Latest / NHA Today Podcast / Better Health Starts With Your Next Choice with Dr. Jeffrey Pierce
Transcript
- Stephan Esser MD: Hello and welcome to the NHH's Day podcast. Today I'm joined by Dr. Jeffrey Pierce, who's a double board certified physician in family and lifestyle medicine. He's an advocate for healthy living and patient empowerment. He transforms the world for good as a physician, an educator, a gardener, a musician, and a father and a husband. I love this multidimensional life. Dr. Pierce, welcome to the podcast. Jeff Pierce, MD: Thank you so much, Doctor Esser. What a pleasure to be here. thank you for having me. Stephan Esser MD: I'm gonna jump right in. You know, you've cared for patients struggling with malnutrition in the countries of Malawi, South Sudan and Kenya, and you've also cared for American middle class suburbanites dealing with a different kind of malnutrition. What commonalities and what differences have you seen? Jeff Pierce, MD: Wow, well that's a great question. I think there are vastly different types of malnutrition here, but so many commonalities down the line, right? So in in areas of sub-Saharan Africa, parti particularly rural areas that were hit hard by poverty and often chronic illnesses like HIV and tuberculosis. I'd see adults and kids who are just struggling, getting enough calories, getting enough protein, getting enough micronutrients. And it led to, you know, inflammation, it led to susceptibility to more illnesses, and really just not being able to reach their full potential because they were set back in so many ways. And I was I'm very thankful for that for the chance that I had to to work there and I learned very much along with them. but it was it was challenging work to see folks just not getting enough healthy food to eat so that they could flourish. and then back in the US, a very different type of malnutrition. It's in in in many ways, it's almost the opposite, where there is just an excess of calories, sometimes an excess of protein, like animal protein, where, you know, everywhere you turn, you might be checking out at the local home improvements place and there's excess sweet Stephan Esser MD: Right. Jeff Pierce, MD: and salty snacks right there, right? And so we have we have too many calories, we don't have the right access to the healthiest foods oftentimes. or maybe we have some access to it, but we don't realize that they're the healthiest foods. And this leads us to a different kind of malnutrition, right? excess fat deposition in in the liver, for example, and we'll hope we'll have a chance to talk a little bit more about that. and affecting our our hearts, our blood vessels, pretty much every inch of us inside and out, and leads to chronic illnesses, chronic inflammation, inability to reach our full potential and flourish. So, you know, downstream, very similar outcomes to that. Stephan Esser MD: Yeah, kind of making me think of almost like a bell curve or a J curve, one of one of these curves, right? Where kind of at the extremes of either end, we end up in a less than ideal state, whether it be inadequate calories or excess calories, whether it be inadequate micronutrients, right? And perhaps in some cases, excess micronutrients, you know, like in supplements, right? Of things that kind that can cause Jeff Pierce, MD: Yeah, yeah. Yeah. Yeah. Stephan Esser MD: problems too. So very interesting and varied populaces that you've certainly worked with. Now, on your website, Jeff PierceMD.com, you wrote, quote, I learned that with the right information motivation. People could get to the root cause of their illness and cure themselves. What is the right information? And does it vary by person? Jeff Pierce, MD: Well, I think what I what I have in mind when when I wrote that, what I had in mind was that it's not just our genes, that we have so much control over our health destiny, so much more than I think the average person knows, and so much more really than the than most healthcare providers know. it's just we've been learning so much about what they call the the epigenome. what We you know, we got our gen we got our genes from mom and dad, but we have a wide variability in which genes are turned on and which genes are turned off, right? And so by taking control of what do we eat, how much do we move, how much do we sleep, how do we handle stress, you know, are we smoking two packs a day? All these things add up to either turning, you know, good genes on or off, or turning bad genes on and off. And when you look at this doing sort of doing your best in in all of these areas, at least 80% of of our chronic illnesses that are the plague of you know, Americans and many folks around the globe, 80% of those conditions can be avoided. And so I think that's the information. Not everybody's gonna act on it right away and and maybe never, but number