Dr. Tiffany Di Pietro: 0:00

People gain weight. They go through divorces, you know, a child dies something catastrophic happens. We're human things happen to us weight fluctuates, stress fluctuates, life fluctuates, but it's about kind of getting back on track and loving yourself enough to want to be around to want to live a long life to be around for your children to be around for your family.

Philip Pape: 0:21

Welcome to the wit's end weights podcast. I'm your host, Philip pape, and this twice a week podcast is dedicated to helping you achieve physical self mastery by getting stronger. Optimizing your nutrition and upgrading your body composition will uncover science backed strategies for movement, metabolism, muscle and mindset with a skeptical eye on the fitness industry so you can look and feel your absolute best. Let's dive right in Whitson weights community Welcome to another episode of the weights and weights Podcast. Today I've got a very special guest joining me. Dr. Tiffany DPAA. tro is a triple board certified cardiologist, internal medicine specialist and nuclear cardiologist who's on a mission to help people achieve their goals through preventative measures. And when I came across Tiffany's work through a member of our community who recommended her from another podcast, I was immediately impressed by her passion for educating the public about health and nutrition and disease prevention. This is a woman who graduated magna cum laude with a Bachelor of Science in psycho biology at just 19 then went on to become the youngest graduate from the College of Osteopathic Medicine at Nova Southeastern University down in my home state of Florida. You know how I'm drawn to overachievers. But what really drew me to Dr. DE Petro was her focus on prevention. When it comes to cardiovascular disease in particular, she also tells it straight and I know she's going to do that today, we're going to dive into some of the myths surrounding heart disease, like the idea that it's only a man's disease, or you have to have symptoms to have a problem. Tiffany is going to share her best practices for nutrition and movement to maintain a healthy heart and effective ways to prevent cardiovascular issues. And then later on the episode, we're going to step into the minefield of the biggest beautiful movement and ask the question can be also be healthy. As an assistant clinical professor at three medical schools, a medical adviser and a law firm, a regular medical expert on national media outlets, and so much more. Dr. DT, Pietro has tons of experience and expertise to share with us. And I think you're going to love Tiffany's approach to health care, which I'll be honest, we don't always hear this from doctors on the preventative side. So she believes that helping people understand complex medical issues is the key to promoting better health outcomes. And she has a lot of positivity to go with it. And it's just what we need these days for anyone looking to improve their cardiovascular health and well being. And I think you'll love the rule that she lives by, which is simply be nice, Tiffany, thanks for joining me on the show today.

Dr. Tiffany Di Pietro: 2:45

What a nice welcome. Thanks for having me.

Philip Pape: 2:48

Absolutely. I know my listeners are gonna love to hear all about this, because we talk about heart disease, sometimes as just a man's disease, and not realizing it's really the number one cause of death for women as well, obviously, and there are a lot of other, you know, scary statistics we can get into here. I do want to understand from you, you know, why is it a concern just in general for the population? And then what the risk factors are individuals have to think about before we get into, okay, how do we deal with that? Sure.

Dr. Tiffany Di Pietro: 3:14

So, you know, as you said, heart disease is the number one killer of women also in this country. And I feel like I say that on repeat. And yet I still feel like people don't know it. So it's a little frustrating. You know, I think the society's for breast imaging and mammograms, they do a great job in October, where everything's Pink, pink, pink, and everyone remembers to get their mammograms. But at the end of the day, more women die of heart disease and all forms of cancer combined. So, you know, I tell my female patients, it's great that you know, when your last mammogram wasn't, it's great that you know that you're due for one, but I mean, you really should just know your cholesterol and know your blood sugar and know what your blood pressure is and what those numbers should be. And really kind of ask your doctor, what do I need to be worried about? What should I be focused on? What are these numbers? And what should they be? As a little statistic since 1984, which is before I was born, believe it or not, more women have died of heart disease than men in this country. And that's a staggering statistic. Forget just that, you know, that's number one killer. I mean, more women actually die than men have heart disease. And I think that's partially education. And I think that's partially like we still especially physicians, honestly still don't think that when a woman coming in with chest pain or palpitations, you know, it's kind of chalked up to being anxiety or something else. And there's a big lacking in medicine, amongst even physicians kind of taking women seriously.

Philip Pape: 4:38

Yeah, I understand what you mean. Because just in my own family's history, you know, primarily think of, you know, my grandfather died of heart attack and heart disease on on men side, and I wonder where the stigma comes from. I'm curious if you know where that history comes from. I mean, there's a lot of stigma when it comes to women's health and a lot of areas that we're now trying to correct. But I'm just curious about that.

Dr. Tiffany Di Pietro: 4:59

I don't I'm You know, the reason I became a cardiologist is truthfully, I just I found that it was a niche that really I can make some difference. And I know it sounds corny and cheesy, but it's just the truth. And you see a lot more female cardiologist starting to graduate and come out as well. But it's still definitely even an underrepresented field amongst female cardiologists. If you go to the cardiology conventions, it's like, you know, 75 80% men and 20% women. So I think as more females graduate, as cardiologists we'll kind of see the stigma, hopefully start to dissipate some. But yeah, I don't know. I wish I knew the answer to that. But

Philip Pape: 5:35

okay, yeah, no worries, well, let's we can dive into the practical stuff and try to understand it here, as well as what people can do about it. But you mentioned bloodwork, I think, you know, if anybody goes to like the CDC website, or just Google, or even just from experience, we all have heard the main types of things to measure, right? blood pressure, cholesterol, things like your weight and your activity come into play alcohol and things like that. What would you say, are the top two or three things that everybody should be measuring on a regular basis, as opposed to say over testing certain things? And just getting freaked out? What are the things they really should be measured? And then where does the distinction for women particularly come in with some of those measurements?

