The Actual Dietary Guidelines Approved By Cardiologist Dr. Alo

Comprehensive Dietary & Lifestyle Guidelines for Weight Management, Longevity, and Cardiovascular Risk Reduction

Based on the clinical framework of Dr. Mohammed S. Alo, DO, FACC and major peer-reviewed evidence and consensus statement and guidelines. (see References).

Many people are confused by the new Dietary Guidelines that were released by the Health And Human Services and the USDA because of conflicting messaging on social media and television that does not match what the guidelines actually say. 

They are also confused because the new "upside down" food pyramid appears to emphasize butter, steak, double cheeseburgers, lard, and fatty meals. This has been shown to increase morbidity and mortality and this is what got us to this place to begin with. The aim of Dr. Alo's "Cardiologist Approved" dietary guidelines is to correct the mistakes and over representations of the government guidelines with real evidence and data based on over 100 years of evidence  and robust clinical trial data. 

How to use Dr. Alo's Dietary Guide

This protocol separates two different goals:

• Weight loss → driven primarily by energy balance (calories)
• Longevity / disease prevention → driven primarily by diet quality, lipid exposure (ApoB), blood pressure control, and lean mass preservation

You can lose weight eating almost anything if you maintain a calorie deficit. But you cannot reliably optimize long-term cardiovascular and metabolic health unless you also manage ApoB/LDL exposure, saturated fat, fiber, movement, and blood pressure.

Below is a summary infographic you can use as a New Dietary Guideline summary:

Part I — The Actual Health Nutrition Hierarchy

1) Caloric awareness (for weight loss): Weight loss requires a sustained caloric deficit.

Simple starting estimate: Target body weight (lb) × 10 ≈ daily calories for weight loss (example: goal 180 lb → ~1,800 kcal/day).

Metabolic protection: Pair calorie reduction with resistance training and consider periodic diet breaks (maintenance calories) after prolonged dieting.

Note: Calorie needs vary by body size, activity, sleep, medications, and genetics. This formula is a starting point, not a prescription.

2) Protein (the metabolic anchor): Target 0.7–1.0 g per lb of ideal body weight/day minimum. You can target more if you are weightlifting and building muscle, usually up to 1.6 g per pound of lean body mass.

Why: Preserves lean mass during weight loss, improves satiety, and supports metabolic health.

Best sources: Egg whites, poultry breast, fish, nonfat Greek yogurt, whey/plant isolates, tofu, tempeh.

3) Saturated fat (the lipid lever): Keep saturated fat <10% of total calories; if higher risk or known ASCVD, aim for <6%.

Reduce these first: butter, cheese, lard, tallow, coconut oil, bacon/sausage, fatty red meats (e.g., ribeye), full-fat dairy, cheese.

Why it matters: Saturated fat raises LDL/ApoB partly by reducing LDL receptor activity and increasing atherogenic particle exposure over time.

Fermented dairy, like Greek Yogurt, kefir cheese (labna) that is low in saturated fat appears to be neutral or slightly protective.

4) Prioritize unsaturated fats (including many seed and vegetable oils): Olive oil, avocados, nuts, seeds, and liquid vegetable oils such as canola/soy/sunflower/safflower.

Evidence summary: Replacing saturated fats with unsaturated fats—especially polyunsaturated fats—lowers LDL-C and is associated with lower cardiovascular risk in human studies.

This is the easiest swap to reduce cardiovascular disease. Substituting saturated fat for unsaturated fats, in an isocaloric fashion, reduces LDL and cardiovascular disease rates significantly. Even very small swaps make a big difference. Even a replacement of 3-5% of your saturated fat intake, substituted for unsaturated (poly and mono unsaturated), can lower cardiovascular risk significantly.

5) Fiber & minimally processed carbohydrates: Emphasize soluble fiber (beans/lentils, oats, fruit) to support LDL lowering and glycemic control.

Practical approach: Build meals around vegetables/legumes/whole grains, then add lean protein and healthy fats.