one is getting that information out there and helping people implement it. Stephan Esser MD: Well, and I know how was it in your medical training? Do you feel like your kind of attendees, right? Your teachers, did they say to you, people never will change, don't you waste your time? Or did they say, Hey, people want this information. We need to figure out how to deliver it. What was the most common experience you had in your training? Jeff Pierce, MD: You know, I so I'm a family doctor by training, went to a great program. but the the main focus was on prescribing the right medications. You know, the the first one you should prescribe for high blood pressure is this one, the second one you should add on is this one, the third one you would add on if those two aren't strong enough is that one. And I got decent, I got pretty good at that. and then if this doesn't work, this is the right procedure and this is the right surgery that they might need. But there wasn't a ton of focus on diet and exercise. And it was a little bit of the and I don't fault my my trainers, because that was kind of the the what they learned in school and what they learned in residency. But the the common thing was, you know, give give six weeks of diet and exercise. Most people aren't gonna do it and just, you know, kind of prepare yourself for prescribing the medication. and funny, you know, one of the one of our instructors who did talk to us about habit change was having the hardest time quitting smoking. and so it, you know, there was I I think I didn't have a lot of f training, knowledge, and faith in the whole habit change process. I feel a lot better about it now. Stephan Esser MD: I love it. Yeah. Well, with your double board certification in lifestyle medicine, I'm sure you've got that a little bit more down at this point. You know, it's interesting, you know, I saw, and maybe you did too, that recently, you know, the Department of Health and Human Services, perhaps is who it is, is gonna is trying to force medical schools, right, to do nutrition education. what's your take on that? Jeff Pierce, MD: well, more nutrition education in medical school sounds like a great idea. it's gonna be all about the implementation, right? So most of us got very little nutrition training. and as many folks have heard, it's you know, silly little basic science stuff on how vitamin C prevents sc scurvy and and things like that. And so you can kind of almost only go up from there. You can only make it better from there. but my hope is that they're doing it based on scientific evidence. And thankfully we have decades, more than a hundred years in some areas, looking at what healthy nutrition can be and what it can do for us. So as long as the is the the the nutritional education that gets into medical schools is based off of good science and they teach the medical students on how to implement it, I think that that could be a very positive thing. Stephan Esser MD: Love it. You know, and I think that last phrase you said about implementation in my training, that's just the biggest thing I feel like. You know, it's like you you might read a study or have heard a speaker who talked about, you know, reversing heart disease or improving kidney function through nutrition, but yet how do you talk to a patient about that? Right. How do you deliver that information in a way that motivates them to change? And I know right now you work with the telehealth lifestyle company and you help people virtually, as well as you do some in-person visits as well. Is that correct? Jeff Pierce, MD: I do virtual care now and I have recently stopped all in person care. So I am working Stephan Esser MD: Wow. Jeff Pierce, MD: from the home office now, a hundred percent. Stephan Esser MD: Wow. And so what's your favorite part of this virtual medical care? I mean, what what's your favorite part of being able to interact with these people in that capacity? Jeff Pierce, MD: What's it's been an interesting switch, you know. I so much about being a doctor is being at the bedside, you know, holding holding, you know, a patient's hand during tough times, you know, the classic walking somebody through the the challenges in life and giving hard diagnoses, all these kinds of things and the physical exam and so much, you know, all throughout history, of course, that's how doctoring has been. and when I first started to have friends who started to do online medical work. I thought, wow, how challenging would that be and how unfulfilling. and also how risky, right? Someone tells me, hey, I have this pain here in my abdomen. And, you know, what do you do a thousand miles away? to say, you know, well, just push right there. Does that hurt? And so that was sort of my initial thoughts on it. But ha after having done it, I'm I'm in love with it to the point, of course, now that I do it 