Dr. Tiffany Di Pietro: 6:13

Yep. So luckily, that's a very easy question. So blood pressure, for sure. The problem with blood pressure Well, amongst other cardiovascular issues, but the problem with blood pressure is we call it the silent killer for a reason, you can have very high blood pressure and have zero symptoms. And so that's probably truthfully number one, followed by blood sugar and cholesterol levels, in particular, the LDL, I tell my patients think of L for lousy, that's the bad cholesterol, that number, the pendulum has really started to swing. So Europe is always ahead of the United States in medicine. And their guidelines are usually three to four years ahead of ours. So I tend to look at European guidelines a lot, because I know what's going to come downstream for the United States. But when I was in training, and in medical school, the goal LDL was less than 130. Now it's less than 100. And if you have diabetes, or have a history of a heart attack, it's less than 70. So what we've really started to see in medicine over the past really decade is that the lower the cholesterol, it's almost a one to one correlation in terms of lowering your risk of heart disease. So by far easy stuff, this is like bread and butter hasn't changed in many years, except for maybe the cut offs is blood pressure, blood sugar, and cholesterol numbers.

Philip Pape: 7:27

Okay, and I want to jump into my first of the controversies that are out there. And that is, I currently eat a flexible diet as to you know, we're proponents of, you know, eating what works for you tracking, you know, working out all of this stuff, and not being too rigid with any particular food you don't We don't cut out foods or anything like that. However, there are some camps out there in the fitness industry with food when it comes to cardiovascular disease and saturated fats, for example, or even the measurement of LDL cholesterol, you know, not believing that it's as serious, can you address some of those misconceptions of why understanding LDL and having an under certain number is important for everybody, and what the links are any evidence with that and cardiovascular disease, that's one piece of it, the other we can get into like low carb and all that later.

Dr. Tiffany Di Pietro: 8:12

You know, there's more links in research with this, and probably pretty much anything else in cardiology, I mean, I could pull article after article after article. And again, to my point earlier, that's why we now know that the lower that number, the less the risk of heart disease. Now, I think what's important is people take things to the extremes. And you could have a very low LDL and still have a heart attack, or you could have a very high LDL and have no coronary disease. So a big part of it is the number. But what comes into that also is someone's genetics and what they're genetically at risk for. So you can have a very kind of normal ish LDL, let's say it's maybe 110 115, it's close to being normal. But that LDL might be very sticky, or what we call atherogenic, LDL. And if you have a very atherogenic LDL, it really doesn't matter how low it is, you're higher risk than someone that does not have an atherogenic LDL. And that's where some of these more advanced lipid panels come into play. In terms of diet, I am a big fan of pretty much everything in moderation is okay. That's always been what I stand by. Obviously, if I have a very uncontrolled diabetic, it's, you know what, well, let me let me back up. What I realize is when you tell people a little bit, it's not never really a little bit, it's more than, you know, maybe a little less than what they were doing. And when you say no, then they'll still do a little bit. So, for instance, my diabetic patients, I'll say Listen, no refined sugar, no, this know that knowing that they're going to have a little bit. But you know, I think you'd be hard pressed to say, well, you know, if I have an egg or two, you know, twice a week that something catastrophic is going to happen to me. And a lot of times, that's where their medications come into play, too. And I think my biggest frustration with the world right now is thinking that everyone's doing something for some fun pharmaceutical company to make money. You know, it's frustrating. I have never made$1 off of any pharmaceutical company. But yet some on the internet says that we do. I don't know where they're getting this information, but I'd like to know where my money is, if that's the case, for sure

Philip Pape: 10:13

you gotta get I've never made a dime, get those royalty checks. Yeah, yeah, it's, you know,

Dr. Tiffany Di Pietro: 10:18

I'm sure there's some margin of truth to someone somewhere, some CEO of some business, but when it boils down to it, you know, our your regular hometown, good cardiologists look at data, we analyze that data independently, and we come up with the right decisions for our patients, and you'd be very hard pressed to find a cardiologist that's not, you know, doesn't want to be famous for being different. Let me put it that way. That would say that cholesterol medications are going to harm you. I mean, there's just too many studies saying that they're not going to do I want to put patients on medications? No, but do I have to sometimes because it's the right thing for them, and I want them to live a long healthy life. Yes. So you know, it's a conversation that you have to have with the patients. And my most common quote in my office is you can take one medication now, or you can take for for the rest of your life, after you have your heart attack, it's your pick,

Philip Pape: 11:13

I totally relate. And I'm not going to criticize that either. And I've seen in my own family where someone my own father included, has gone on medications, but then change his lifestyle was able to maybe come back off some of them, maybe not all of them. And at the end of the day, we want to have give ourselves the best shot I think while also not being stupid, just not I hate to say it that way, but not just, you know, following the, the extreme kind of influencer, you know, mentality here, like you said, against maybe against the medical profession. Well,

