Welcoming our newest doctor, Dr. Jeffrey Pierce, to our group of plant-based physicians!
Dr. Pierce and the team discuss supplements for families with plant-based diets, hair-loss, and hemochromatosis.
Questions Answered
- 01:48 – Special considerations for pregnant women starting a plant-based diet
- 04:15 – Dr. Pierce's experience with a whole food plant-based diet
- 11:45 – Should young women supplement Folate?
- 13:47 – Recommended daily dose of B12
- 15:33 – Should you test your B12 levels?
- 15:33 – Advice for people struggling to commit to a plant-based diet
- 22:27 – Post-pregnancy health
- 25:06 – Are my children getting enough calcium?
- 27:43 – Do you accept Tricare?
- 28:18 – Suggestions for hair loss caused by dietary changes
- 31:55 – Do I need K12 & Where can I find K12?
- 33:04 – Hemochromatosis, How do I get enough plant protein while avoiding iron?
- 38:04 – Dry skin on a plant-based diet
Complete Transcript
Dr. Laurie Marbas
(00:03)
Welcome, everybody to the Plant Based Telehealth live Q&A. We're here to help support you in your transition to a plant based diet or any questions you might have. And today we want to welcome Dr. Jeff Pierce who's our new addition to our team. Welcome, Dr. Pierce.
Dr. Jeff Pierce
(00:18)
Hi. How are you doing? Nice to meet you. Nice to see you guys.
Dr. Laurie Marbas
(00:21)
Excellent. So Dr. Pierce, we really want to make sure that everyone knows about you and what you enjoy and do. So can you tell us a little bit about your practice and specifically maybe some fun cases or something that you'd want to share with us, especially maybe your interests?
Dr. Jeff Pierce
(00:41)
Sure. So yeah, my name's Jeff Pierce. I'm originally from Texas and have lived in California since I came here for residency training in family medicine back in 2004. And my practice has involved since then working a lot internationally in Africa, Latin America, little bit in Asia. And I've had a focus on infectious disease care and then also in the care of pregnant women. And that's probably been my greatest focus is I'm working in the obstetrics and gynecology department at a hospital and that's where I'm doing most of my care. And as far as lifestyle medicine goes, help using diet and other lifestyle modalities to help people prevent, treat, and reverse chronic illnesses. That goes from all stages of the life from birth to death and with a special focus on obstetrical care.
Dr. Laurie Marbas
(01:48)
So could you tell us, is there anything special that we have to be… For example, how do you approach someone who's pregnant and how do you get them started on this plant based diet? And any special considerations for someone who's pregnant?
Dr. Jeff Pierce
(02:04)
Sure. So it of course will depend on where the person is starting. For someone new coming in, they're already eating great and they're plant based or vegan and they just want to know, “Hey, what supplements should I be paying attention to? And do I need to increase my iron or my protein and things like that?” To be honest, in my current practice in the inner city county clinic and county hospital, most patients aren't coming from that standpoint. They are coming from, “Hey, I'm in my first trimester and you're just telling me that I have a new diagnosis of totally uncontrolled diabetes that I didn't know about. And I'm 100 pounds overweight maybe and I have high blood pressure and risk factors for heart disease. And just I guess give me the insulin and give me the medications, doc, I guess if I have to.” And so we're starting at a very different place for them. And certainly it's an interesting lessons from both groups of those patients.
Dr. Jeff Pierce
(03:17)
But you asked are there certain things that women should be paying attention to and I think as I was learning from a webinar with Dr. Klaper and Brenda Davis and others recently, there are, thankfully for women eating a plant based diet, by and large you're going to have your bases covered. And there's some things that you have to pay particular attention to and we can go into that in more detail as the webinar progresses perhaps, but making sure that you're getting your folate and B12 and your iron. And you need some more protein, but you'll get that from eating your legumes, and your whole grains, and nuts and seeds, and health fats, and things like omega-3s. And all that stuff comes in, little bit of supplementation, as well as eating a broad diet.
Dr. Laurie Marbas
(04:13)
Dr. K, Dr. Miller, do you have any questions for Dr. Pierce?
Dr. Chris Miller
(04:15)
I do actually. Dr. Pierce, I would like to know how you went whole food plant based. What motivated you to go that direction?