100% of time. Because you know, now I can reach folks, not just in the town that I live or in the neighboring county, but you can reach folks in whichever state you're licensed. and so that extan extends the reach greatly. And then Stephan Esser MD: Right. Jeff Pierce, MD: by I I'm not doing I'm not doing acute care visits. So, you know, not s no sore throats or possible urinary tract infections. It's it's all on focusing on chronic illness prevention and treatment. And that's very conducive to online discussions, reviewing labs, talking about what's working and what's not working, in sort of working on improving your somebody's healthy habits. Stephan Esser MD: Nice. You know, what's the name of the telehealth group that you're with? Jeff Pierce, MD: So I'm lucky to be working with a great group of docs at Lifestyle Telemedicine. Stephan Esser MD: Nice. And if people want to connect with you, what's the best way for them to do so? Jeff Pierce, MD: easiest search for the lifestyle telemedicine or our website is lifestyle telemedicine dot com. And I I'm I'm licensed in California, Florida, and Texas, but with this group of brilliant doctors, about half a dozen of us, we cover all fifty states and international, so it's nice to have reach to to all around the US and abroad. Stephan Esser MD: Awesome. I want to pick your brain about a few specific topics today. the first one I wanted to chat with you about is fatty liver disease. So I've read articles suggesting that this is now one of the top causes of liver failure in America today. And I wanna ask you, you write, what is fatty liver and why does it matter? Jeff Pierce, MD: Great great question. so fatty liver, first of all, you know, it it keeps going through all these different name changes. So I d I'll just touch base on that with for folks who have heard different things in your audience. fatty liver hi is also most recently been being called metabolic dysfunction as associated steatotic liver disease, which doesn't really roll off the tongue. Stephan Esser MD: Ha ha. Jeff Pierce, MD: M-A-S L D or Mastled. but you can see how there the the the medical groups are still working on something catchy. fatty liver can sound sort of pejorative, and so I think that's why they're working on it. But basically this is an accumulation of fat within the liver. And you know, we having fat on our bodies is is natural, some some amount of that, but it should be. In our adipose tissue, right? So our buttocks, breasts, belly, things like that. and it's storage for energy for when the next famine comes along and you can't eat for the next 20 days. that's some of the more healthy fat, what we call subcutaneous fat. But when fat starts getting deposited with deposited in our organs, that leads to trouble. And so in the case of fatty liver disease, fat's being deposited in our liver cells, it leads to inflammation. It leads to dysfunction of the liver. And over time, the liver can be inflamed enough that it gets scarred, increasing risk for liver cancer and even needing a liver transplant. And what's crazy, I mean there's so many crazy things about it, but one is that about one it's estimated about one in in three adults in America has some degree of fatty liver, which blows Stephan Esser MD: Wow. Jeff Pierce, MD: And back in back in training, you know, I I sort of felt relieved when that was the diagnosis. Maybe we'd saw see abnormal liver liver tests and we get an ultrasound and we see that the liver looks a little bit different. It looks like it has, you know, a different mm echogenicity, which is the fancy word for just saying it it it has fat in it and so it looks different on ultrasound. And I'd say, you know what, this is It's not from too much alcohol or it's not from liver cancer. You've got just you just gotta eat better and exercise more. And of course, if that's the extent of your coaching for improving lifestyle habits, most people aren't gonna make changes, right? So that's fatty liver in a nutshell. And thankfully there's things that we can do to treat it. Stephan Esser MD: So when you think about all of this fat, like you said, the liver itself is meant for detoxification, protein synthesis, bile formation, right? it's not really meant as a storage organ for fat. It shouldn't be in there, right? And so when that occurs, when all that fat builds up in there, is this one of the just one more of those diseases of inflammation where now we're seeing kind of those liver enzymes elevate? Is is that kind of what happens, or what how does that play out? Jeff Pierce, MD: Right. It's I mean, so it's very complicated, more complicated than than I could ever understand on a on a basic science level. But I would say that the but that's at the core of it, right? So our bodies are designed to deal with short-term inflammation, where we scrape our knee and then the