're all low calorie now Here's the part though that I think is rarely discussed because I mean that's a hundred percent, right? We know that I say that all the time like high sugar high fat whatever Boy, the context makes a big difference if you're in a deficit doesn't make nearly as big of a difference as if you're in a surplus But here's what does make a difference how those foods affect your energy your appetite your cravings and how you look in the end Yes, yes, like, you know, there's a there's a this is a I'm sure you guys have read about this There's something called the Twinkie diet Kansas State University professor the head of nutrition Literally the head of nutrition was eating lunch with his colleagues and they're like laughing at him They're like, dude, what are you eating? And he's like I can eat whatever I want. What do you mean that you're eating junk food? He's like, I can lose weight on junk food. They're like, you know, you can't he said sure These are all his nutrition colleagues. He said sure and I'll show you he for the next three months a only twinkies He made sure you got a hundred grams of protein a day because you know you have to it's insane Not to you end up being a you know looking horrible He made sure he got a he got you know protein shakes and that was all he got a hundred grams of protein a day And the rest of his food was basically Twinkies and he lost 28 pounds in three months And he's like here look at my food logs. Follow me around all day if you want 28 pounds in three months eating 100 grams of protein a day and basically just trunkies, right? But of course I would argue unsustainable probably That's the problem with all these diets like I always tell like I had like I have this fictitious patient called Leslie All right. Yeah, he has mind is mrs. Johnson. Yes me one day. He's like he's like doc What's the best diet for me? I said it's called the Leslie diet. He's like what you know, what do you mean? What's the Leslie diet? I was like, it's your food that you like to eat It just has to be less than what you're currently eating. He's like, what do you mean? How do I do that? I was like, well, how do you eat now just eat whatever you eat now It just has to be a lot less now. He's like 65 and he doesn't care to be a bodybuilder I'll protein and all that I don't listen if I give you a diet and I call it something else You're gonna do it for two or three months and then get bored from diet fatigue like all these diets Keto whatever it is. I've done most of them atkins back in the day I'm sure you guys remember that or South Beach slightly after that It works it works for a while and you do it, but then like what do you do afterwards? You might gonna keep eating Rib eyes for the rest of my life or not or eating grains, you know paleo diet stuff that was available You know hundred years ago or the the hallelujah diet the God diet if God didn't make it and don't eat it Like it has to come out of that one. Yeah. Oh my god. There's the man. That's great Yeah, you eat like stuff that comes out of the ground if that's the terrier God didn't create it Then you don't eat it but anyways like eat whatever you like to eat because that's the only way you're gonna be able to do it long-term like Justin's not gonna eat what Adam likes to eat what I like to eat. You know, it's just doesn't work Yeah, she's like cheese as much as me. Yeah What you like to eat I told Leslie this and bro, you just not bro. Listen, Mr. Leslie Bro, you gotta eat what you like to eat Just it has to be less than what you're currently eating and I give them all kinds of resources to help them with that But the patients that actually do it and you'll be shocked guess How many patients actually lose weight or I'm sure you guys know because you worked with clients forever Maybe of the 5,000 people I've seen like 10% or less Yeah, it's disheartening sometimes but but but they really wanted it like you have to want it Like I like I'll give the patients the same spiel every time like listen. Here's what you got to do But you got to want it. I don't live with you I can't force you to do this stuff same thing with smoking cessation, but here's what you can do Do this at home if you want to do it I guarantee you if you do this you will lose weight. Yeah, but you have to want it Yeah, you're dealing you're dealing with I mean just behaviors It's so hard to change that in fundamental ways and presenting people with all the information and statistics It just doesn't matter even people's own mortality Doesn't matter. It's the behavior. They're seeing me because they have had cardiac problems like they almost died usually I Can't tell you like I've had people have three heart attacks. They're still smoking. I mean, that's why it's so addicting I mean, they're like yeah, I quit for a couple, you know a couple weeks after my first heart attack and then I was back at it I mean, it's that it's super addicting same thing with people lose weight like they'll like like all the gastric bypass patients I mean you rearrange your anatomy. They don't have an anatomy problem. They have a psychological behavioral Hand-to-mouth problem that you got you bypassed their stomach Temporarily they lose weight for a year. You guys see them afterwards. What happens after that first year or two They stretch that little tiny stomach back in there. They're all back to Overweight some back to their beginning weight. I mean It's good because you save their life like it's called morbid obesity because it's you're gonna die That's what morbid means, but you save their life temporarily you gave bought them a few years But they have to want it like like all my patients that eventually Flip that switch like doc just one day. I decided that was it and the same thing with smoking cessation It cold turkey works the best 48% of people will quit forever Quit cold turkey the rest of this stuff is like, you know random meds acupuncture like one or two percent here and there But if you flip that switch and you want to lose weight and you want to get healthy It works and and you can do it, but you have to want it You you you obviously work out you obviously lift weights I know you listen to the show for a while and when I talk you're on a 4-4 which is impressive That's insane. Yeah smart and fast. I mean geez that you know save some girls for the rest of us But anyway, we were you know when we were talking you were talking a lot about the benefits of resistance training and strength training And it's not typically or at least not traditionally thought of as an as a form of exercise to improve cardiovascular health or heart health how important is Muscle in this or building muscle in this hole, you know everything that we're talking about Doesn't make a difference to have more strength. Yeah, so so they found that having more muscle improves cardiovascular mortality It improves like if somebody sick like chronically ill or you know really sick in the ICU You're more likely to make it out of the ICU if you have more muscle more lean body mass it also they found that Resistance training improves bone mineral density like they do scans of dexa scans on hips if you resistance train It actually goes up if you do aerobic exercise. It actually goes down I mean you talk about that one client of yours who her doctor was like, oh my goodness, you know your bone mineral density osteoporosis is improving Which we almost never see we have medications for it. It helps slow it down and sometimes reverses it They're all like, you know infusions usually she was on I think it was fozamax was the name of it Yeah, yeah, and you got to take that and sit upright and drink it and she felt terrible for a couple days It's horrible isn't it affects the immune system if I'm not mistaken Well, I don't know the exact Mechanism because I don't it's not my specialty, but either way resistance training showed that bone mineral density actually goes up Whereas with aerobic it actually goes down and you guys know all the stuff with aerobic So first of all, I'm a cardiologist My patients and like I when I give these lectures like I teach doctors how to teach their patients to lose weight Like my number one requested talk is hey doc, you know, we want to fly you out there You know, we need we want your weight loss for that lecture and these are CMEs These are continuing medical education conferences where doctors want to learn about weight loss. So they call me in So that's them the main talk I give is usually about weight loss to doctors so that they can teach their patients How to lose weight? So I forgot about the about resistance training. Oh, yeah, so resistors. So yeah, so I'm giving this talk and I can I'm tall I've been doing this for like 20 years almost telling