Dr. Jeff Pierce
(04:24)
Sure. So, born, raised in Texas, where you might've heard we have lots of meat over there. And also coming from a bi-cultural family, Hispanic, Latino on my mom's side… Hi, mom. I know your supposed to say hi to mom whenever you're on television. It's required. And so from multiple directions, lots of pressure for eating meat and drinking dairy. And I had a very healthy and luck upbringing by and large and I owe my life to my family. I'm thankful for it. But it was in college that I saw my first documentary on the modern meat industry. And that was in 2000 and so I quit eating meat at that point as I was finishing college, going into med school.
Dr. Jeff Pierce
(05:22)
Had been vegetarian for 20 years, but in the last eight years or so when I met my wife who did a good job of showing me how to not be a junk food vegetarian and to eat better. Plus showing me how we can grow our own food and eat really healthfully from the vegetables and fruits that we plant in our own garden. As well as stumbling initially into the literature from Michael Greger at NutritionFacts.org and the good folks at Physician's Committee with Neal Barnard, Dr. McDougall, et cetera, I learned that there's a difference between being vegetarian and eating a very healthy whole food plant based diet for prevention, for treatment. I have noticed that my hand arthritis that would come and go has gone away. My seasonal allergies that they say everyone in northern California just has to deal with every winter and spring have pretty much gone away. And it was subtle and I was thinking back to it and I was like, wow, I haven't taken pills for allergy for years.
Dr. Chris Miller
(06:34)
We'll have to have your wife on next time since she's the one who made the change.
Dr. Jeff Pierce
(06:41)
She'll keep me straight and make sure that everything I'm saying is true.
Dr. Laurie Marbas
(06:44)
So Dr. Pierce, you're licensed in California, correct?
Dr. Jeff Pierce
(06:51)
I am. I'm licensed in California since all my training and work has been here. I did college and med school in Texas, but you're not licensed in med school. But I am in the application process for getting medical licensing in Texas and that should hopefully be coming through pretty soon.
Dr. Laurie Marbas
(07:11)
Excellent, excellent. And then as far as any other, there's a few questions, are you okay with me… You're starting Monday, first of all. You have appointments. We're starting on Monday, so you guys can book out the new appointments. Just go to the website, the PlantBasedTelehealth.com website where you can click and request an appointment with Dr. Pierce or any of us should you like to do that. And so I would suggest, there's some questions here if you're cool with-
Dr. Chris Miller
(07:36)
I have one more question for Dr. Pierce.
Dr. Laurie Marbas
(07:38)
Go for it, Chris.
Dr. Chris Miller
(07:39)
I want to know why you're excited to work with Plant Based Telehealth. Why should everybody know that you're excited to work with Plant Based Telehealth?
Dr. Jeff Pierce
(07:48)
That's a great question. So even I guess eating a vegetarian diet for the last 20 years, when it came to patient care, I kept that pretty much to myself I think. In medical training by and large we're told politics, religion, personal habits like this, you're sort of encouraged to keep it to yourself and not maybe make a patient feel awkward by sitting down and talking to them about your beliefs on who's coming up for President and stuff like that. And so I had that as a very personal thing. I kept it to myself. But after learning more in the last really just in the last couple of years of just how powerful this can be, I felt like I couldn't not share this with my patients. This is almost a form of medical malpractice with the knowledge that I have to not talk about it.
Dr. Jeff Pierce
(08:51)
And so what a way to be able to day in and day out share such a powerful modality with my patients in a group like Plant Based Telehealth. Instead of where I'm say in a regular clinic where I have to do these 10 topics in a 15 minute appointment where I'm rushing through to make sure that the baby's heart rate is good and that you've gotten your ultrasound and you've gotten… And you have such a narrow amount of time to talk about, “Hey, well, let's try to get to the root of your diabetes and your obesity and your hypertension.” And you have five minutes to do that if you're going to move onto the next patient. And so with Plant Based Telehealth, this is our chance to do that.
Dr. Laurie Marbas
(09:42)
That's a wonderful explanation. That's fantastic. And speaking of sharing this information, that's the joy of doing something like this so we're actually able to share the power of nutrition and lifestyle intervention with a broader audience and I do know we have some questions. By the way, it looks like someone said, I don't know if I'm saying this correctly, but it says, “Love the Guayabera, Dr. Pierce.” Is that the plant or what you're wearing or what is that?
Dr. Jeff Pierce
(10:10)
Right. The shirt is a Guayabera and sometimes people refer to it as the Mexican wedding shirt. But you see it all throughout Latin America and even the Philippines.