Sugar context: Added sugar is easiest to overconsume because it raises calorie density. The primary risk is caloric excess and weight gain, not “sugar as a toxin.”

Part II — What to Do With Popular Diets

Mediterranean (gold standard): High in plants, legumes, nuts, olive oil; moderate fish/lean protein; low in ultra-processed foods and saturated fat. Best evidence for reducing events and mortality in randomized trials. The DASH Diet also falls into this category, it's the same as the Mediterranean, but no salt and no alcohol and is usually considered superior.

Keto / low-carb: Main risk is high saturated fat versions that can raise LDL-C/ApoB substantially in some people. If choosing low-carb, do Mediterranean-style low-carb using olive oil, nuts, avocado, fish, and keep saturated fat low. It's hard to keep these diets low in saturated fat, but it may be possible.

Carnivore: Avoid as a long-term health strategy. Eliminates fiber and many protective phytochemicals and often increases saturated fat exposure. Most carnivore dieters have increased LDL/apoB and insulin resistance as a result of this dietary pattern.

Intermittent fasting: A tool for calorie control—not a metabolic cheat code. Not consistently superior to continuous calorie restriction when calories are similar. Generally, more difficult to do and some evidence suggests that it is harder to build muscle on such diets.

Part III — Exercise: “Actual Fitness”

Resistance training (metabolic priority): ≥2 days/week. Use 8–10 exercises covering major muscle groups. General health/hypertrophy: 8–12 reps near-fatigue. Strength focus: 1–6 reps heavier sets. Progress using the “2-for-2” rule (increase load ~2–10%).

Why: Improves insulin sensitivity, blood pressure, function, and longevity markers.

Aerobic training + daily movement (longevity priority): 150 min/week moderate or 75 min/week vigorous. Start with 7,500+ steps/day (then build). VO₂ max is strongly linked with longevity; consistent training is the lever.

Read the "Actual Weight Loss" book, or download the Dr Alo App for a nice comprehensive exercise program for people of all levels.

Part IV — Cardiovascular Prevention & Advanced Testing

ApoB: ApoB reflects the number of atherogenic particles; discordance with LDL-C is nor very common. You can use either if you don't have apoB.

Educational targets (individualize clinically):

• Lower risk: ApoB ~70–80 mg/dL (often corresponds to LDL-C <100)
• High risk / established ASCVD: ApoB ≤55 mg/dL (individualize with your clinician)
• Very High Risk target LDL or apoB < 40 mg/dL (multiple ischemic events or elevated lipoprotein a)

Lipoprotein(a) [Lp(a)]: Test once in adulthood. If elevated, lower all other modifiable risks aggressively (ApoB, blood pressure, smoking).

CAC vs. soft plaque: CAC detects calcified plaque; CAC=0 lowers near-term risk but does not guarantee absence of early atherosclerosis. Treat based on lifetime exposure, not calcium score alone. Calcium is a late stage finding and we can avoid ASCVD if we suppress LDL/apoB for decades starting at a young age.

CCTA vs Soft Plaque: CCTA does not detect soft plaque unless it encroaches on the lumen of your arteries, in which case it is also a later stage finding. Keep apoB/LDL low to avoid ASCVD altogether.

Part V — The Truth About Supplements

Supplements:

• Alo verdict: “supplement the diet with food.” Use targeted supplements only when there is a clear indication (e.g., pregnancy folic acid, documented deficiencies, vegan possibly B12, iron, vitamin D, protein), ideally guided by labs and clinician oversight.

Multivitamins & antioxidants

• High-dose antioxidant supplementation has been linked to harm in some analyses (including increased mortality with certain antioxidants).
• The USPSTF recommends against beta‑carotene and vitamin E supplementation for preventing cardiovascular disease or cancer.
• Routine multivitamin use has not demonstrated clear prevention of cardiovascular disease or cancer in the general population; the U.S. Preventive Services Task Force finds insufficient evidence for benefit for most supplements.