telling doctors listen Cardio is good for you, you know, there is there's no doubt cardio is good for your heart Endurance cardiovascular mortality goes down There was a study published in the Journal of American College of Cardiology in 2014 that showed if you run twice a week for just five minutes And not not even fast just like two and a half to maybe three and a half miles an hour Like a light jog or maybe it's even just walking if you're taller For five minutes, you reduce your cardiovascular mortality by 45% If you did it every day of the week could be 50% and all-cause mortality went down 29% So it's good for you cardiovascularly cardio is good for you. It's just not efficient for weight loss. It is You're and they have they have found that there's this thing called the constrained model For for activity they found that people they found that you there's a cap to how many calories you can actually burn with activity If if you run a mile, let's say you burn 200 calories depending on how much you weigh Running an additional mile, you might burn another to you know make it to 20 then another mile to 40 Then it kind of caps out your body starts taking energy from your knee and other places So that we that is not it's not linear like you can't just keep running all day and burn 18,000 calories It just doesn't work that way. Your body just doesn't do it. It adapts and says listen This is insane. We're not gonna burn any more calories So there's a constrained model to activity now. We know we know this for sure tons of studies on it I think I sent you a link to all the studies the constraint model says that The more activity you do There is a cap to the amount of calories you can burn So you you can only burn so many calories They like I like I give my page like when I'm given this talk I give the the doctors or a patient an example a 200 pound person If they ran for three miles, they would burn maybe 300 calories, right? If they lifted weights quads deadlifts, you know big compound movements, they lifted weights for an hour hour and a half They might burn 150 200 calories too Or how long would it take you to run three miles like a 5k an hour for most of my patients like 40 minutes to an hour You could not eat the plain bagel with cheese. That's 320 calories. That's way more efficient. That costs zero seconds Like literally I just don't put it in my mouth, right like that's zero seconds Whereas I run for an hour or lift weights for an hour and a half to try to even come close to the calories in the plain bagel with cheese So I think the point of all this is like I'm a cardiologist I'm not telling you guys don't do cardio like this You know my patients need to do cardio and I try to transition them over into lifting weights once they're like, you know Their endurance has come up But my biggest issue is like if you actually lifted weights kind of like you know in your book You know I read the whole thing in your book You outline this clearly if you lift weights and put on just a little middle muscle like even just five pounds in a year Your metabolism goes up by a lot like you know the studies show Anywhere from like six to eight calories, maybe 60 calories of per pound of get a muscle gained We don't know there's not really like a really good way To measure that so you so your metabolism goes up You're burning more energy doing everyday stuff even while you sleep your body needs more calories If you were mate maintaining on 1800 calories a day and now You put on five pounds of muscle now, maybe you can eat 2100 or 2200 and still Maintain your weight. They all they also have found that With that same that constrained model of exercise People who are less active or sedentary they actually burn more calories if they start an exercise program Like if somebody just sits around all day suddenly they start moving people at lower levels of activity You do burn calories people who are already quite active if they increase their activity They're not gonna burn that many more calories. That's like that whole constrained model Like it's not linear where the more activity you do the more college you burn If you don't do very much activity and you start doing more it goes up and then it kind of like plateaus Well, this is why like Adam when he was competing he would and he would coach Competitors all these people going on stage trying to insulate their experts are getting shredded He would save the cardio for the end to get that boost because eventually it kind of tops out and you start to Right. Yeah, and that's not I did that too like I didn't compete, but I got done like 7% body fat something But that's why I did I did zero cardio till like the very end add a little bit And it's not like insane cardio because you don't even lose muscle like they found With excessive intense cardio and you guys already know this you talk about it every day, but excessive cardio Eats up muscle. Like you know, you always say it pairs down muscle. Absolutely true Your muscle mass your lean body mass goes down and then if you still have fat on you Your body fat percentage goes up That's not something most people want now when you're lecturing and doing this in front of all these physicians Like is it well received because there's not a lot of doctors I hear like really emphasizing the need for resistance training. Well, you can't argue with studies Like they're all scientists like me sure if it if the research doesn't prove it They would be like, okay, dude, you're insane But they I present it like, you know study by study like listen here's Everything we know I have like a two-hour lecture on YouTube on everything we know about exercise goes through every single study It's boring as hell, but doctors like this stuff. So you you might yeah, you like us enjoy it Yeah, you guys would probably like it But I go through like every single study on exercise and what it does and what we know about and you know How it works and how you can use it to benefit yourself And then there's another one like that. That's two hours on every study We've we've ever done on diet. Obviously not the stupid studies that make no difference like ours There's like a billion studies on diet and exercise, but the ones that Kind of shape what we know about exercise and diet today Are very important. So yeah, so it is well received because you can't really argue with, you know We we made people exercise for two whole years and they lost three kilograms Two years of exercise and they lost three kilograms. That's not efficient weight loss They could have lost three kilograms in two weeks if you just cut your calories Three kilograms is six maybe eight pounds at the most In two years, that's bad like my patients who weigh 300 pounds if they lost three kilograms Good, but that's horrible now. What do you need to be you need to weigh 100 something now? What about the studies that have shown that excessive exercise actually increases risk? So there are you you mentioned some of them. There's one study that showed your calcium Score there's a scan we did the dr. Agaston who's a cardiologist in Miami He's actually the doctor that wrote the south beach diet Dr. Agaston is a cardiologist who invented the heart scan. There's the CT scan in your chest It looks at your calcium score the more calcium you have in your heart The more likely you are to have cardiovascular disease. There's a correlation there So people who ran Uh at an excessive amount like they did an excessive cardio and I think it was seven miles an hour More than four times a week something like that really excessive Um fast pace lots of running lots of mileage You know like like I got training for a marathon or a gal training for a marathon Their calcium scores went up. Um, there was also another study um, male clinic proceedings published this one that um If people like ran a little bit they would they would their their longevity increases But once it hit a certain threshold and I don't remember the exact number But once it hit a certain threshold Um, you your chance of dying went up your mortality goes up after a certain point I don't remember the exact cutoff in that one But you that's why like I I I want people to have a balanced approach Yeah, you need some endurance and they actually help you lift better I'm sure you guys have noticed this when a patient's just or clients are just lifting weights They do really well throwing like one day of cardio here and there just get their endurance up Suddenly they can do more reps and throw away. I mean that's I've seen that all the time um So there is some of that there is some crossover But definitely if you're trying to build muscle and lose fat You definitely don't want to be like running marathons I mean you guys see the pictures of people