Dr. Laurie Marbas
(10:24)
Ah, yes. Definitely in the Philippines.
Dr. Chris Miller
(10:27)
Especially you're getting married to us today.
Dr. Jeff Pierce
(10:29)
I guess so.
Dr. Laurie Marbas
(10:31)
It's a public announcement.
Dr. Jeff Pierce
(10:32)
We do need to bring my wife in on this. Yeah.
Dr. Laurie Marbas
(10:36)
All right, excellent. So, here's a-
Dr. Jeff Pierce
(10:40)
Before we-
Dr. Laurie Marbas
(10:40)
Go ahead, Dr. K. Yes.
Dr. Michael Klaper
(10:41)
Before we move into the questions here, I just want to say how wonderful it is to have another experienced professional join our team here and it's certainly going to increase our breadth and our depth. And so I did six months of obstetrics at University of California at [inaudible 00:10:59] Hospital and I know the world that Dr. Pierce is coming from and bringing to us. And so if you are a couple or young woman who's either thinking of getting pregnant, is newly pregnant, has a question about your pregnancy as you go through this, he's just a jewel of a resource. And don't hesitate to make an appointment, at least layout your questions and the things you're dealing with, supplements, et cetera. At least a one time visit if not having him look over you during your pregnancy. But with his kind of obstetric experience, it's a gift to our practice. But to everybody who might be in that market to get this information, it's great to have him on board.
Dr. Laurie Marbas
(11:45)
Yes, I think you're exactly right. We all echo the sentiments. I was telling him how excited I was to share Dr. Pierce with the audience today. It's really amazing. But I will go to the next question. There was a question, whoever would like to take it, should young women supplement folate? It's one that comes up often. Any suggestions, thoughts?
Dr. Jeff Pierce
(12:10)
I'm happy to start with it. So, folate is a critical micronutrient for pregnancy, particularly in formation of the neural tube of the very early nervous system in the first trimester. And this is going on sometimes before you realize that you're pregnant. It is not an uncommon thing for a woman to come to my initial obstetrical visit where she's like, “I think I'm six weeks along.” And she's actually 20 weeks or 16 weeks, et cetera. So, being on folate is very helpful if you are in the age range where you could get pregnant, even if you're not planning actively on getting pregnant, because I would say the majority of my patients, when I ask them, “What was going on? Were you planning this? Was this a surprise? How do you feel about it?” And they're like, “It was a surprise, but we're happy with it,” which is the most common response. And so being on folate means that you are going to be prepared.
Dr. Jeff Pierce
(13:16)
Now for some women, that's being on a multivitamin, getting that 400 micrograms a day. For a very healthy eating, whole food plant based person, folate comes from foliage. And so eating lots of greens, which people eating whole food plant based diet do, you will be getting lots of folate. But particularly, if you're thinking about getting pregnant, if you're in early pregnancy, add that supplement as part of a prenatal vitamin.
Dr. Laurie Marbas
(13:47)
Excellent. And another question here. “What dose of B12 do you suggest? Do you recommend it daily or less frequently? I've seen Dr. Greger recently change his suggested amount and Dr. McDougall recommends less than others I've seen.” It looks like Dr. Klaper stepped out for a bit. So, Dr. Pierce, Dr. Miller, any suggestions on that?
Dr. Jeff Pierce
(14:09)
I can say something from the pregnancy side. So, this is an interesting one where you will see some disagreement among big names in the plant based community. The participant mentioned a couple who feel differently about it. So yes, B12 is very important in pregnancy. So, you'll see the recommendation that the B12 that's in your prenatal vitamin, you're getting that every day. And we need really just a few micrograms per day and that's going to be enough. Other people say, “Well, maybe it's not absorbed so well when you're getting it as part of a multivitamin. Add an additional B12 supplement.” That could be 50 micrograms a day, it could be 1,000 micrograms twice a week. In addition to the multivitamin, you could be adding two, a lunch and a dinner worth of vitamin B12 supplemented foods, which could be cereals or nutritional yeast and things like that.
Dr. Jeff Pierce
(15:17)
And so I don't think the science is to the point to where we can say definitively this is what pregnant women should do when it comes to B12, but there are a range of options that will probably work for you. I hope the rest of you can add to that
Dr. Laurie Marbas
(15:33)
Absolutely. I really agree. So, I usually test the levels and see where they're at and then we'll make some suggestions from there because sometimes some people are symptomatic within the normal range. You get them a little higher, they feel better and including tingling, the discomfort that they may have. And maybe their methylmalonic acid is elevated, which is another indicator of where you don't have quite enough B12. But there are several indicators that would say test and don't guess. And Dr. Miller, Dr. K, you have any suggestions on that?