 Vitamin K2

• Alo verdict: don’t use K2 as a substitute for ApoB lowering, blood pressure control, and lifestyle fundamentals.
• Claims that K2 “pulls calcium out of arteries” or reverses coronary plaque are not supported by high-quality clinical evidence; trials to date have not shown reliable reversal of atherosclerosis or consistent reductions in coronary calcium scores.
• Vitamin K biology is interesting (it affects proteins involved in calcification), but controlled human outcome data are limited.

Red yeast rice

• Alo verdict: don’t use red yeast rice as a workaround for statins—if you need LDL/ApoB reduction, use standardized, evidence‑based therapies.
• Some products have been found to contain contaminants such as citrinin (a nephrotoxin).
• In the U.S., products with “enhanced/added” lovastatin/monacolin K are considered unapproved drugs; consumers can’t reliably know potency or safety.
• Red yeast rice can contain monacolin K (chemically identical to lovastatin), but commercial products vary widely and labels typically don’t disclose monacolin content.

Niacin (vitamin B3)

• Alo verdict: niacin is not routinely recommended for cardiovascular risk reduction in modern guidelines.
• Harms in large trials included higher rates of adverse effects (e.g., infections, bleeding, liver toxicity) and worsened glycemic control in some participants.
• Niacin improves some lipid numbers (LDL down, HDL up), but major outcome trials did not reduce heart attacks or strokes when added to statin therapy.

Fish Oil

• Alo verdict: don’t use OTC fish oil as a substitute for proven lipid therapy; prioritize eating fish 1–2×/week and follow evidence‑based lipid management with your clinician.
• Exception: icosapent ethyl (Vascepa®) is a prescription, purified EPA product with outcome benefit in selected high‑risk patients with elevated triglycerides (REDUCE‑IT).
• Higher-dose omega‑3 formulations have been associated with an increased risk of atrial fibrillation in meta-analyses.
• Large randomized trials of standard OTC-style omega‑3 supplements have not shown consistent cardiovascular benefit for primary prevention (e.g., VITAL; STRENGTH).
• Over‑the‑counter (OTC) fish oil is a food supplement—dose and oxidation (rancidity) can vary by product; some independent testing has found label inaccuracy and high oxidation in certain markets.

Specific supplement myths (and the evidence-based take)

In the SPORT randomized clinical trial, researchers compared common “heart health” supplements to low‑dose rosuvastatin (5 mg) and placebo.

Cholesterol-lowering supplements: what the SPORT trial showed

• Low‑dose rosuvastatin lowered LDL‑cholesterol dramatically versus placebo and the supplements.
• Result: none of the supplements produced a meaningful LDL‑cholesterol reduction compared with placebo over the trial period.
• Supplements studied included fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice.
• Most supplement failed to lower LDL
• Cinnamon increased CRP (inflammation)
• More people on supplements quit due to side effects than the medication arm

Supplements Bottom Line

• Practical safety rule: treat supplements like medications—assume interactions are possible (especially with anticoagulants, blood-pressure meds, antiarrhythmics, and statins). Choose products that are third‑party tested (USP, NSF, Informed Choice) when possible.
• Supplements are regulated differently than drugs: most are not required to prove effectiveness before sale, and quality can vary by brand and batch.
• Many effective drugs started as natural compounds—once proven, they were purified, standardized, and properly dosed (e.g., aspirin from salicylates; statins from fungal compounds; ACE-inhibitor development inspired by snake venom peptides).
• Maxim: “If it worked, it would be a prescription medication.”

The “Billion Dollar Drug” rule

Dr. Alo’s operating principle on supplements is simple: if a product reliably prevented heart attacks or meaningfully lowered cholesterol or blood pressure, it would be regulated, standardized, and dosed like a prescription medication. Most known cardiovascular medications began as "supplements". Aspirin, coumadin, lisinopril, ozempic, metformin, digoxin, statins, etc. all began as naturally occurring substances We need to be able to regulate them and dose them, as some are deadly.