that win marathons They're like they don't look anything It sounds like based off what you said a good strategy might be uh run a mile twice A week because you're saying five minutes. You said five minutes of of cardio five minutes not even running It was literally like two and a half miles per hour two three Oh, that's like a power walk. That's like you walking a walk if you're tall or like a light jog Yeah, I walk I walk at a three I walk on the treadmill of three five to a four Yeah, so you would be a walk for you but for people my height it would probably be like well 3.5 is not but It would be a basically a faster walk. Wow interesting now. What about insulin resistance? I know and I I talk about some of this in the book and and there was a study I didn't quote in the book that showed that just building muscle regardless of of body weight Improves uh your sensitivity to insulin like how important is Your body's ability to utilize insulin effectively in terms of cardiovascular health. Yeah, it's it's definitely huge The more muscle you have the more you the insulin resistance gets better and in fact like diabetic doctors endocrinologists will tell their patients If you ate a little bit more Carbs and you should you don't want to increase your insulin, you know shots afterwards just do like a minute of squats Because just getting the blood flowing to those muscles Um releases factors that make that make it so you can handle that extra sugar load better But yeah, definitely having more muscle is very Uh protective against uh diabetes and when it comes to testosterone um, you know, they've they've done studies where They've given people exogenous, you know, injectable Testosterone that didn't have bad low testosterone. I know you you talk about testosterone all the time It actually has protective credit. We'll get into that. I suppose. Yeah, I love that. But by definitely um When they inject the testosterone and the people when their body fat would go down their muscle mass would go up Their insulin resistance improved significantly testosterone Uh, I'm sure your audience wants to hear about it. Yeah, but I talked about this on another Podcast but testosterone has like a u-shaped curve. We found that people with testosterone is under 200 Their cardiovascular mortality goes up and some of the worst cardiovascular patients have the Lowest testosterone like people with chf or congestive heart failure Their testosterone levels are usually low really bad diabetics. Testosterone levels really low People with uh, coronary artery disease. Testosterones are really low. They've actually found that testosterone Dilates your arteries your coronary arteries. They put people on a treadmill Make them run or walk, you know, whatever it is for as long as they could And they time them to see when they start getting the the chest pain or the you know ischemia Where your blood flow your oxygen demand and supply don't match you get and you start getting squeezing chest pain And then they would give them testosterone put them on it for a few weeks and bring them back and have them do it again Their arteries are more dilated and they they actually can go farther In one of the studies it was only like 26 seconds more but on this bruce protocol on an incline 26 seconds is huge In another study it was like an additional Two minutes where they could actually go further before they got the just for me testosterone Yeah, wow, but they've also found that people so so at really low testosterone is the cardiovascular mortality is higher And then as it normalizes you're in the four five six hundred maybe eight nine hundred range It it's like your cardiovascular mortality is normal and compared to normal populations But then as testosterone goes up again, like, you know, we got these bodybuilders injecting Wapping dose is a gram a day two grams whatever or per week. I mean Um, their cardiovascular mortality went up, but there are studies that showed there was no, uh If people were on therapeutic level trt like not these one gram a week, right? But like 200 maybe 300 at the most a week or every other week, whichever There was no additional Cardiovascular risk the problem with testosterone when you get too much of it is it aromatizes into estradiol Which is a female hormone and those Have been shown to increase clotting and you know those kind of things that cause some of the strokes and heart attacks that we see Um with testosterone but at normal levels or a therapeutic like like they they have hundreds of thousands of people on testosterone Most of my patients that are older are on it. There was no additional they've looked at You know populations of hundreds of thousands. There was people on trt and people not on it And we're talking like normal doses, obviously. There was no Uh worsening, uh cardiovascular risk and in some cases there was improvement like they were less likely to have their their chf Classification got better They had less symptoms less hospitalizations The ischemic conditioning where they can actually do more before the chest pain starts got better So there are there is there were some trends towards improvement Their body fat went down. Obviously they're their muscle size lean body mass went up I mean, we're not these patients are not body builders But still even with just small, you know therapeutic doses they improved in a lot of categories Was there any studies to like with growth hormone? I know that's sort of like the fountain of youth for people that they I've seen a trend there in terms of that and how that affects the heart growth hormone got popular A while, you know, like maybe 10 15 years ago Maybe more than that, but it hasn't really shown Anything in terms of heart disease and even bodybuilders don't really use it anymore because it has so many You know, you get that weird gut, you know thing and turtle shell. Yeah, you get all kinds of weird stuff with it So I didn't I didn't see anything about yeah, I know it can affect insulin You can actually develop insulin resistance from because you get all that up or just too much growth hormone I know what opposes right if you well, there's also a massive difference between what bodybuilders take and Like if you go see like a specialist that puts you on and like taking a lot of things Yeah, I know they had my mother-in-law and like like the dose was like so tiny compared to like what You know, bodybuilders taking 10x Yeah, yeah, but back to the testosterone because that's very fascinating because it's and it's extremely You know, I tell people it's it's a very safe hormone Like if you had to inject yourself with a very high dose of a hormone It's one of any or a man testosterone is probably one of the safer ones Probably not going to kill you whereas you did that with insulin or other hormones. You'd have some big problems Well, insulin you can crash your blood sugar and you could technically die for right Yeah, taking a whopping dose of testosterone. I mean bodybuilders do it all the time nothing nothing bad I mean, there are had there have been some who've had heart attacks and strokes and died even but You know, we can't say with absolute certainty that that was why they're probably engaging another high risk behavior too. Yeah Yeah, and I know it you talked about the widening of the of the blood vessels So it's got some of those those. Yeah, the vasodilation is dilating effects and now along those lines are there Any any because I mean we read about supplements that supposedly help with You know vasodilation Supplements you take before you work out and you get a pump and I I even read some studies on citrulline And how it might lower blood pressure a little bit because of some of that Are there any supplements that you know of that help with some of that stuff? So nitroglycerin works we give that to patients in a prescription form when When somebody we know that they've had a heart attack and have stents or whatever it is We know they have blocked arteries. They say I walk halfway around the block. I start getting that I pop a nitro opens up I can keep going. We know that works So the nitrous type stuff definitely works. I know it's supposedly in some supplements The problem with supplements you don't know what's actually in it. Yeah, you're buying a bottle of something And it says it has all the stuff in it. It's really not FDA regulated There are third parties that test it and you could you can always look for that To make sure but I remember there was a study done on at Target Walgreens CVS vitamin shop all the supplements 95% of them did not contain one lick of what they said they contain just heavy metals Maybe but they contained almost nothing Like you're you're buying a vitamin b12 and even something benign like b12 or