Dr. Chris Miller
(16:01)
I test as well now. And a study came out just in the past year, which is why I think you're seeing a lot of people go with lower doses where people who had highest levels of B12 were having higher all cause mortality and so we have all backed down. We used to think, oh, you just pee out extra B12, it's not a big deal. But that's not true actually anymore. So, now I think you'll see everyone is starting to back down their numbers. But the other thing is if it's too low, people for all sorts of reasons don't absorb it very well anymore. So, it is individual and so I also test. And some people 300 is enough. Some people they don't need very much at all. They can do it through foods. Other people are on 1,000 micrograms a day and they're barely getting right where we need them to be. So, I actually do monitor that now. But in general, I tell people to start with about 500 micrograms a day of B12 and go from there then, follow levels.
Dr. Michael Klaper
(16:55)
I certainly agree with Dr. Miller. The only thing I would add is that the majority of folks, the question is what form of B12 should be used. And it's the issue of the cyanocobalamin versus the methylcobalamin and turns out the cyanocobalamin is cheaper and more stable and it works for the vast majority of folks. And so I have no problem with people taking that. I don't think the cyanide is a significant amount. But when you get your B12 measured, you should also get your level measured of a substance called homocysteine. And homocysteine is not friendly to your artery walls and if it's high, even though your B12 levels are normal, you may be someone who needs a methylated form of your B12 and your folate. And so if you're homocysteine is stubbornly high, 14, 15, 16, or higher, then you probably should not only be on the methylcobalamin but also methylfolate as well.
Dr. Michael Klaper
(18:00)
As Dr. Pierce said, folate really comes from foliage and it's really true. And the vast majority of vegans and plant based folks I've seen who really do eat those big plates of greens, like we're all told to do, their folate levels are off the chart when you measure. It really does [inaudible 00:18:20], it does the trick here. But if you're not eating that and your folate level is low and your homocysteine level is high, you might want to get a supplement that has methylcobalamin and methylfolate in it. But eat more greens anyway.
Dr. Laurie Marbas
(18:37)
Excellent advice. And so another question here is, “I'm having a hard time making 100% commitment. Was brought up eating meat at every dinner table. Any suggestions on someone struggling with commitments?” Anybody? Chris.
Dr. Chris Miller
(18:58)
So, I was just starting to form a plan in my head. But basically, it's different for every person. So, I would ask you what your goals are and what you want to accomplish. And I would probably recommend something like watching some of the documentaries, maybe get some inspiration, and start getting the information on what a whole food plant based diet really does and why you want to eat less meat and why it matters for your body, for your health, about the eating more meat. And when you review about the increased risk of cancer, the increased risk of heart disease, increased risk of all cause mortality, the increased risk of diabetes, obesity, all of these things, inflammation, autoimmune symptoms. All of this is significantly increased with increased meat. And so when you start to review that, that helps.
Dr. Chris Miller
(19:47)
That information is going to help. It's not enough to get you over the hump, but it's going to help. So, keeping that in your mind and writing out a plan or writing out your why. Why does it really matter? Why do you care whether you have heart disease or not? Why do you really care ultimately? And writing that down, looking at it, thinking about it, maybe meditating on it, having it there. And then from there, there's all sorts of different ways we can approach it and that's where you want to work with maybe one of us or someone else. But there's things like small steps, baby steps, so starting small. Maybe starting one meal a day, maybe just working on breakfast, breakfast alone, building a breakfast that has no animal products and substituting, make sure it's nice and substantial so you don't miss it. And doing that for a couple weeks and just that alone.
Dr. Chris Miller
(20:33)
You could also start with great meat reduction, instead of a big piece, you're doing a little piece and adding the plants in, so just starting adding in. So, there's a lot of fun ways you can do it. Make it fun. Make it not about depriving, oh, you can't have meat anymore. You can have meat. You're choosing not to. You're choosing it for yourself, for your health, maybe for the animals, think about them, maybe for the environment, think about that. So yeah, we'd be happy to help you build a plan or if you're working with someone, but you can get there. You just have to figure out a way that works for you I would say.
Dr. Laurie Marbas
(21:09)
Any other thoughts, suggestions on commitment?