Part VI — Blood Pressure & Sodium

Sodium target: keep sodium <2,300 mg/day for most people; lower targets may benefit certain patients.

Salt substitutes: potassium-enriched salt substitutes reduced cardiovascular events in a large randomized trial.

Safety note: Potassium salt substitutes are not appropriate for everyone (e.g., advanced kidney disease, certain medications). Ask your clinician.

Part VII — Special Topics

Dietary cholesterol (eggs, shrimp, “hyper-absorbers”): Saturated fat usually has a larger impact on LDL-C than dietary cholesterol, but high cholesterol intake may matter—especially at higher doses or in certain responders.

Practical protocol:

• Egg whites: excellent protein source
• Egg yolks: if ApoB/LDL is elevated, reduce yolks and recheck labs
• If ApoB remains high despite low saturated fat, discuss absorption-targeted strategies (dietary cholesterol reduction; clinician-directed therapy such as ezetimibe)
• Dietary intakes over 300-400mg daily increase cardiovascular mortality as well as all cause mortality regardless of whether one is a hyper absorber or not.

Alcohol: Less is better for longevity. Alcohol is carcinogenic; risk rises with dose. Avoid drinking “for health.” It's a class 1 carcinogenic and should be avoided as much as possible. There is no benefit, and mostly harm.

Part VIII — Hormonal Health & Cardiovascular Risk

Men (TRT): Lifestyle first (weight loss, sleep, strength training, minimize alcohol). In high-risk men with hypogonadism, TRAVERSE found TRT non-inferior to placebo for major adverse cardiovascular events, with monitoring needed for adverse signals.

Women (MHT): Used for symptom relief, not cardiovascular prevention. Timing and route matter; transdermal estrogen may have lower thrombotic risk than oral in several analyses. Individualize decisions clinically. You do not need labs to determine therapy decision (except for testosterone).

Transgender care: Hormone therapy can alter lipid profiles and risk markers. Apply the same evidence-based prevention tools: ApoB/LDL control, blood pressure control, smoking cessation, resistance training, metabolic optimization.

Part IX — Smoking Cessation

Smoking Cessation: Target Zero. Smoking is a direct endothelial toxin that accelerates atherosclerosis and increases thrombotic (clotting) risk. It negates many benefits of diet and exercise. Quitting is mandatory for longevity and reduces the risk of heart attack by 50% within the first year. Use Nicotine Replacement Therapy (NRT) or prescription aids (Varenicline) if needed; the priority is eliminating combustion immediately.

Summary: “Actual Health” Targets (Educational)

Disclaimer

This content is for education and is not medical advice. Discuss any major diet, medication, supplement, or exercise change with your clinician—especially if you have heart disease, diabetes, kidney disease, pregnancy, or are taking prescription medications.

References (linked)