b6 or whatever Doesn't even have that. Yeah, I saw these guys this a study on gas station like libido pills And like a majority of them contained No, no, a majority of them contained like viagra or you know, the active grains that are in Yeah, and uh, they're like sneaking in some of these drugs in there and you're like, man, these you know gas stations Other pills really work. They used to do that with like dihydrotestosterone or like the uh, dha and all that They had like, you know the stuff mark mcguire was taking. Oh, yeah. Oh, believe me. I did my chair that I mean back in the day But it wasn't illegal like you know at that time you could buy these stacks animal stack and whatever oh I remember I used to take uh, there was one that was uh, methyl master drawl I think was the name of a super drawl was another one and I remember I it was over the counter You take them and they work you're like, well later on I did some research And I found that they were actually anabolic steroids that pharmaceutical companies Dumped in the 60s arms. No, they weren't even psalms. They were actual steroids But they these pharmaceutical companies dumped them because of the side effects But because of the way the laws were written They kind of were gray market. Let's you could sell us talk a little bit about psalms. What doc? What's your thoughts on what what you're seeing? I mean that's exploding right now The problem is they were they're uh The problem is we we don't know a lot like if you're gonna do something shady and not really legal Why not just take testosterone, right? Or like something like anavar or you know any of the stuff that we actually know works and is safe Is not going to kill you some of these things The reason they abandon them now people go up and look up these old patents on this stuff And they're like, oh, you know a receptor modulator. Let me you know steroid androgen set receptor modulator for people who don't know what that is But um, let's look let's try to make this and see what happens like there's the reason there's a reason why it was dumped Like there's a reason why they're like, hey, this is a really bad idea like let's not Pursue this patent and make billions like if it worked and it was safe. They'd be making billions, right? I mean that that's kind of how it works They dumped it for a reason because you know They want to take the risk of you getting cancer in your in your stomach or Whatever it might be and then people like recreate this stuff because they find the formulas You know if we took a pseudofedron and we flipped it one way, you know, it's kind of like how they make certain other drugs but like, you know Why would you take this? When it could be Insanely dangerous when you could actually take something that we already know works and works better. Yeah, it's better It's actually what they're trying to emulate. They're trying to create something that works Like testosterone, but it's not testosterone like just take testosterone Like it would be better and safer now along the lines of things that work Let's talk about aspirin for a second. It's been around forever Lots of studies show that in some people it's it's taking a little bit is very beneficial for Preventing heart attack and stroke. Do you is this something that you will recommend to your patients? Yeah, so the isis 2 trial They looked at aspirin and it was it gave you an 80% reduction. Now, there's almost no drug That's crazy. We've ever like discovered that gives you an 80% reduction. It's like 10 12 maybe 20 and some of the you know better stuff But an 80% reduction in preventing heart attacks and strokes So most of my patients they've already had a heart attack or stroke And they have to be on it regardless because if you've had a stent put in Or a stroke or whatever you have to be on aspirin. I mean it's insane not to you're just asking to die Um, so those people have to be on it But like a normal person like you know young and healthy The there's no evidence that shows you should be on these things now if you're like above 50 diabetic hypertensive Cholesterol through the roof Smoker you have every risk factor. You really should be on it. Um, there's a score Where we plug in your age height wage sex all the conditions you have And it spits out. It's called the framing ham risk score. It spits out your cardiovascular disease risk Anybody over seven and a half percent That's like the risk of you getting a heart attack or stroke over the next 10 years or heart attack Is seven and a half percent or more you should be on a statin and you should already be on uh aspirin So definitely make sure That you are but like a normal young person that's pretty healthy and fit Doesn't smoke not really risk factors. There's really no. Yeah. Why do we see? More cases of heart disease and heart attack in men than women. I mean, it's the number one killer of both It's almost even it is there's about 630,000 people every year that die of heart attacks and heart attacks Let's just put a heart disease Half for men half for women. It's like 52 to 48. Okay, 52 percent men 48 percent So then it's a myth that that men suffer from and more They used to Um, but then women caught up. They started do you think that I would say smoking has probably I was probably that Right. Yeah, it was smoking women have a protective effect. They because of their hormones the estrogen Once they pass menopause though, they're equal Once they're like they're not creating hormones anymore But they have like a 10-year delay like men at 55 is about when they start having all these issues and men Women are like 65 But once they're passed menopause by about 10 15 years or so they kind of catch up But because women started smoking That kind of caught them up. But right now it's almost even 52 to 48 Wow, do you ever get the a patient that just just boggles you where they for whatever reason their numbers look like They should be this way, but they're totally fine or maybe the opposite where somebody gets a heart attack And you're you're doing the traditional test and you can't figure out why or what's going on. Does that ever happen? No So the issue is here's here's I know what you're asking and uh the The the I I tell medical students this all the time. I like listen all the patients that we've seen they're all smokers 95% of my patients had a heart attack and have stents now or have heart failure or whatever it is because they smoked Like no doubt about it. Like that's why it's the top 10, right? One two There was this lady who's 39 years old and she had a heart attack You know a big one like you know put a stent in her lad Like that's usually it's called the widow maker that that artery because people usually die They don't anymore, you know, but back in the old days. We didn't have good treatments. They did 39 years old, you know, beautiful healthy fit crossfits, whatever And my students were like, oh, how did she have a heart attack? I was like, I bet you she smoked. She said she doesn't smoke I was like, okay. Let me go ask So I can they're like, hey, you know, I start talking to her ask all the way I was like, hey, do you do you smoke or did you ever smoke? She's like, no I was like, you never smoked before She's like, well when I was a kid and then like she starts telling the story she smoked for like 10 15 years When she was like in college So it always comes out Of course, they're not a smoker now or they don't think they smoke well We smoked for a few years on enough but that stuff adds up But there are people the other percentage of people that I see because they've had a heart attack or stroke is used as one So like a really high genetic Cholesterol if they're also smokers, that's obviously even worse But those are the people with the cholesterol is like four or five hundred now when we talk about smoking Where did where does okay cigarettes vaping marijuana? How do that how do those all like tobacco? What's Adams? What's Adams risk? Where do we wiggle? Yeah, yeah, right. Yeah, give me the cigars. So let's start with tobacco smoke So the the problem with smoking is the volume of smoke And all the other chemicals the other 4000 chemicals lead to cancers and other stuff But When you smoke it like like if you were just taking nicotine It does constrict your arteries a little sort of like caffeine does but it's not like going to kill you You know if you're sucking on lozenges or gum or patches or whatever But it's the smoke once the smoke gets into your lungs. It causes Reactions and inflammation stuff that starts to destroy your arteries So it's actually the smoke that causes so people who smoke hookah are like, well, you know, I don't smoke cigarettes You know cigarettes are bad for you Well the volume of smoking like one puff of