Dr. Michael Klaper
(21:12)
Yeah. If you haven't seen a film called Cowspiracy, another one called What the Health, see those two films and see if that doesn't change your opinion of a meat based diet for all sorts of reasons. Highly recommend it.
Dr. Laurie Marbas
(21:25)
Excellent. Dr. Pierce, any other suggestions? You're good. All right. The one thing I'd say is when you're looking at commitment is what keeps tripping you up. So, obviously you have the desire to do so, but I would sit down and analyze what are the circumstances that are tripping you up. Is it family members? Is it not being prepared? Is it fatigue? Is it all these different things? And then try to come up with solutions in small steps, like Chris was saying, that will help you overcome those things that trip you up. So if it's stuff that's in the house, get it out of the house. If it's a family member bringing home something, have a conversation. So, there's just all these different things. If you get hungry when you're traveling home from work, bring healthy snacks with you. So, just find where that tripping point is and then that'll allow you to be prepared for it and you're more likely to be successful when you're prepared. Having come out of the military background, preparation is key when you're confronted with something. So absolutely practice it in your mind what's going to get you over the hump.
Dr. Laurie Marbas
(22:27)
So additional questions, here's a good one. Looks like we have a few actually about hormones. One in particular, “How do you go about healing adrenal fatigue and balance hormones postpartum?” So, I guess mostly you get all these things occurring after having a baby. Any suggestions or things that people should be doing after pregnancy to promote their health?
Dr. Jeff Pierce
(22:53)
I can speak generally. I haven't followed evidence based guidelines for this, but speaking generally, we encourage many of lifestyle habits that are pillars of lifestyle medicine teaching and movement. So, eating a very healthful diet full of fruits and vegetables and healthy carbohydrates and stuff like that has been shown to help mood in general. And I think I've seen something specifically when it comes to postpartum depression. And so the foods we eat effects our mood and our return to balance because we know that hormonal shifts equal mood shifts and postpartum depression is, for example, is a very important consequence of that.
Dr. Jeff Pierce
(23:48)
Exercise and this in part comes from not just focusing just on your baby, which is often the core desire of many moms. But to be able to focus on yourself. So, are you getting enough exercise? That might mean going out for a walk in your stroller with a nice wheel that allows you to walk at a good clip and help in that way. And when you're outside walking, you're getting some sunshine for yourself. Covering your brand new baby from the sun is a good idea. But you're getting the vitamin D and the mental health benefits that come with that, related to body balance. Working on sleep, which is, if you have not done it yourself, you know someone who has faced a challenge of getting good sleep when they're a new mother. And there's some ways to handle that. And making sure that you have good connection with other people who are supporting you. The proverbial village that you're working with to help support you through the difficult nights and the difficult days and all of that.
Dr. Laurie Marbas
(25:06)
Excellent. Anybody else? All right, we'll go onto the next one. Regarding calcium, “My kids aged 8 and 11 do not drink fortified drinks. And despite getting daily greens, I fear it's nearly enough to meet their growing body needs. What type of supplements do you recommend, preferably in powder form so I can add them to our homemade soy milk and smoothies?” Do you have any suggestions on the kids and calcium needs and how to move that needle forward? All right, so honestly, Kip, what you want to do is just really pay attention to your children and their growth. Are they staying on the same growth chart pattern? Are they falling off? That would be one thing. Do they have energy? Are they really running around like crazy mad people with tons of energy like most kids do? Make sure you're getting enough calories because if they're getting their greens, honestly they're getting some wide variety of foods so they should be fine.
Dr. Laurie Marbas
(26:04)
But I would definitely look at their vitamin D levels and make sure those are appropriate. Have your doctor check those and of course their B12. But as long as they're getting all the greens and the beans and all these lovely foods, they should be good to go. And just in quantities sufficient to sustain a growth of a child. But any other suggestions or thoughts there?
Dr. Chris Miller
(26:25)
Agree.
Dr. Laurie Marbas
(26:27)
Okay.
Dr. Michael Klaper
(26:28)
I would just [crosstalk 00:26:29], if you're raising a child, as part of our master class, we interviewed two authors of just a wonderful new book. Let me just write it here and the book is called Nourish by Brenda Davis and Reshma Shah. And they go through all the stages of life. And Dr. Shah's a vegan pediatrician and she really has a wonderful chapter on raising kids and getting enough calcium and all that in there. So, I highly recommend that you get that book and they have very good advice. But it's pretty easy to get enough calcium if your child, find ways to get greens into them. But yes, there are liquid calcium supplements that you can use to put into a smoothly. Just look for them online. You'll find them. Just google liquid calcium supplements.