1. Paluch AE, et al. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update (AHA Scientific Statement). Circulation. 2024. Link
2. Paluch AE, et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. 2022. Link
3. Lee DC, et al. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 2014. Link
4. Ference BA, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. Eur Heart J. 2017. Link
5. Borén J, et al. Low-density lipoproteins cause ASCVD: EAS consensus. Eur Heart J. 2020. Link
6. Sniderman AD, et al. Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiology. 2019. Link
7. Fernández-Friera L, et al. Normal LDL-C levels and subclinical atherosclerosis (PESA). J Am Coll Cardiol. 2017. Link
8. Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet (PREDIMED). N Engl J Med. 2018. Link
9. de Lorgeril M, et al. Mediterranean diet and cardiovascular complications after myocardial infarction (Lyon Diet Heart Study). Circulation. 1999. Link
10. Iatan I, et al. Low-carbohydrate high-fat diet and incident CVD (UK Biobank). JACC Advances. 2024. Link
11. Hooper L, et al. Reduction in saturated fat intake for cardiovascular disease (Cochrane Review). 2020. Link
12. Christensen JJ, et al. Dietary fat quality, atherogenic lipoproteins, and ASCVD. Atherosclerosis. 2024. Link
13. Dayton S, et al. Diet high in unsaturated fat and complications of atherosclerosis (LA Veterans). Circulation. 1969. Link
14. Marklund M, et al. Biomarkers of dietary omega-6 fatty acids and incident cardiovascular disease and mortality. Circulation. 2019. Link
15. Neal B, et al. Effect of Salt Substitution on Cardiovascular Events and Death (SSaSS). N Engl J Med. 2021. Link
16. International Agency for Research on Cancer (IARC). Carcinogenicity of consumption of red and processed meat. 2015. Link
17. Pan A, et al. Red meat consumption and mortality. Arch Intern Med. 2012. Link
18. Gu X, et al. Red meat intake and risk of type 2 diabetes. Am J Clin Nutr. 2023. Link
19. He FJ, et al. Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020. Link
20. Gardner CD, et al. Low-Fat vs Low-Carbohydrate Diet (DIETFITS). JAMA. 2018. Link
21. Liu D, et al. Calorie restriction with or without time-restricted eating in weight loss. N Engl J Med. 2022. Link
22. Zhong VW, et al. Dietary cholesterol or egg consumption and incident CVD and mortality. JAMA. 2019. Link
23. Wood AM, et al. Risk thresholds for alcohol consumption (599,912 participants). The Lancet. 2018. Link
24. Voskoboinik A, et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med. 2020. Link
25. Nissen SE, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023. Link
26. Rossouw JE, et al. Risks and benefits of estrogen plus progestin (WHI). JAMA. 2002. Link
27. Hodis HN, et al. Vascular effects of early versus late postmenopausal estradiol therapy (ELITE). N Engl J Med. 2016. Link
28. Vinogradova Y, et al. Oral vs transdermal estrogen therapy and vascular events. J Clin Endocrinol Metab. 2015. Link
29. World Heart Federation. The Impact of Alcohol Consumption on Cardiovascular Health: Myths and Measures. 2022. Link
30. Laffin LJ, et al. Comparative Effects of Low‑Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers (SPORT). J Am Coll Cardiol. 2023.
31. Manson JE, et al. Marine n−3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer (VITAL). N Engl J Med. 2019.
32. Nicholls SJ, et al. Effect of High‑Dose Omega‑3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events (STRENGTH). JAMA. 2020.
33. Bhatt DL, et al. Cardiovascular Risk Reduction with Icosapent Ethyl (REDUCE‑IT). N Engl J Med. 2019.
34. Gencer B, et al. Effect of Long‑Term Marine Omega‑3 Fatty Acids on Atrial Fibrillation: Systematic Review and Meta‑Analysis. Circulation. 2021.
35. Boden WE, et al. Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy (AIM‑HIGH). N Engl J Med. 2011.
36. Landray MJ, et al. Effects of Extended‑Release Niacin with Laropiprant in High‑Risk Patients (HPS2‑THRIVE). N Engl J Med. 2014.
37. Albert BB, et al. Fish Oil Supplements in New Zealand Are Highly Oxidised and Do Not Meet Label Claims. Sci Rep. 2015.
38. U.S. Preventive Services Task Force. Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: Final Recommendation Statement. 2022.
39. Bjelakovic G, et al. Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention: Systematic Review and Meta‑analysis. JAMA. 2007.
40. NIH Office of Dietary Supplements. Dietary Supplements: Background Information (Consumer Fact Sheet). Updated 2020.
41. NCCIH (NIH). Red Yeast Rice: What You Need To Know. Updated 2022.
42. Brandenburg VM, et al. Prevention of vasculopathy by vitamin K supplementation: can we turn fiction into fact? Atherosclerosis. 2015.

43. The Health Consequences of Smoking: CDC / Surgeon General Report 2014

44. Benefits of Quitting Smoking: AHA/ACC Guideline on Lifestyle Management