Dr. Tiffany Di Pietro: 11:41

it's also about what's maintainable as well. So when I talk to patients about diet and exercise, you know, if I say, you know, you should eat a diet full of X, Y, and Z, and they hate all of those foods, well, that's just not going to work. It's not feasible for that person. And so, you know, every decision that is made should be a very educated decision between the patient and the doctor in there, yes, very personalized between the patient and the doctor, and what's going to be best for them. But to say that we don't have so many tools in our armamentarium to help people not die of heart disease. I mean, 90 90% of heart disease is preventable 90. Yeah, that's a staggering number. And we have so many things to help us prevent it, but yet, we get so much pushback. You know, look at our life expectancy, we live a lot longer than we ever did before. That's not because we're miraculously more healthy. No, we're fatter. We're fatter than we've ever been in this country, yet. We're living longer. That's because of medicine. Yeah, so Okay. Fair

Philip Pape: 12:37

point. Now, the people listening to this show may be in a little bit of a different tier of the prevention side, where they are, you know, trying to be preventative with their lifestyle, they are willing to, you know, eat more whole nutrient dense foods, you know, they don't want to cut everything out because they understand flexibility. And sustainability is important. But they want to know, for example, dietary fats, it's confusing. There's, you know, mono unsaturated poly, and they're saturated, we've heard that there may be as a threshold for saturated fat associated with cardiovascular disease. And so two points there, I would love to hear you help clarify is, is there a reasonable, say limit to saturated fat in particular, that we should be cognizant of? And is any of the research confounded in the populations with that level? In other words, if you have an overall healthy lifestyle, with everything else, is that saturated fat limit as important? Probably

Dr. Tiffany Di Pietro: 13:25

not. Again, I think it's very difficult. Well, it's very difficult to give a global answer on that, because it really is so personalized each person, I think, probably from my experience in my research, I mean, obviously saturated fats, there is a link between saturated fats and cardiovascular disease, I don't think No is the answer, I think, you know, really watching and being cognizant of it is probably the answer. More importantly, is the effect on those saturated fats to inflammation in the body. And so the more research we do, the more we find out that it's yes, it's cholesterol, and yes, it's saturated fats. But really, it's what's causing this inflammatory response in the human body, which is then leading to the cancer and the heart disease and the heart attacks in addition to that, and so really, it boils down to for most trying to avoid things that come out of animals, especially very big animals, because there's a pretty good link between that and systemic inflammation. So you know, we like things that grow out of the ground first, and then we like things with no legs in the ocean, and then things with little teeny tiny legs on the ocean floor, and then we kind of work our way up to where I would never tell someone ever that they can never have a steak or a hamburger or hotdog, which should it be definitely, but should it be the the mainstay of their diet. Do I want someone eating? You know, something that came out of a cow every day? No, because I can almost guarantee you their inflammatory Mark. because you're going to be elevated. And

Philip Pape: 15:02

is that measurable through any sort of like autoimmune type panels or I'm just curious when it comes to inflammation, it's kind of a confusing topic for a lot of people, because people will talk about inflammatory foods or, and they'll kind of overlap it with things like insulin resistance and sensitivity and a whole bunch of other things that get confusing. Is there a way to measure that are very

Dr. Tiffany Di Pietro: 15:21

different stuff? Yeah, so we use something called a high sensitivity CRP or CRP, there's CRP. And there's a high sensitivity CRP, in particular, in cardiology, we use a test called a high sensitivity, CRP. And that gives us an idea of if there's any inflammation going on inside of the arteries, generally in your body, but more particularly the arteries of the heart. And that's what cardiologists really care the most about is really that inflammatory response you could have. So people kind of that are listening, understand, like I said, you could have a very high cholesterol, you could have all of these problems, but it's usually an inflammatory event, some sort of inflammatory response that causes disruption of the arterial wall and the plaque that then causes the heart attack. It's an inflammatory response. And so you know, my take home for my patients is listen, I'm really never going to say you can't ever have anything. But if you, you know, if you love fish, I'd rather you have more fish than steak. And if you love steak, I'd rather you have the filet not the New York Strip, like there's ways of manipulating it some. But yeah, I'm not, I'm not a no go type of physician. I just don't think it's maintainable. And at the end of the day, I just want people to maintain health, I don't want them to be super healthy for five years, and then fall off the wagon. That doesn't that's not success in my book.

Philip Pape: 16:37

I totally agree. I mean, there's small changes that if anybody made them would be a big step change, right? It's kind of the 8020 because I believe something like most Americans consume, like 70% Ultra processed foods or something, if you just flip that around, that's a huge improvement, huge, you know, huge.

Dr. Tiffany Di Pietro: 16:53

I even say, you know, if someone could have, like three vegan meals a week, and then we manipulate that to just one a day, you know, think about like a lunch with just like salad and like a balsamic vinegar and lots of vegetables, like, I could never be vegan. So it's very hard for me to tell my patients to but I know I could do one meal a day vegan, I know, I can do that. I could eat oatmeal that's made with water, almond milk. And there's ways of doing this. And I think taking those little, it's like parking far away and walking instead of parking, you know, at the closest spot, taking those little steps, is really what makes the biggest difference long term. Yeah,

Philip Pape: 17:29

I hear you. And same thing. I'm an omnivore. And I'll have occasionally a non meat based dish here and there. I don't know if I've gone a whole day without me. But that's just me. And at the end of the day, like I know, when I work with my, like nutrition clients, if we look at something like saturated fat, and it's way up there, then you know, there's some shifts that could be beneficial in what you're saying, you know, incorporating more plants or seafood and things like that will just naturally get you away from that. And so there's different ways to kind of look at it. You mentioned arteries. So that brings to mind the calcium score. Do you recommend that the calcium like that heart X ray, or no? Oh, no, it's just a controversy.