Dr. Laurie Marbas
(27:27)
Okay, excellent. And so that was Nourish by Dr. Reshma Shah and Brenda Davis. Fantastic. All right. Oh, Kip says he's got the book. So excellent, Kip's on the [inaudible 00:27:43].
Dr. Chris Miller
(27:42)
He's on it.
Dr. Laurie Marbas
(27:43)
Kip has a lot of books I have a feeling. All right. And someone did ask if we accept Tricare. They said I need a plant based doctor. We don't accept insurance. If you go to PlantBasedTelehealth.com, if you look under information, it discusses pricing. But we can provide what we call a super bill or a receipt for a visit and then you can submit it yourself to your insurance company and hopefully you can get some reimbursement. I've had patients get zero to 100%. So, there's no really rhyme or reason why one and not the other, but that is certainly an available service should you choose to come see us.
Dr. Laurie Marbas
(28:18)
And I think we're closing in here, but you guys have time for a question or two more? Okay, good, because there's this one question. We do see this kind of often. This patient says, “I'm 44. My hair has been very thin since becoming vegetarian at 20. I take two tablets of ferrous gluconate every other day. Can I bump that up daily and still avoid constipation? What else should I look at? I miss the volume and it won't grow past my shoulders because it breaks off so regularly. Thanks.” Any suggestions on the hair loss that sometimes can occur when transitioning to a different diet?
Dr. Chris Miller
(28:53)
Yeah, there's a lot of reasons for hair loss actually. So, I work with a lot of patients, I'm sure we all do, see patients that have hair loss and iron insufficiency is one reason. So, I'm assuming that you're iron deficient, that you're replacing your iron, because otherwise you usually don't want to be on an iron supplement, but you most likely are. So, I would make sure that you see what your iron levels are before you think about increasing the iron. You don't want to over treat iron. You want to just be in the normal range, so that's real important because iron is actually pro-oxidant. And so that's one thing. I would check your levels and make sure. And it's good that you're doing it every other day though. I agree with that plan, so that's that.
Dr. Chris Miller
(29:35)
But there's so many other reasons for hair loss. So, inflammation can cause it, so people undergoing autoimmunity or any other chronic inflammatory state might see hair loss. Different medications can cause it. Stress plays a huge role in hair loss. So, what's going on in your life right now? That's a thought. Also, other nutrients, so zinc plays a role in iron, B7 I believe it is, biotin plays a role in iron. And so basically take a look at your diet and how well you're absorbing it. So, we can check levels and we can help make sure that other causes of it, besides just iron deficiency, and there's actually a few other things that aren't coming to mind. Maybe someone else will think it right now, but there's a differential for it that we can maybe help you with. Yeah, we see people with hair loss and often it changes with the diet and then it changes back. But if this is going on for 20 years and now you're noticing it, then maybe you do want somebody to check your levels and help you with that a little bit.
Dr. Laurie Marbas
(30:35)
Any other thoughts?
Dr. Michael Klaper
(30:36)
Yes, that was really well answered. The only thing I would add, you need a sufficient omega-3 fat for nice skin oils and to make sure hair quality is healthy. So, eat a couple tablespoons of ground flax and chia seeds every day. But also, as Dr. Miller was hinting at, these iron tablets, they're not candy pills. And for iron deficiency to be a cause of hair loss, you're dealing with a pretty significant iron deficiency, in my experience. But if you're not at that level of iron deficiency, it's not a matter of taking more iron tablets to get your hair to grow. And there certainly is such a thing as iron overload. It can really damage your liver, your bone marrow, et cetera. It can be pretty toxic stuff there. So as Dr. Miller said, get your iron levels checked. And if they're already in the attic, they're really high, don't be taking more iron pills just to make your hair grow. A word to the wise there, work with your doctor on that one. And we're a bunch who knows how to do that.
Dr. Laurie Marbas
(31:43)
Excellent. And yeah, she said her ferritin had been low in the past so she was-
Dr. Chris Miller
(31:48)
I'm assuming she's [inaudible 00:31:49] woman. That can be common for that.
Dr. Laurie Marbas
(31:52)
All right.