hookah can be equivalent to like 50 puffs of smoke on a cigarette Wow, or a hundred, you know, the studies are a little they vary depending on how big your breath is I suppose or how long you draw it in for marijuana Very similar you're inhaling a ton of smoke into your lungs. I bet if we took your lungs out Hopefully never but if we did You would have a lot of the same changes that people who smoke cigarettes now Obviously not as bad Because cigarettes for whatever reason contain chemicals upon chemicals upon chemicals and that's why we've you know We've tried so hard to to ban advertising and you know, they sued the companies and all that stuff But definitely it's the smoke that actually causes all the problems and then how You know, does the body naturally start to repair that like say somebody is a You know date, you know, they smoke every day and then they Reduce that or eliminate that like how quick does the body heal or the lungs heal? So they say after five years your risk goes back to like 80 percent of normal I've I've not found that to be the case. I mean, I've had patients that smoked 20 years ago. I haven't smoked since then they're like 15 now or you know, 65 whatever They have a heart attack now So it's not perfect. But also don't forget my population of patients bias They're seeing me because they had that so there is a bias there. It may be that that's true But if you're seeing me, it's because you've had this problem. There's like a selection bias So I've seen patients who quit smoking many many years ago who are now having heart attacks and strokes But they say after quitting after about five years Your risk kind of goes back to close to I would imagine too I mean, you're saying that the volume of smoke is really what matters the most and so let's You know, take somebody who has a cigarette or two or three cigarettes in a day And then you take someone like me who's like every other day I you know puff on a joint that I take about three to four hits before I go to bed, right? So the volume of smoke that I've been taking in comparison of that is not only am I taking in some But also you're not taking the chemicals Right, uh, then the nicotine and the nicotine itself does constrict your arteries and that that's a that's a part of it It's it's not just I mean it is mostly the smoke and all the stuff that's in it because there's a lot of stuff in it But a joint I'd have to look at but I if it's just pure marijuana Um, it's obviously not as dangerous as as cigarettes. I'll have to look at those Yeah, from what I've seen with with cannabis because it also has a The cbd has somewhat of a protective for cancer all the cannabinoids So the big ones were the big issue was it does it cost cancer and then they couldn't prove that it cost cancer In some cases there might even be a small protective effect. That's because the cannabinoids were were anti-cancer So that's the chemicals that are in the marijuana smoke As far as heart stuff is concerned studies do show that it does increase heart attack risk, but it's interesting because Cannabinoids are vasodilating. That's why your your your blood pressure drops a little bit and then your heart beats faster To make up the difference right versus what you would get from cigarette smoke, but it's not like a like a zero risk You know, but cigarettes have to be the worst, right? Cigarettes by far the worst and a lot of people smoke cigars, but they don't get it You know they keep it in their mouth and that that helps lower the risk and then what about this? I mean this the the vape pens that are going crazy So the vape it kind of depends if it has the formaldehyde and all that crazy stuff in it It's obviously not good for you. The word formaldehyde is bad That's like saying sulfuric acid. I mean, it's horrible But if it's water vapor and whatnot, it's like chewing nicotine, but you know, they have something called vape lung Where or popcorn I read about this it's called popcorn lung or vape lung Your your lungs change in a way based on whatever chemicals are in the vape pen you use It destroys your lungs in a different way May not cause heart disease like heart attacks and strokes, but it definitely has a lot of you know, bad effects Um, I just remembered a study that I wanted to bring up with you I just remembered it There was a study that I read or maybe a couple that showed that That older people older populations with higher cholesterol actually Lived longer. Um, are you familiar with that's the obesity paradox. Okay. We talk about that In and a lot in medicine the obesity paradox says that older people especially men over 65. They're a little bit overweight They seem to live longer. So that's where they started doing these fitness versus fatness studies to see like Can can it this be true like an overweight person? Just because they're old they live longer And they found that it still has nothing to do with the actual weight If they're fitter even if they're obese that their mortality is similar Um, I know that doesn't directly answer your question cholesterol They used to think that you know, if we've been controlling your cholesterol for the last 50 or 60 years And and now you're 70 or 60 and we take you off some of your meds That you'll do better and and that is true like there are a lot of patients You know, they're like I have some 80 and 90 year olds now They're like doc I just don't want to be on 30 pills Imagine if you're putting 30 chemicals into your body every day and suddenly we eliminate some of them You're gonna feel better unless like some of them are like for high blood pressure and stuff That's like really going to kill you but if your cholesterol bumps up a little at this point You know, you're not gonna at this point your mortality is Probably pretty well defined, you know if you're 92. Are you really going to live 280? No, but you know, well if we start removing some of these things Um, especially beta blockers like you know, it makes you feel fatigued and tired If we start removing some of these and a lot of patients are like demented But then you look at it's because their blood pressure is so low take off, you know, they're they're acting Take off some of their blood pressure meds They're suddenly getting profusion to their brain and they're no longer low and they are like, oh, we cured his dementia Wow So you with the elderly population is that's why there's geriatric medicine You got to be careful if you start removing Some of these medications and you worked with the elderly a lot If you start removing some of these medications Not to where their pressure is like dangerously high again, but or or there are other numbers like, you know, diabetes and whatnot But when you start eliminating some things, they feel better. They're more energetic They might have been fatigue tired depressed because of beta blockers and now they like have energy Um, all those kind of things. So they actually feel a lot a lot better Um, that also contributes to your longevity and health I would also imagine that there's there might be a little bit like under being underway when you're older That can mean a lot of bad things being underweight at any age is not good for you That's why we have the bmi the the body mass index below 18.5 and above 30 The like 30 they use 30 as a cutoff because that's when mortality or morbidity starts to affect you Like 30 is not an arbitrary number Like if your bmi is over 30 and I get it bodybuilders don't harass me I know how it works But if your bmi is over 30 and you're a normal person You're not like muscular and a football player, you know, whatever If your bmi is over 30, which is 95 percent of the population But if your bmi is over 30 mortality stuff starts to happen cholesterol diabetes, you know Heart disease all that stuff, you know strokes, whatever all starts to go up And the more over, you know 30 the worse So so that's where and then also under 18 and then under 18 That's but those people are like the bulimics and the anorexics. Yeah, those people have serious serious health issues I mean like they it's literally deadly. I mean, that's why those those eating disorders I'm sure we've all seen tons of those those type of eating disorders anorexia and bulimia In part a huge huge risk because you know, it's psychological and and and and they They go vomit or they're like, you know binge eating sometimes and then go throw up Or they don't want to eat in front of people they eat like a piece of lettuce and then go eat a whole cake like that kind of behavior is is Is Not conducive to living a long health and also the nutrient deficiencies that they tend to you know come Just like people with gastric bypass when they first get gastric bypass They're not absorbing anything. They have this