inflammatory cells come in and help f put everything right, and then a couple of days later everything's turned around. But our bodies are not great at dealing with Day in and day out, low grade chronic inflammation that just leads to more and more organ dysfunction and chronic illness. And so, very similar to conditions like diabetes, you actually see conditions, you can you see these chronic illnesses like diabetes, like heart disease, like obesity, and fatty liver all oftentimes being diagnosed in the same person because they have so many things and similar at the root cause of things, at the origin. Stephan Esser MD: And so what tests should our viewers consider having to see if they have fatty liver? Jeff Pierce, MD: Yeah, so that's one of the tricky aspects of it. I you know, it'd be nice if you could just go to lab and say, okay, do the fatty liver test. but it's it's not really that simple. You know, so what happens most often in practice is it's kind of a surprise diagnosis. so maybe you're going to get an ultrasound because you've got belly pain and your doc thinks it might be gallstones. And so they they look for gallstones in your gallbladder, which is just underneath your liver, and they say, hey, good luck. I mean, good news, there's no gallstones. But unfortunately, you have what is probably fatty liver based on the way it looks on ultrasound. So then your doc sees that and says, Hmm, well, let's see, do you have risk factors for it? Let's see, you're you're you have you're dealing with overweight, you have d type 2 diabetes. you have high triglycerides, low HDL, cholesterol. These are risk factors for it. you probably have it. Let's check some lab tests. it looks like there's a liver little bit of liver inflammation based on this what we call a comprehensive metabolic panel is probably the most often ordered that looks at that includes liver tests. and do you have anything else that might explain it? Well, you don't have hepatitis C and you're not a heavy drinker, so yeah, this is probably fatty liver. Stephan Esser MD: So kind of a stepwise diagnosis, it sounds like. Walking through one after the next after the next. Kind of getting those labs, then possibly doing the ultrasound like you said, then further work up. So making sure you got the right person who's looking at you. Sounds like it's pretty important. Jeff Pierce, MD: Right. And who pays Yeah, and who who then pays attention to the diagnosis in a timely fashion. Because you know, hats off to the primary care providers who see someone who comes in with seven different concerns. and you know, maybe down at number seven is this new diagnosis of of fatty liver disease. Stephan Esser MD: Right. Jeff Pierce, MD: and and it's important though. I you know, I think to me this is just as important as finding out that you have cor coronary artery disease, that you have, you know, heart Stephan Esser MD: Rent. Jeff Pierce, MD: disease, or that you have a diagnosis of type two diabetes in your blood sugars in control, because it might not kill you today or tomorrow, but it likely will cause pain and suffering and and untimely death down the road. So now's our chance to jump on it. Stephan Esser MD: And when you say jump on it, right, what if someone's diagnosed with fatty liver, what should they do to try to reverse it or improve the symptoms? Jeff Pierce, MD: Yeah. So I you know, I think about it in four steps or four sort of ways to address it. You know, number one, the cornerstone is often weight loss. And weight loss by a number of means will show you benefits in the realm of fatty liver. And so that could be on an extreme end bariatric surgery, where a surgeon does a radical surgery and causes you to lose weight, massive amounts of weight in a relatively short amount of time works very well for reversing fatty liver. But most of us don't want to go through a major surgery that's gonna have l potential side effects lifelong, right? and so weight loss from a number of ways can be helpful and even five to ten percent of of weight loss can be helpful. But I think Weight loss tied in with my number two approach is is the way to go, which is switching to a low-fat, whole food plant-based diet. And so basically trying to get all or the majority of your calories from healthy, minimally or un or totally unprocessed plant foods, right? So your veggies, your fruits, your bean and lintel family, your mushrooms, herbs, spices, whole grains, nuts and seeds, and That sort of a diet is high in antioxidants and it's low in pro-inflammatory components and low in saturated fat. And and so you're getting weight loss because that's naturally lower in calories and helps in so many ways with weight loss. You're getting more antioxidants, you're getting less foods that are promoting the insulin resistance and fat deposition in the liver. and so those are the