Dr. Tiffany Di Pietro: 18:06

It's a big concert. So anyone who's probably cracking up right now, I absolutely despise calcium scores. Okay, let me maybe refrain that, you know, rephrase that a little bit. I despise calcium scores on anyone under the age of 60. The older you get, the more reasonable and sensitive and specific a calcium score becomes. Here's the science behind it. A calcium score measures calcium, okay, calcium in or around the arteries of the heart, it does not look at nor can it measure any cholesterol rich plaque, which has not calcified yet. That process of calcification takes time, it does not happen overnight. So if you do a calcium score on a 45 year old, and the score is zero, then what happens with the pavement and let's say their cholesterol is high, and this is my problem with it. I get a patient that comes in doc, and this happens once a week. Doc, my cholesterol is high, my primary wants to put me on a statin, I don't want to be on it, I want you to order a calcium score. No, because what's going to happen is I'm going to order that calcium score on a 45 year old and it's probably going to be zero, because calcium has not had time to form yet. And then what happens is that patient who might actually have cholesterol buildup in those arteries now definitely is not going to take medication because now you've just told them what they want to hear. Now you fast forward 10 years and that person's had a heart attack when the medication probably would have prevented it had they taken it prior. So older patients it's an okay test and I don't Super Fight on someone that's kind of 60 and older, questionable mid 50s. Maybe I start negotiating never before mid 50s good to know because you're just going to miss a substantial amount of cholesterol plaque that is not calcified yet and give people this false sense of security that everything's okay. I have horror stories of patients that have normal calcium score. And I've had heart attacks and open heart surgery and you name it, that it's bad. I mean, I lecture doctors on this, usually about once a year. And inevitably, all of them come up to me, there's like a line out the door afterwards like, Oh, my God, I've been doing this wrong all along, you have to understand how this works. So, you know, it's a cheap test, but it only risk stratifies. It's kind of like giving you half assed information. If I'm going to order something, I want to know everything. I

Philip Pape: 20:26

get it, because it'd be one thing I guess, if you said if the score was negative, that's the only time we're going to act on it. But like, you know, humans don't work that way. Because the zero comes back and you rely on that. So

Dr. Tiffany Di Pietro: 20:37

you know, in a 45 year old, the only positive meaning of a calcium score is when it's not zero, because then you got a real problem. Yeah, I have and you already have patients

Philip Pape: 20:45

started early. And it took that long. Yeah, right. I'm glad I asked. Because I have heard that I was asked to take one years ago when my cholesterol dipped up just a tad. And it came down later. And it was like, what was the point? But ya know, I've heard people get recommended that so now that listeners was more informed, and that's why I asked it. Okay, so I think we talked about a little bit about nutrition. I don't know if fiber is another one that comes to mind. I mean, for years and years, I grew up in the 80s. And it was like, fiber rich cereal, you know, hard, healthy and all that. Cheerios. Right, I think they still have it on there. Tell us more about the link there. Yeah,

Dr. Tiffany Di Pietro: 21:16

fiber, from a cardiovascular standpoint helps to increase the HDL a little bit, which is the good cholesterol, and decrease triglycerides a little bit, which is another type of cholesterol particle. I think more important for fibers really colon health, if anything, you know, it keeps your poop nice and soft, and you get to have nice bowel movements. And there's a pretty good correlation between high fiber diets and less incidence of colon cancer, just like there's incidents of high animal protein like high red meat diets and a higher incidence of colon cancer. Yeah. So I think that's probably more the correlation now, less so for heart disease, and probably more for colon health.

Philip Pape: 21:50

Okay, yeah. And that's a good reason to your fiber anyway, your gut health and your digestion and all that. Let's talk about exercise a little bit here. We're big into muscle building muscle strength training on this show. I can't shut up about it. I have tons of guests on all the time to talk about the importance of muscle, almost more important than weight loss for a lot of people in our population, just because they're not dealing with like, significant obesity. But let's talk about the big picture like cardio when you are when you think of heart you think cardio, and then you think cardio is a form of exercise. And there's a strong at least mental lick, link and semantic link. What are your thoughts on overall training regimen for somebody who does have a healthy lifestyle and wants to have the best shot?

Dr. Tiffany Di Pietro: 22:31

I think it's both. You know, personally, I'm not a huge cardio person, because my weight training really is cardio. It's kind of both, because my heart rate is high. I hear you and yeah, and I honestly I tell my patients I'm like if you do high intensity interval training, and you incorporate some weights into that, you don't need to do both, like you're probably crossing the T's and dotting the eyes, but resistance training. There's been some studies that show 15% decrease in mortality, for resistance training and 17% decrease cardiovascular mortality. So there's their strong data on resistance training, and overall health and and heart health, for sure. And then I think more importantly, especially for your women listening, big decrease in osteoporosis, big, really big, like, you don't want to take an extra pill every day you go lift some weights, because that's what's gonna keep you from having brittle bones and ending up on medications like next bisphosphonates that we have to give women and men but mostly women when they are postmenopausal and have us and have osteopenia or osteoporosis. Yeah,

Philip Pape: 23:29

love it. Okay, yeah, yeah, no, so that's huge. So 17% Decrease in cardiovascular mortality from resistance training. And obviously, osteoporosis, osteopenia. huge benefit for way too. Okay. So obviously, there's no shocking revelation there. You alluded to the fact that if you're training and maybe doing a little bit of cardio in some form or another, you're good. What about walking?