short gut syndrome They have to take all these extra vitamins and minerals to like at least keep the stuff that they have Because they're not let's talk about that. Where do you where do you stand on that? You get a client that comes and sees you and they're you know morbidly obese Are are you pro that surgery or are you trying to get them to do it through their lifestyle first? Like what are your thoughts so the way they do it that the gastric surgeons don't just throw them into surgery They have them go through psychological counseling They have them try a diet They they want to make them lose 5 to 10 percent of their weight on their own first They usually send an immediate clear them for surgery like you got to see cardiologists to say that You're not going to diet during surgery. So they come to see me We run a few cardiac tests on them now if they're like 30 years old and pretty healthy There's not a whole lot you need to do like okay. Can you walk upstairs without being short of breath or whatever? Okay, sure you're going to be a little short of breath because you're 400 pounds But like you're not like huffing and puffing like you're going to die But anyways, I cleared them for surgery, but it's not like a surgeon just okay Let's just slice you open and take out half your stomach Or 90 percent of your stomach, but so they send them to me usually to get them cleared but the um They they make them try to lose weight by calorie restriction for like six months It's like a process. You got to go see the psychologist Then you got to go see this person then that person then this and in the meantime those six months They're restricting cows and trying to lose weight on their own. So it's not like they just Throw them to me and say hey, you know, here's a patient Yeah, they do they do that now they put a lot of rules and still though the fail rate still is uh because again You're dealing with yeah, so I guess my question though is that you know are are you a fan of it? I mean, are you pro? I mean if it's going to save your life, right and you are morbidly obese and you You've tried everything else You have to do it like this is literally life saving Yeah, if you've not really tried and you just want to be like this is like a cosmetic and you think it's fun Which I don't know too many people that do but if you're just doing it just to do it Or everyone's telling you to do it and you've not really tried anything else You really shouldn't you you should try the other stuff, but there's almost no gastric surgeon now that would You show up in his office at 400 pounds. They're right surgery tomorrow like that just doesn't have it's not even legal How have you have you thought about or I don't know if you do this because in the past You know at one point like I've said before I trained a lot of doctors and then they started to send me their patients You know a few might a few the doctors I trained were vascular surgeons And they're patients very similar to yours like all smoked They all had issues with their Cardiovascular health and then they started to send me some of their patients and we actually had good success because of the daily And weekly coaching, you know, it was like I was with them doing stuff Have you ever worked with people that you could say okay? Look, here's a deal. You need to lose weight It's really hard to do on your own. I could tell you what to do, but then you're gone on your own Here's some people that you might want to work with Yeah, so I usually have them work with a registered dietitian and I'll say I'll give them references of personal trainers like listen You if you're serious Here's two people you need to talk to and at the end of my talks if I'm like in Chicago Because I used to live there. I know some personal trainers there and like some registered dietitians I'll give them at like my last slide would be Here's the name of this person and here's the name of this person Go talk to these people send your patients to them as they're all doctors that listen to mind pump Well, oh my god, I've done that a million times. I run all these fitness groups I don't know I was telling Sal the other day I run a lot of fitness groups on whatsapp And you know the combat stretch. I'm like, okay. You got to watch this video go to minute four Four four minutes ten seconds Do this combat stretch before you squat or the 90 90 whichever one it is and I'll tell them where to go But yeah, no, I reference your guys stuff all the time. I'm so glad we have people like you guys Awesome. Thank you But I I send them Your links and your videos especially the videos because it's like a visual Demonstration like here's exactly like the active plank thing. Do you try to look I could plank for 50 minutes That's not actually what you're supposed to be doing Sure, I could do it for eight hours probably But that's not the like you're not really working out your abs or core You need to be doing it this way where it's actually like Hard or like the the the uh physical ball crunch crunch nobody does those right like You know or like, you know, I want to do something for my abs. Well, here's something You know like that looks easy like just try it. Trust me You're not gonna be able to do more than like eight or nine without you know, feel like you want to bomb it Do you remember doc what uh what attracted you to the show? Like do you remember the first seven? I was on some fitness group on facebook and Somebody's like any good fitness podcast and then people listed a bunch and I One of them was my bad pump. I added all the other ones on Not that good and then I'd listen to you guys. Oh like this is different. This is really really good Like you guys talk for like 40 minutes and but recently 50 55 57, but it was like okay. Sometimes I would fast forward. We stretch I'll tell the truth in the beginning. I did at least because I was like you want the fitness I was getting into fitness and I wanted the fitness like yeah, the stories are awesome And now I know you guys person like I know he has a dog and you know, Jessica Katrina and and you know He has older children You have some older ones a new one and you guys both have new younger ones like I know you guys life story I feel like I know you like my patients tell me that they're like doc. I watch you on youtube You're like my friend Well, great Which is good like it people feel like they can relate to you. Um, so I wouldn't stop doing that It's great, but in the beginning I would fast forward to the fitness. I'm like, oh my god This is exactly what I've been doing like like I had my own fitness journey and um I've always been fit because I played sports and I worked out as a kid, but never like properly in 2018 like I was around 43 maybe or 42 and I was like, you know, I'm like 193 pounds. This is just not right I need to lose some weight. It's like, you know, I'll do squats and push-ups every day I'll do 100 a day the squats were easy. I could do 100 body weight push-ups a day That was no problem start doing the push-ups. I could do like 10 15 in the beginning You know, you know, eventually got up to like 40 15 a row, but I still look the same so um friend of mine and and some of her friends and my wife even They hired a fitness trainer and he would come to our barn. I got a really nice home gym And he would train train us there. His name is matt longley. Good friend of mine. He's a linebacker at Charlotte university now, but he lived in Toledo But then he moved away. So then I got another fitness trainer Worked out with them No, nothing about nutrition whatsoever. Um, and I got more fit. I would my lifts were getting stronger everything got better No problem 2000 he moved away too. I don't know why they do this to me He moved away too and I'm like, all right. I got trained myself. So I trained myself. I was like It's working, but I'm Fat still like I'm fit, but I'm fat. All right. I'm 193 pounds. Maybe 188 And I was like, you know, I gotta I gotta lose weight. This is insane So I this is when I started really researching stuff and I started reading All the stuff online found you guys was reading. I was like, you know, I need a calorie deficit It's the only way so I You know ria redid my fitness pal. I'd always been using it, but not religiously just to track my weight Put it at 1400 calories All right, that's a big 100 to 1500. I lost a ton of weight. I got down to 145 In like six or seven months. Wow by august. I was 145, but I was like I'm shredding and I'm Small. I'm tiny though. Like this is this can't be good. I was I was not eating like enough protein I just ate 1400 1500 calories a day and I was like, okay, this is good. My weight less than I did in high school But this is also not good. Like this is I look like I walked out of a