first two steps. and then the the next two would be daily movement and exercise. studies show that exercising helps fatty liver even without any associated weight loss from it. So if you took a hundred people with this metabolic dysfunction associated with diatotic liver disease and had started to get them to exercise 45 minutes a day. Even if they didn't lose any weight, they would see improvements in fatty liver. And then the last sort of approach to add in there is to think a little bit about different kinds of fasting and time restricted eating, where a number of studies have shown that by you know eating in an eight hour window, or maybe eating one day on, one day off, or taking one or two days off to water fast, et cetera, may give additional benefits to the exercise and the weight loss and the plant-based diet. Stephan Esser MD: Awesome. Sounds like some good foundational tools from the NHA right there. You know, d are you an advocate Jeff Pierce, MD: Mm-hmm. Stephan Esser MD: for any sort of supplements for fatty liver disease, or do you usually want to kind of avoid those? Jeff Pierce, MD: So I'm I'm hesitant in general about supplements because it's for many reasons. Number one, sometimes folks think about them as magic pills to where it's like, Well, I I take my ten supplements with my, you know, nightly f fifth of vodka and cigarettes, and this is Stephan Esser MD: Ha ha. Jeff Pierce, MD: what's gonna save my life, you know? And and it's you can't out supplement your bad habits, is one aspect of it. And number two is That the industry is so at risk for not having what you think should be in the bottle at the right concentration for with regulation Stephan Esser MD: Right. Right. Jeff Pierce, MD: can be limited. And so so in general I'm hesitant to to do that. I think two things I would compliment comment on though when it comes to fatty liver. Number one, some supplements that are easily just added to your food would be There's some studies that looked at ginger turmeric and nigella sativa, also known as black cumin or charnoushka. those three things may give some additional benefits, potentially from the antioxidant angle. And you can just have that as part of your food on a regular basis. And then I'd be very hesitant with vitamin E, which you see in the literature often at 400 or more. milligrams and the problem with vitamin E, even though it's been shown that it may help with fatty liver is that in some other studies it's been associated with more prostate cancer risk, more hemorrhagic stroke risk, and and more maybe early untimely death even. And so why why risk taking a supplement that may help a little bit with your fatty liver, but then give you a a brain bleed at the same time. And so I I definitely recommend folks not to supplement with high dose vitamin E. Stephan Esser MD: We'll start with the basics and build from there. So there's a wave Jeff Pierce, MD: Yeah. Stephan Esser MD: of anti-aging medicine out there, right? Everyone wants to prolong their Jeff Pierce, MD: Yeah. Stephan Esser MD: youth, slow aging. And in you know, searching for this immortality, many men are taking testosterone. in your mind, who's an appropriate candidate for testosterone repletion and who is an absolute risk and should avoid that? Jeff Pierce, MD: Right. Testosterone is a it's a hot market, right? If you if if you want to give up clinical medicine, just start selling testosterone supplements and and focusing on menopause. but I I I think we have to be really careful with this because when you look at the science, it really does seem that there's a whole lot of mm there's a whole lot of overemphasis on the potential benefits. There's a lot often underemphasis of the potential risks. And a whole lot more people are taking than they would than those that really need it and would benefit from it. And so in the sh kind of the short of it is that you gotta know your level and it's supposed to actually be checked two different times with some weeks or even a month in between And study after study shows that it's not gonna make your memory better. It's not gonna make you, you know, an elite athlete. It's not it's it may help you with with libido, with you know, frequency of thinking about sex or desiring sex. It could help with that in someone with a low level, and in those people who are willing to risk the side effects. And there was a whole hullabaloo of risk of Potential cardiac side effects that was sort of said, you know what? Actually, it's just fine. That trial that said it was just fine, unfortunately had a lot of folks that really that received financial benefit from the testosterone, the whole testosterone industry. and there was still an increased risk for atrophibrillation, which is a type of irregular heartbeat, blood clots to the lung. and kidney disease. And so it just seems like it's in a