Dr. Tiffany Di Pietro: 23:49

I like walking, I think, you know, it's like, what kind of walking are we doing now? Are we taking a leisurely stroll around the block are we like, really walking? For me, I don't buy this whole, like 10,000 steps a day, you know, I want I would rather someone walked in sit around all day long. Obviously, that makes me happy. But I don't consider that exercise. For me that heart rate has to get up you've got to get your heart rate up for to be considered exercise you want your heart to have to work moving all day long. hitting those 10,000 steps, you know, will help keep some weight off, you're obviously burning energy, you're utilizing your metabolism, so on and so forth. But for to really be considered exercise in my book, The heart rates gotta go up. Like if you can carry on a conversation like this, what I tell my patients if you can carry on a conversation like you and I is not exercise.

Philip Pape: 24:31

So you mentioned walking, which is interesting, because that wasn't precisely my question. And I'm not criticizing your answer at all. But what's interesting is I recently did an episode called, actually just came out. Today, I think we're yesterday. Who cares if walking is exercise was the name of the episode. And it was a response to this clip that went viral with Dr. Gabrielle Lyon, where she said like, well, I don't consider walking exercise. And it's interesting you say that because I agree like walking maybe has other benefits. If it's not done at this intense level, we often classified as non exercise activity, right? You know, so it matches there. So what you're saying is that from a heart health perspective, weightlifting is number one, some form of cardio that gets a heart rate is up number two, that's a pretty good metric. And then walking beyond that may have other benefits for just like, calorie burn, metabolic rate, you know, whatever. Is there any other Okay, so I guess there's no other like health benefit that we wanted to focus on from low grade walking, then

Dr. Tiffany Di Pietro: 25:29

not other than just the obvious kind of benefits of just getting, you know, moving moving your body, which is what I tell people half the time, just move just get up and move don't sit around all day long. Yeah,

Philip Pape: 25:41

exactly. Because then you're not not moving, which has its own negative association.

Unknown: 25:46

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Philip Pape: 26:37

So speaking of lifestyle, then outside of training and nutrition, we've got, you know, I know stress and depression are like on the CDC list of risk factors, sleep, probably the whole mental side of it, social connection, and all of that come into play, mainly because of stress. What are your thoughts on that, so it doesn't get too muddied for folks listening. But I

Dr. Tiffany Di Pietro: 26:57

think it's a big problem. You know, if you just look generally at mental health as a whole, most people that have what we would call, like low quality mental health are more of our physically unhealthy people as well. And so we start to wonder Which came first, the chicken or the egg, because you know, patients that have higher, maybe consider themselves healthier, I should say, healthier, happier, excuse me, happier people, they tend to be thinner, they tend to go out with their friends more, have better social interactions, maybe go to the gym with other people. So I think there's a big, big, big connection. You know, people that have positive outlooks tend to have lower blood pressure, lower heart rates. And there's been a few studies as well on stress, and patients that think that they have a lot of stress or define themselves as having a very stressful life, have higher inflammatory markers also, and higher incidence of high blood pressure, high cholesterol. So there's a big, big, big Interplay amongst that. Okay,

Philip Pape: 27:55

so and I liked that you made the link like chicken and egg, because people always wonder, and I definitely talked about this, too, the mental health is often improved. When you go for a walk, when you work out, you hang out with your friends, right, like you said, even just maintaining a healthy body composition and bodyweight. So that leads to like, the question, is there one thing that underlies all of this? And is it really just maintaining a healthy weight in body composition? And really everything else? As a corollary of that, is that a stretch? Or is that? You know, reasonable?

Dr. Tiffany Di Pietro: 28:24

I think it's generally reasonable. You know, again, you know, if we're just looking statistically, yes, that's probably a reasonable statement to make. I mean, obviously, I have been people in my office that are not very healthy. And I've had heart attacks. But, you know, I think that's a pretty, it's a pretty easy conclusion to make. Yeah, you know, because a lot of people say, Oh, well, I'm happy because I have this, and I have that, and I have an expensive car. But these are very, my patients that have very high stress jobs, and they're really not that healthy, they just appear to be happy from the outside, and you really, as their physician, I can tell you, that's not always the case at all. So

Philip Pape: 29:01

when somebody is in your office that visually appears what somebody would say is thin or, quote unquote, healthy visually, and they have high cholesterol, what's typically the cause there are what are like the top two or three causes.