concentration camp or a jail Like I've been malnourished. It was horrible So I was like, you know what? I need to be a fitness trainer So I I signed up with the NASM Took the classes and and did the course and became a fitness trainer But then I hired a person who gets people ready for bodybuilding shows He was like, dude, what on earth did you do like seven months straight of dieting? No diet breaks No, you know, are you tracking protein? Like, no, not, you know, I just eat what whatever adds up to 1500 or 1400 He's like, okay, that's not gonna work So he gave me some tips. So I bulked up a little after august got up to like 178 Then I stayed around there. Um still working out by myself In the next year, january, I was like, I need this is I need help I hired another guy who gets people ready for shows Um, his name was jake He was like, dude, you need to eat protein and do this whatever I got down to 163 again But it was like really shredded and I had like muscles that sounds like, okay, this is good. This is what you got to do Um, so I was doing I was doing all and then I had and I had bought my anabolic at the time That was like the first one I got that was I don't know somewhere in there. I mean like in 2019 maybe towards the end I was doing that. I mean that was that was my work. I mainly compound lifts with a squat rack and a barbell Nothing fancy obviously made huge Gains and I think that's what most people should probably do Is start with something that's like three days a week big huge compound lifts and just let it be Yeah, um, and I used to train kids because I coached like a lot of sports a lot of youth sports soccer flag football tackle football Golf baseball softball whatever so I was having the kids come to my home gym and we trained them And I wasn't doing anything dangerous with them. It was all regular stuff But then when I became a fitness trainer and I knew like kind of what to focus on what to what to have them do Um, but it was fun and um, I just wanted to make sure I was doing the right stuff So that's why I wanted to become a personal trainer. Did you do you see that? Did you see any carry over to your medical profession? Oh my god? Yes Now when I give my lecture, this is the other thing Thanks to to you guys and the fitness. I've changed my weight loss lecture a lot Like I used to when I like I used to do all the dumb stuff. All right I would not give these talks You know the stuff you guys tell don't eat after 7 p.m. And you know, try not to eat, you know simple carbs and and You know, you know Carbohydrate insulin model of obesity and weight loss like like dr. Talb's I'm sure you don't know I am his book somebody told me buy it and read it So I did keto for a while lost a few pounds But then I noticed like when people do these, you know, weird restrictive diets Like keto for example, you lose weight because you've reduced your calories But then once your calories match your maintenance, you no longer lose weight Increased fat, okay Then you start gaining weight again or like, you know, all the stuff they tell you doesn't or they go off in the rebound Which is usually what right and then that's kind of what happened. I was like, you know, this is not working anymore I need to stop But either way like I used to give Some of that stuff in my talks, you know And and you can find the research articles to prove that it works There was tons of research articles in the 90s late 90s It showed that the Atkins style or keto style diets worked and you can find it rolled your cholesterol It lowered, you know, all that stuff But it's because of the weight loss and we found out later that's not because of the Atkins diet We're eating lots of protein and almost no carbs. It's actually because of the weight loss in and of itself There was there was a more recent study done in 2007 When they wanted to kind of dispel all these myths They took patients and they had them eat an isocaloric diet, which was a deficit And they had they all ate the same amount of protein or like enough protein for them And and then they looked at varying the other stuff carbs and fats and they found No difference like they all lost the same exact amount of weight whether they were on a high carb or high fat diet And all their cardiovascular more risk factors went down insulin resistance cholesterol all that stuff all improved Regardless and then they did another study where they took they were looking at Diet only versus diet plus resistance training and then diet plus aerobic training or diet plus Combination training you talk about this one. Yeah. Well, this might be one of the ones I talk about Yeah, they found diet alone like energy intake alone Was what predicted weight loss whether they did aerobic or weights or both None of that stuff affected weight loss as much as the calorie deficit did So the calorie deficit alone was responsible for all the weight loss. I'm sure there's other studies I mean there's really thousands of them But that that was huge now I've changed my talk to my patients like my patients Like I never would sit with them and set up my fitness bout I'd be like, yeah, I try not to eat after 6 p.m. Or sure, you know avoid simple carbs, which does work You know if they Aren't a deficit or that creates a deficit. That's why it works. Right. That's why it works But now it's like, hey, you need to eat x amount of calories And and some of my patients like look doc. I just can't track I mean my patients are older not that older people are bad with apps A lot of them can do it but some of my patients like, you know, I don't want to track this sounds crazy Like fine Take your food like your breakfast plate if you have two eggs two pieces of toast two pieces of bacon Just cut in half one egg one toast one bacon put the rest aside Wait 20 minutes because it takes 20 minutes for your stomach through your vagal nerve and hormone signaling to tell your brain that it's full If you're still hungry Go back and eat a little bit more don't eat the whole thing like a whole idea is to eat less So go eat a little more and then wait again And just do it that way do it visually and that actually works too because there I was like if you're eating half the calories you used to eat you technically should weigh half your body weight that you weigh now I would tell clients that it was exercises for fitness And the nutrition is the weight loss right and then and then the other side of the exercise aspect is Yes, the fitness, but also do it in a way where it'll help with the metabolic adaptations that are going to help with the weight loss Right, so you don't want to do something that that takes away from that Right, I thought he was going to reference the study that you always reference about the Muscle loss. Yes the ones that did a calorie restricted diet cardio only without resistance training Yeah, that's one of the ones I have in my talk too. If you do a if you do a diet only or diet plus aerobic You actually lost a lot of muscle like nine 9% of your lean body mass went down Whereas the resistance training group only lost like 2 and then the combined training lost somewhere in between like 5 point something percent it was uh The group that did a diet only with aerobic lost the most lean body mass Resistance lost a little not not as much and then the combined group lost somewhere in between the two Yeah, that's the one that I I'll talk about that one and then in in my experience in some cases You'll build muscle as well, but remember lean body mass also counts water right like that. So 2 1% you know, that's not big No, it's significant and then when you start like maintaining or walking back up You obviously have a better baseline foundation to to go with right right, so that makes a huge difference What's the biggest I guess piece of pushback you get from colleagues? When you talk about, you know weight loss nutrition and health or is it any or is there any pushback because you're always referencing studies The way I do it they you can't really argue. I mean it's like I mean the biggest and the funniest things when they tell me like dude You're a cardiologist and you're telling people not to do cardi Like cardio your it's your name like, you know shooting people. I'm like, I'm not saying don't do cardio It's very good for you. You can do it I would love for my patients if my patients did that. I probably wouldn't have that many patients But they don't and and and it's not how you lose weight. Like if you're doing Cardio to lose weight. I got a 10 different ways. You could do it. They're much better. Right like like there are literally Millions of ways you can lose weight that includes zero cardio Like you don't even have to lift a finger like my patients like doc. I can't even get out of my chair