very small select group of men who are at high risk for it. Maybe they have chronic HIV, maybe they've had been on chronic opioid medications, they have a low level, they have low libido, they're willing to to deal with the potential serious side effects for Stephan Esser MD: Right. Jeff Pierce, MD: a little bit more sex drop. And so I think most most people just shouldn't be on it because most people aren't gonna fit into that category. Stephan Esser MD: Yeah, fair enough. I think that sounds reasonable. Certainly so many men seeking right their youth, right? And like you're suggesting, unfortunately end up with more than they bargained for. but when you do think about testosterone levels, right, obviously there's a whole category there. There's free testosterone and toll testosterone and right DHT and all these other things that you can test as well as sex hormone binding globule and et cetera. But are there any foods that you're familiar with that seem to help with a healthy level of testosterone? That you might say, hey, look, if you you want to increase the consumption of these, these are beneficial. I heard you talk about sexual, you know, function libido. Certainly we all need to be more of our greens and our berries and our right things that produce more nitrates and with nitric oxide production, dilation. but what about just for in general kind of testosterone levels? Any any data there you want to share? Jeff Pierce, MD: Sure. I think the the way that I often address this is to look at diet and sleep and exercise and all these habits that we can focus on because it probably the reason why so many men have lower and lower testosterone as they age is not due to the aging process, but due to all of the chronic illnesses that come along with us as we age, right? As we get older, oftentimes we get the hypertension and the diabetes and the heart disease and the depression and all these things. That seem to directly cause lower testosterone. So, what can we do with diet, with exercise, with sleep, and stress management to prevent these other illnesses that seem to be the cause of the lower testosterone levels? And so, you know, it comes down to where even there, though there might not, there isn't a study that looked at, you know, 10,000 people eating a low-fat, whole food plant-based diet and what it does to testosterone, we know that. From study after study, that that sort of a diet helps prevent these other health conditions that I just mentioned, and so therefore should be able to help maintain a normal testosterone level. There is some evidence looking at high saturated fat meals, high refined sugar meals seem to at least acutely and over the short amount of time lead to lower testosterone levels. But like we we know that we shouldn't be having a Double bacon cheeseburger with a deep fried apple pie for so many reasons. I don't I don't know if if also knowing that it lowers your testosterone 10% for that day it will change anybody's practice. Maybe it will. Maybe that that is the thing that is most important to someone at that point. So use it as a lever, sure. Stephan Esser MD: I love it. I you I would agree with you. I mean that there's so many guys and and ladies, right, that we see and we talk with that sexuality and aesthetics is the motivator for them to change their behaviors, right? I mean, more almost more than anything else, which sometimes blows my mind. You're not worried about your heart disease, but you want to have a better, you know, erection. Okay, wow. Okay. Jeff Pierce, MD: Yeah. Stephan Esser MD: So so be it, buddy. Whatever it takes to get those that arugula in. So Jeff Pierce, MD: Mm-hmm. Stephan Esser MD: How about sleep? Is that again the same sort of thing? We are getting the ideal amounts of sleep. Our testosterone levels are are better. Is there any part that sleep plays in this? Jeff Pierce, MD: It seems to, you know, you and I recommend for most people to be shooting for those seven to nine hours of quality restorative sleep, for so many reasons already, you know, helping with blood sugars, helping with our risk for dementia. it seems that fragmented sleep, obstructive sleep apnea, chronically low amounts of sleep is correlated with lower testosterone levels. one direct trial took young healthy men and limited them to five hours of sleep per night, which is funny because to some people that might be five hours, that's pretty good. But limited them to five hours of sleep per night and and found maybe testosterone levels at about ten to fifteen percent lower than they were before. And Stephan Esser MD: Wow. Jeff Pierce, MD: so it seems like sleep plays a a role as well. Stephan Esser MD: What I'm hearing there from you on all these different lifestyle factors is even small incremental changes can put you in the deficit, right? Which can then throw your body off over