Dr. Chris Miller
(31:54)
Thanks for the update.
Dr. Laurie Marbas
(31:55)
I would say one other question here, “Can the panel comment on the need for K2 and where you can get it? It has a lot of attention lately.” Any thoughts and suggestions on K2?
Dr. Michael Klaper
(32:07)
Latest word from Dr. Greger is that we make all you need and really it is not an issue, so he says. I'm looking to see other studies to corroborate that, but it was a big relief to hear that. But he says that the precursors that are in the dark green leafy vegetables, another reason to have a big helping or two of dark leafy greens every day, so your gut bacteria can generate K1. But they continue to metabolize and you get a significant amount of K2 from that as well. So he's just saying in general don't worry about K2. I haven't closed the chapter on it, but there was a 50 year stay tuned to this channel, we'll give you updates if we find anything new.
Dr. Laurie Marbas
(32:51)
Yeah. K2's important for your bone health, for your arterial health. And it is, it's hard to measure. I've looked at trying to figure out ways to measure it and there's just not really reliable [inaudible 00:33:00] measurement at this point. Yeah, stay tuned. I don't know.
Dr. Chris Miller
(33:04)
I do pay attention a little though because the microbiomes [inaudible 00:33:08] but a lot of people with autoimmune diseases or IBS or gut issues that maybe don't have that healthy microbiome yet. And if people have osteoporosis or heart disease, some of the higher risk people, I do supplement a little bit of it for them. Kind of keep an eye on it because we're not as healthy, Dr. Greger, maybe as we want to be. We're striving to get there. But it is a work in progress. So like everyone else has said, stay tuned because we're also trying to get to the bottom of it. But I do tend to supplement in some people for sure.
Dr. Laurie Marbas
(33:39)
Yeah, absolutely. I would say the final question here is from Kathleen. She asks about her mom having hemochromatosis and since we were on the iron talk anyway and being hesitant about eating plant foods that are rich in iron. She started eating more plants. Greens in her daily smoothie, beans in soups, and her most recent blood work shows the highest level she's had in years. And they've been recommending a phlebotomy due to the elevated numbers. She isn't giving up, but any advice on still getting in dark leafies and plant protein while staying away from lentils and beans? And thoughts or suggestions on hemochromatosis and plant iron? Actually it's safer to eat plants than animals.
Dr. Michael Klaper
(34:21)
[crosstalk 00:34:21]. Yeah, sorry. Hemochromatosis is a serious condition. Iron builds up in the body. Under the best of circumstances, normal people, we don't get rid of iron very easily. Unless you're a menstruating female, then you folks lose iron every month. But us guys and post-menopausal women, we eat iron and outside the little bit that goes out in the stool, a little bit comes out in our sweat and our skin cells and they slough them, we don't get rid of it very easily. And people with hemochromatosis don't really get rid of it at all and it can build up to high levels, as I mentioned, damage the liver, et cetera. It can be a fatal disease.
Dr. Michael Klaper
(35:03)
So, here dietary iron makes a difference. And like you very appropriately described, you eat a lot of high iron containing foods and it shows up on the lab tests. That's true. So a couple of things. Here's where it'd be helpful to find a plant based dietician who can do an analysis because you need to be eating the low iron greens and the low iron legumes and the low iron grains. Someone needs to look at your diet and get a low iron version of that going for you. And Julieanna Hever and others in the field can help do that.
Dr. Michael Klaper
(35:45)
But then, the doctors mentioned phlebotomy. Not a crazy thought just to drain off a unit or two of blood and just get rid of the iron directly out of the blood stream. And that's an absolutely approved and legitimate maneuver for people with hemochromatosis. So if the doctor thinks it's gotten to that stage, yes, she should definitely have that. It's just like giving a unit of blood at the blood bank. It's nothing that dramatic. But regular phlebotomies may be part of treatment there, but she needs to really get serious about low iron foods and tailor her diet to not give her more iron overload.
Dr. Laurie Marbas
(36:21)
Yeah, absolutely. And with my own hemochromatosis patients, when I was in brick and mortar, certainly did, you'd hit a certain critical level and then you literally just send them to the lab and they draw the blood and they come on back down. It's just what you have to do as part of management of that disease process. Dr. K's very right. It can be dangerous for the heart and the liver and so it can cause organ failure. So, it's really important that she monitor her intake. But you got to think about it plant foods are healthy version than the animal products. So, she'll be getting less iron absorption most likely if she would have been eating more of the animal products, if that makes sense. But yeah, like you said, I certainly think a more qualified dietician should be able to guide her in that. And like he said, don't dismiss the phlebotomy. It's just the way it is. It's just management of the disease, like taking a medication. So, sometimes you have to do that.