Like how do you expect me to do any activity? Like like a 400 pound patient who has heart failure who has swollen legs and all this stuff How do they get out of a chair? Right? They don't so like doc. What can I do? Like, okay? I got an idea Exercise your hand not putting food into your mouth. Right. That's a really easy way that costs you zero time And you'll actually lose weight if you actually do it So that is that costs you zero. They're like, well doc, isn't it expensive to eat healthy? I'm like don't eat healthy just eat less. Yeah, that's like a lot of patients in some areas like well eating healthy is expensive Like don't eat healthy eat whatever you're eating now. It just has to be less Like don't give me any excuses like well or like patients that smoke or whatever like well My mom died last year and I just went back to smoke like okay Lots of my patients mom's dies and they don't smoke Like you have to find something else don't always make an excuse or have some built in Like the biggest problem I have with doctors and I tell them this in my talks Stop saying diet and exercise Like we're creating a problem when you say the only way to lose weight is diet and exercise like The exercise part nobody does it's like raise your hand if you exercise like two people raise their hand I'm like, how did you lose weight? Do you uh, do you exercise or do you just not eat much? Or are you just overweight? Like, you know, a lot of doctors are overweight But the point is don't give patients a built-in excuse because when once you say diet and exercise Patients automatically think I can't lose weight. I can't exercise. No, but they can't exercise. That's what I mean Yeah, oh, I can't do that. So I'm not doing any of it right and they have a built-in excuse like he the doctor told me That if I don't do diet and exercise, I'm not going to lose weight So cut out the exercise part and tell them just diet. Well, here's where to god you lose weight Here's something interesting you might want to might want to and this depends of course on the on the patient But um studies will show that when people exercise They do tend to eat better But they don't show the opposite if people die it they tend to not go out and exercise So I wonder if that strategy might even work as well. Say hey, look, I tell you what just try moving more and exercising Oh, I tell them to do that like, you know, they like a lot of people I'm sure you guys notice when when once they start exercising or sign up with a personal trainer Like why would I eat like crap if I'm paying all this money to get healthier? You know what I'm not gonna eat a whole pizza, you know, whatever it is But like when doctors say to patients the only way to lose weight is diet and the end part And exercise like no You're giving them an excuse a built-in excuse to think they can never lose weight because they can't or won't or don't have the time Or drive the kids around or go to soccer practice. They don't have time for the exercise So tell them listen, don't lift the finger do what you normally do. Just don't put more food into your mouth I swear to god, you will lose weight. Yeah, you know Because the success rate is so low and you've been doing this for a while and your approach is better than Most cardiologists in terms of talking to people about how to do things I have stories for you. I was gonna say do you ever get like do you have any do you have a positive outlook? Moving forward. I do. I mean, I think I mean like I literally have 10 copies of the book with me I have a bunch more at home that I'm giving to people. I brought four that you guys can sign for me But either way, um, I like this book Literally is exactly what I've been trying to tell people and now I can say listen There's a book on amazon called the resistance training revolution Just read it. I don't care if you do anything just go read it And you know naturally when somebody actually reads something and does it like I'm not just gonna hand it to them Because then they don't want it like I mean give something out for free People won't do like like your programs if you handed them out for free I know you have free stuff, but if you gave away maps on a block for free What's the likelihood of someone doing that is valuable if they pay a hundred bucks for it or whatever it is They're more likely to actually look at it and at least read it or watch the videos and actually do it Um, so I'm not going to just hand it out But if my patients ask me won't we don't have any books or any resource I'm like here's a bunch of resources and there's this book you really got to read But I think people are starting to realize that look The exercise part is not as important as the diaper Like, you know, they always say abs are made in the kitchen. Well everything in terms of weight loss is made In the kitchen like you don't actually have to exercise. It's great for you Don't go home people watching this and say the cardiologist said don't exercise. I'm not saying I exercise every day Um, it's very good for you. You will lose you you will improve all of your cardiovascular risk But it's not an efficient way To lose weight. Um, it can help the one thing we have found about exercise. I'll tell you this It attenuates your propensity to gain weight back Like it prevents you from gaining weight that you've already lost back Interesting. So like if somebody lost 30 pounds and there aren't an exercise program That being being an active in exercises, you're less likely to gain that weight back So that's something we definitely know that exercise does in terms of weight loss Um, all the other stuff it helps a little like literally they've done Hundreds of studies on people the amount of weight they lose from exercise only It's not much you have to do both you have to do both and the diet part is the most Uh, that makes the big I mean there's those studies done that were done on modern hunter gathers And they thought they would be burning so many calories From all their activity and they weren't your body just learns to adapt So it's like exercise for fitness mobility For quality of life and then eat for you know, maintaining a lean body. That's that that would always the way I communicate I completely agree with you Um, excellent. Well, I tell you what dr. Allo. This has been great. Yeah I appreciate you coming on and thank you for Handing out the book to your patients. Yeah, no, I definitely maybe we'll give you maybe we should He'll come up with some kind of a a code or something for his first patients for some of our workout programs That would work. Yeah, so they could have I do have I do have a weight loss Program that I sell to to people. I mean I give it away to my patients, but like Like like the lectures I give to doctors I put on youtube and they they you know It's very scientific lots of research based stuff But the general population like like, you know, I they're like All this research like what does this mean to me? So I have a I have a program that people can can get if you go to dr. Allo d. R. A. L. O. No period D. R. A. L. O. Dot net There's a weight loss one-on-one course and it goes through like all the basics from like what is a Calorie, what is a macronutrient? You know, how to actually lose weight There's a workbook that you can put in, you know to calculate your calorie deficit and your protein intake All that stuff and then going through like a fitness program that if you want to do some weightlifting You don't have to to lose weight But if you want to here's a basic compound lift type program that you can follow with like a schedule and everything It's very simple and I do some Basic exercise demonstrations to kind of show people how to do it or how to regress them even because my patients are usually older Um, but but that is something I usually give to my patients as one I would love to be like, hey go to the resistant train revolution calm type in this code and boom You can get it for you know, whatever excellent. Excellent. That would be awesome. All right. Well. Thank you, man Thank you. Thanks for what you're doing. Sure. No, thanks for having me appreciate it time And thanks for coming on and actually talking to my audience Because they're all doctors usually and when they hear like from someone who actually believes in the same stuff And has the research to back it that makes a huge difference. So I really appreciate that awesome Thank you when you're always trying to eat little calories This is very common for women your hormones get really thrown off in a negative way your hormones make A very big difference your hormones can tell your body To build muscle or to gain body fat or to keep fat off or to get rid of muscle Of course, it controls your libido your energy your