time. So very good reminder for all of us, you know? so let's jump back to the start of our conversation. Many people want to change. They're tired of being fat sick and nearly dead, right? Let's let's say someone's inspired after watching your podcast today and they want to make changes in their health. What do you want to tell them? Jeff Pierce, MD: Well, you know, you there's don't wait for the perfect day to start. Don't wait until you have it all figured out. you know, I'm not a business person, but I've heard from business oriented people is that you just you start today and you make adjustments as you go. And I think from a health standpoint, that that fits too. You know, like you you're at the next meal is your next chance. The next morning is your next the next night of sleep is your next chance. That you should just get started. And I'm a big fan I'm a big fan of making small changes and how they add up. I I am cognizant about folks who are like, well, I've added one vegetable. You know, I eat now one vegetable a week, and and I've done that for the last year and I still have diabetes. Why is that? Right. So you start with small changes and then you just keep adding small changes over time so that little by little you have completely reworked your your healthy habits. so but but just start and don't wait for the perfect day. Stephan Esser MD: Awesome. Awesome. Right. Because that perfect day never comes. Well, we can't get off our podcast here without touching base on your passion, which is gardening. I know many of our viewers love growing things as well. I know you spend a lot of time out there in your garden. So what is in your garden right now? Tanalize us with some stories. Jeff Pierce, MD: Well, yes, I love growing food. my family and I grow the majority of our fruits and vegetables, and I use it as my, you know, it's my it's my pharmacy, it's my grocery store, it's my gym, it's my meditative place. It's all kind of all wrapped up into one. and we've kind of made it work so that we're harvesting a couple times a day, almost every day of the year, fruits and vegetables. So right now here I'm in I'm in wine country and what grows really well in wine country in Northern California are grapes. And so it's grape season and we're harvesting grapes and just eating them. Believe it or not, you can eat grapes, wine grapes and table Stephan Esser MD: Ha ha. Jeff Pierce, MD: grapes alike. And so we've been eating a lot of grapes. our our apples are coming in. our peaches just finished. and there's a A crop of avocados that hopefully in a couple of months will be ready too. So that's th those are some of the things that are keeping us busy in the garden. Stephan Esser MD: Awesome. Awesome. So do you recommend to people who like to be healthy that they should try to grow some things? And if so, what do you what do you think they should start with? What's easy? Jeff Pierce, MD: Yeah, definitely. I think I think gardening is is a way to health. You know, you can you can work out in the gym, which is great, but at the end of your workout, you don't have a fresh bowl of strawberries. and so so I that's one of the reasons why I like getting getting active daily in the garden because it's beneficial in so many areas. And so grow what you love, grow what works well. in your growing zone and to figure that out, you know, reach out to your local university extension, your master gardener group, and and find out what grows well, you know. Something tells me no matter where you live, there's gonna be something that grows really well. And and then you can add that to your table. I I'm a big fan of greens just like you are and find a green that does well whether it's kale collards or chard or whatever. and then all of a sudden you have too much and you don't have to worry about it wilting in the back of the fridge because you only go to the store, you know, once a month or something. You can just pick it the day that you want to eat. Stephan Esser MD: Awesome. So once again, if someone wants to connect with you, what's the best way? Jeff Pierce, MD: Well, for folks that would like a consultation, we're at lifestyle telemedicine.com. For folks who just want to geek out on lovely edible things that we grow in our garden, they could follow on Instagram and I'm at Dr. Jeff Pierce. and yeah, get out there, get healthy, get growing, and we'll have so much more control of our health destiny than we ever thought. Stephan Esser MD: Love it. Thank you for joining us today on the podcast, Doctor Pierce. Jeff Pierce, MD: Thanks for having me, Stefan, Doctor Esser. love all that you do, love the NHA and am so lucky to be a small part of it. Thank you so much. Stephan Esser MD: All right, everybody, join us for the next NHA Today podcast. We look forward to sharing a passion for health and vitality with you soon. Take care.