Dr. Tiffany Di Pietro: 29:14

Number one is genetics. You can't escape your genetics, you cannot escape your genetics, patients, people listening, everybody must know. And if they don't know they should dig around until they find out what you know, people have died from or what diseases they had in their family because you cannot escape that. So I think that's unequivocally number one. Number two is remember, there's such a thing as skinny fat, right? You could be skinny and have high cholesterol if you're not eating the right foods to your point earlier. So you could sit around and have Cheetos all day long and not consume a lot of calories and be thin but you're consuming awful foods with lots of fat and no whole grains and no Whole Foods. So that's a real thing. So

Philip Pape: 29:59

yeah, I'm glad you mentioned that yeah, skinny fat. You're right, because that's that's why I say body composition specifically. You know, we often talk about fat loss versus weight loss, because there is a heavy emphasis on weight loss, but not at all costs, right? Not if you're losing your muscle mass, your bone density decreases. And then like you said, it could even lead to hidden or stealth things happening with your health, like cardiovascular disease just because you look skinny. So it's important for people to know, the spectrum, which then leads me into this whole the obesity paradox, right? Can big be beautiful and healthy? I know you wanted to get into that. Let's talk about that. Right? I guess we can talk about the movement in the body positivity thing. I don't need to get too much into the political stuff, but we can get into reality and what is healthy and what's not, and how we should be approaching the subject. Yeah, you

Dr. Tiffany Di Pietro: 30:45

know, I think people don't want to talk about it, because you don't want to get hate mail and get hated. And, and you know, and I understand that I do, but you know, you will never come into my office, overweight, number one obese for sure. And have me not telling you that you need to lose weight, it's just, it's just not going to happen. Like go find another doctor, my job is to make sure I do everything in my power to get my patients to be healthy and live long, fulfilling good lives with a good quality of life, right? That's my goal. That is not going to happen. If you're obese, it's not, it's just not going to happen. So, you know, having someone like the way they look feel comfortable in their skin is very different than you coming to a doctor's office and you being obese and me telling you that you're healthy. And it's a real thing, because what happens, we get laughs on some of these people. And you know that we go off on a healthy fat guy. And it's like, maybe for now, but that's not gonna stay like that forever. And so my line that I tell my patients that I probably, so I preface I said, Listen, I'm going to tell you something, and you're not going to like what I'm going to tell you and you're probably going to leave here really pissed off at me. And then you're going to come back and you're going to be thinking, man, you know, I kind of a team up, I get them ready. And I look at them. And I say you tell me the last time you saw a fat 80 year old, and they kind of sit back. And I'm like, go ahead, tell me, right? Because every once a while someone says, but statistically you don't. And they say, Well, I don't. I don't know if that 80 year old. And they go tell me why I make them say it. Tell me why they go because they're dead. Exactly. Because you do not live long lives in this country or around the world period. If you're heavy, especially if you're obese, and it's like a one to one, the heavier you are, the more likely you are to die early. It's clear cut their cut. And there's something to be said truthfully, about being too big, even muscularly. Right. Let's still wait. So would I rather someone be very muscular than very fat? Having adipose tissue? But there are a lot of like, Mr. Universe, Mr. This Mr. That and all these people that are they walk around like their arms can't even touch their sides, right? They walk around like this. Also not good. Weight is weight. So we we want to be like long and lean and have good skeletal muscle mass with very little as much as we can of adipose tissue. But it's just not good.

Philip Pape: 33:09

Yeah. First, you just triggered all the lifters who are like, are you to tell me not to have all that muscle? No, but it's true. I mean, most people aren't going to be I think that big anyway, the short of performance enhancing drugs, but you know, I do know a lot of lifters in their, in their 50s who have a lot of muscle in there. It's they're bigger. And you're right, like the metabolic markers tend to drift in the direction we don't want them to. But it's partly body fat today. To get that level of muscle, you tend to be gaining fat in the process unless you lean out. So the thing you said about 80 year olds, I mean, it's so true. I've maybe seen large 70 Something year olds and they're all just they've got 20 different ailments, and they're like on death's door. And that's not a place we want to be.

Dr. Tiffany Di Pietro: 33:47

And number one complaint Are you ready for this? Number one complaint is? Well, two. Number one is my knees hurt. No shit. Wait, he's hurt. Yeah, you're carrying around an 80 pound backpack all day long. And that's what I tell them. I said, How do you think I would feel they put on an 80 pound backpack and walked around all day long. My knees are gonna hurt. My hips are gonna hurt and I'm gonna be freaking exhausted at the end of the day. So don't come here and telling me that it's not your weight that's causing it because it is your weight that's causing it. Yeah,

Philip Pape: 34:10

no. 100% Yeah, and the whole thing the biggest beautiful big is healthy that I mean, yeah, we I guess we can separate the subjective side people can say whatever they want about, you know, attractiveness. But as far as loving your body and all of that, right, we have that whole body positivity movie elite movement, at least the way I put it is if you love your body, you're gonna care to get it into a healthy state. And there's nothing wrong with being big now and having the desire to not be there's nothing wrong with that and you can still love yourself and go through that process. Well, yeah.

Dr. Tiffany Di Pietro: 34:41

Yeah. Because you have to love the process. Right? You have to you have to love wanting to be around. I was reading a book this week, just about optimism and life. And then a friend of mine posted something and it all kind of came to kind of coalesce together. This is sometimes you have to do things today. Not because of yourself today, but because of who you want to look back Back on tomorrow and say I wish I would have done it right. So you're doing stuff for your future self, you're not doing it for yourself today. And that's a very good way of looking at everything, you know, just because someone's heavy. Now listen, shit happens. People gain weight, they go through divorces, you know, a child dies, something catastrophic happens, we're human things happen to us weight fluctuates, stress fluctuates, life fluctuates. But it's about kind of getting back on track and loving yourself enough to want to be around to want to live a long life to be around for your children to be around for your family. And I think that's kind of the most important take home point. I don't harp on people for being big. I harp on people for not wanting to change it and not loving themselves enough to change it.