Dr. Chris Miller
(37:13)
Even on a plant based diet, yep.
Dr. Michael Klaper
(37:19)
Absolutely. The beauty of a plant based diet is that the iron that's in spinach and dark leafy greens and beans, et cetera, it's harder to absorb a little bit. But the intestinal lining can decide if there's a lot of iron already in the blood, the intestinal lining can keep plant based iron out. Not so with heme iron from animal muscle. That stuff leaps into the blood stream. And red meat eating macho guys there who don't realize they have hemochromatosis can really give themselves an iron overload severely. So, here's another advantage where a plant based diet gives a leg up as far as iron balance goes. But still, she needs to be on the low iron greens and other plant foods.
Dr. Laurie Marbas
(38:04)
You guys have one more question because this one was actually emailed and she just messaged me. Okay, sorry. Yesterday she goes, “I submitted this question. Not sure how long this webinar goes. Since starting my whole food plant based diet, my elbow psoriasis returned along with both index fingers getting cracked and dry skin. Both shins are dry, itchy round red marks on my left leg. My weight originally fell five pounds and stopped. It's not budging in the last two weeks. In 15 days, my fasting glucose went from 138 down to 112, then back up to 127.” She goes, “I ate a lot of fruit, vegetables, lentil soup, salads, fat comes from seeds, nuts, avocados. My past thyroid tests were normal. Why am I not losing weight and why has my glucose gone up high again” So, I guess we'll focus on let's try on the dry skin and then there's lots of reasons why blood sugar can go up. And honestly, that probably needs to be more of an individual appointment type basis. But can we maybe describe what they may be lacking on a dry skin on a plant based diet? Any thoughts?
Dr. Chris Miller
(38:58)
Just in general, it depends if people are following a low fat plant based diet. So sometimes for reversing heart disease or diabetes, people go on a real low fat diet. So, we do need a little bit of fat actually and so we do need especially omega-3 fatty acids. If it's someone with diabetes or heart disease, we still try to sneak in maybe a little bit of flax or chia seeds, something maybe occasional little walnut trying to get the higher omega-3s in. And that's something you could work with your doctor or you can monitor to see how much you're able to get in, so that's one thing for… And if you're not on a low fat diet, then you can eat. If you're woman, I usually recommend about a quarter cup a day and if you're a man, usually about a half a cup a day of nuts and seeds combined. So, you do need that fat, so I definitely recommend that.
Dr. Chris Miller
(39:42)
And the second thing, we've been talking about this I think within our group, different things that we like to put on our skin. And so some of those oils, we were talking about almond oil or coconut oil, some of that really actually does help in winter. And now we've been washing our hands so much, so we've been using that in our house. And that definitely has helped a lot with our dry, cracked skin. Using some of those oils right after we wash it in the morning, in the evening, and right after washing. So, those are some basic tips that I have off the top of my head.
Dr. Laurie Marbas
(40:12)
And someone was asking about Dr. K's master class. So, that can be found, Dr. Klaper, on DoctorKlaper.com.
Dr. Michael Klaper
(40:22)
Yes. If you go to DoctorKlaper.com, it'll get you onto the teachable website and all the individual master class, all 12 of them, are on the teachable website. But I think the link on DoctorKlaper.com will get you there.
Dr. Laurie Marbas
(40:32)
Excellent. All right. And that's an excellent resource for those who are seeking more knowledge. So Dr. Pierce, thank you again for joining us today and we're so happy to have you on our team and excited to see the presence you'll have in our lives and the lives of our patients. So, thank you.
Dr. Jeff Pierce
(40:49)
My pleasure. Thank you very much.
Dr. Laurie Marbas
(40:51)
Absolutely. Thanks everyone and have a great day. Just like I said, this'll be posted on the Plant Based Telehealth YouTube page and our webpage. You can go to PlantBasedTelehealth.com, make an appointment with Dr. Pierce or any of us as well. And we're looking forward to seeing you in two weeks. On the second and fourth Thursdays of every month, we'll see you here. Thanks, guys.
Dr. Chris Miller
(41:15)
Bye, everyone.
Dr. Michael Klaper
(41:16)
Bye.