Philip Pape: 35:43

Yeah, 100%. And so if someone is in that state, and they're listening, and they're like, Okay, I hear it, and I've want to change. And in fact, maybe I've wanted to change for a while, and I may have taken certain actions change, and something's not quite working. I mean, I definitely deal with this all the time of like, I'm trying to lose weight, I'm trying to do this, or it's my hormones, or it's my gym, or whatever. And it's not working. And there's usually some underlying practical reason for that. But what is your take on that someone says, you know, I've got a lot of weight to lose, I'm trying, it's just not working. But

Dr. Tiffany Di Pietro: 36:13

I see that with everything, you know, I have not to break away from kind of the point of, of our, you know, I have patients like, oh, I can't do it all. And I can't do this, and I can't do that I can't take my kid here. I'm asked for help. You don't have to do everything yourself. You know, if you find the right doctor, and you're willing to have a great relationship, you'll find someone that can help you. And at the same token, I find that, you know, again, we go way off the mountain sometimes and they think it's hormones, and they think it's it must be this, it must be that I'm doing everything right. And you're not. Yeah, they're not, you know, because everyone wants an easy answer. Not an excuse, but they want something easy to put their finger on to not have to do the hard work, be introspective, and say, maybe I maybe this is me. Yeah, right. And so sometimes it takes someone a little tough to say, Listen, I'm going to help you through it, we're going to get you there. But you got to look in the mirror and realize this is not your thyroid, this is not, you know your hormones, this is you and we got it, we got to get you back on track. And we'll check everything else. And we'll make sure everything else is optimized. But at the end of the day, 99% of the time, obesity is not due to some patho physiologic process, it's due to someone creating poor habits.

Philip Pape: 37:23

Yeah. And that's an empowering message. If we want to spend in the positive, that's an empowering message because it means you're not at the whim of fate, you've got total control over the situation. And like you said, just ask for help if you're having trouble, or maybe you don't understand fully the context or the strategy that you need to be successful. And that's where others can help you other experts. Honestly, that's why you go on podcasts and such. That's why I have this it's like to share as much information as we can, based on whatever evidence we're aware of. So people can make those behavioral changes.

Dr. Tiffany Di Pietro: 37:53

And different things work for different people and that we know know intermittent fasting might work for you. It might not work for me, but you got to tease through all the BS and kind of find that and you've got to sometimes also step back and say, Okay, well, why is it so miraculous? And so why? Because someone's making money on it. So you have to, you know, if rapid is in there rapid weight loss or Miraculous Weight Loss, like these are not words that any physician or any clinic should ever be using. Because that's not healthy or safe, either. It's a stepwise approach. It's a very, it took you years to put on 50 pounds, it's not going to come off in three months. Yeah.

Philip Pape: 38:30

So if somebody then is like, okay, now I hear you here, I'm ready to make a change. I'm going to seek help. Let's talk about the medical side, since that's where you're coming from? How does somebody find a provider that is actually going to help them because I know there's a lot of skepticism these days. I know, there's, there's like gaslighting and things like that out there, too, especially with women's health. There's a whole spectrum of quality out there, right? And it depends on where you live and your insurance and so many things. How does somebody find a good provider? What are they looking for, and then like, communicate with that person to get what they need?

Dr. Tiffany Di Pietro: 38:59

I think the first and foremost is finding a provider that number one you like, which that's step one, you have to like your doctor, if you don't like your doctor, it's just it's not gonna go well and that you feel like you communicate well with to a physician that really does focus on prevention, not just curing disease or taking care of someone but because they're coming in with what we call their chief complaint, right? That's for your listeners, it's what doctors say on the forum and you feel chief complaint, that we listen to complaints all day long, basically. Unfortunately, most preventive visits with the exception of an annual physical is not covered by insurances. So it might be something where someone that's listening has to say, Listen, I'm gonna, you know, I've been spending the money on smoking or I've been spending the money on food and you might just have to step back and say, Okay, well I'm gonna spend the money on this now and you might have to pay out of pocket and go without your insurance to have the time to sit down and talk to you know, maybe your current doctor or your new doctor about what your goals are. Because if you're wanting to sit down and spend 20 minutes 30 minutes with your Doctors are going over different goals and what you're trying to achieve, it's going to be hard to do if you're going through insurance because it just truthfully, I know, it's like Woe is me. But the reimbursements are so awful that most doctors just aren't going to do that. So I think finding a true weight loss like, doctor that's board certified, maybe I'm not, but I'm a cardiologist. So I do it but board certified and and Bariatric medicine or obesity medicine that understands this disease process, because it really there's a big mental component to this as well. And those physicians will help get through that break those barriers.

Philip Pape: 40:32

Yeah. Isn't it funny that you're right, we spend so much money on so many frivolous things in our budget, and are not willing to spend on health care? Partly because, like you said, we think insurance should cover stuff. So if it doesn't, it's like not even in our sphere of existence, right? I hear that with hormones all the time. You know, my own wife too. We have to pay money for hormone specialists. And it might be functional medical care might be you know, board certified, whatever, it tends to be out of pocket because insurance doesn't cover it. And then like you said, You've got to like the relationship. I haven't. I've heard so many people who just dwell on somebody who's telling them that they're lying, you know, or they don't believe them or whatever. And that's, that's the gaslighting piece of it. But there's even just somebody who's who's in a hole.

Dr. Tiffany Di Pietro: 41:15

I hear that all the time. Like, why are you here? I hated the other cardiologist dudes. You know, like, I'm like, okay, cool. Welcome. You know?

Philip Pape: 41:23

Exactly. I mean, you know, be nice. At the end

Dr. Tiffany Di Pietro: 41:26

of the day, you just have to care a little bit. It's really not that hard. You know, like, we became doctors really, for two reasons. We like medicine and science. We like people. If you don't like people, you shouldn't be a doctor or you should be a pathologist and look at slides all day long.

Philip Pape: 41:40

There you go. Yeah. Or a surgeon is kind of like in the middle. Yeah. We like or like, I'll talk to you for a little bit and then

Dr. Tiffany Di Pietro: 41:46

or anesthesia. Right, you just night night.

Philip Pape: 41:50

Perfect career choice there. Okay, so let's see, we talked about mental health. I guess let's Why don't we end with since you mentioned being nice. Your be nice philosophy. I mean, I love the science, of kindness of positive psychology, of all that kind of stuff. And that seems to tie in well, with mental health. I mean, tell me more about that.

Dr. Tiffany Di Pietro: 42:08

Makes me feel better. Yeah. That I mean, you know, I mean, listen, we all have our days. And trust me, I've had my moments like, everybody has their moments. But, you know, sometimes I think it's better to just step away, take a few breaths, and not let the excitement get the best of you on most days. And I listen, I and my patients will say like, Oh, somebody's like, are you okay, Doc, you seem a little off. It's like, Yeah, I'm having an off day. But my husband's a lawyer, and he has a he says something. And I said it's so true. As I say it's not it's not what you say it's how you say it. And my husband in law, they say there's a there's a tone and a tenor. Right. It's the tone and the tenor. It's not what you're saying. It's how aggressive you're sounding, or the tone of your voice and the way that you're saying it. And that's something I think a lot of people could probably benefit from. And I think there's nothing wrong with just kind of saying, you know, what, I need a minute and just kind of step away and clear your head. I mean, the world is a very chaotic and busy place, and we're all hustling and trying to be the best and trying to make the most money and thinking that what people look like on social media is actually what they look like in real life, which is absurd. And, and I think part of it, too, is just being truthful. My best friend says, Say what you mean and mean what you say. And I think there's something to that, you know, if you know, it's simple example, if you know, or if I know that someone asked me to go out, I don't know, for happy hour, and I say okay, yeah, maybe. But I know, in my heart of hearts, it's a no, just say no, yes. Because it's gonna create another problem for you and for ours, when they come back and ask you again, you know, yeah, and sometimes it's just say what you mean and mean what you say like, be nice about it. So you know what, maybe next time it's not, you know, that's not part of my journey today. I

Philip Pape: 43:41

love that honest communication. We still read the physical paper, which you can believe it. And they have like the column where somebody writes in for advice. And it's always like, you don't even have to see the question. The answer is you need to talk about it. Like the answer is just communicating. Yeah.

Dr. Tiffany Di Pietro: 43:56

You're not upset, because you're never gonna get anywhere communicating when you're upset sometimes just again, taking a minute back be like, You know what, let's let's talk about this tomorrow. But let's like hash it out. But most problems in this world are because someone didn't communicate with someone else adequately.

Philip Pape: 44:09

All right, last segment here, I did have some questions from our community. I think two of them have already been answered. So I'm gonna focus on the third one. The first question was how much cardio? I think we addressed that. The second one was does genetically elevated LDL in perimenopause predispose you to higher cardiovascular risk when everything else is in check? And I think again, you said Potentially, yes, yeah, higher LDL. I don't know if there's any more nuanced add to that right. A

Dr. Tiffany Di Pietro: 44:32

little bit. I'm a big fan of hormone therapy and the perimenopausal menopausal period. I think that the Women's Health Initiative was very much skewed very early, you know, in the 90s and early 2000s. And now we're realizing that that hormones, probably the pendulum has shifted back and we should probably be offering a lot more hormones. But yes, it's like when you're pregnant, if you have high blood pressure during pregnancy, the likelihood of you having high blood pressure later in your life is also very high. So to answer that question, yes, I mean, if you have Paramount apostle increases in LDL, then there is a higher likelihood of having cardiovascular disease for sure.

Philip Pape: 45:05

And that's kind of leads to a side question. So even if you have genetically higher baseline LDL from a fairly young age, that never goes up, let's just say it just stays that way your whole life. Does that still mean you have a higher cardiovascular risk? Yes. You're nodding. Yes. That's important for people to realize because sometimes people talk about Well, no, if that's your baseline, and then it's really only if it goes up. You're saying that there's

Dr. Tiffany Di Pietro: 45:26

not like, it's not like, Oops, like, I'm a twice a day pooper. I've always been a twice a day pooper and the other person's I put three times a week and that's me. And that's normal for me. No, okay. You have a genetically elevated LDL, you are genetically predisposed to having heart disease. Okay, good.

Philip Pape: 45:40

Good to know. And then the last one, perfect segue. You mentioned HRT? And I guess the question is more? Well, this was actually from a man. But I mean, I think it would apply to both that was for testosterone. For women, it could be all the other forms of hormone replacement therapy. And it was what this is a long question I should have, I should have shortened this. Oh, man, this is a very long question. So much information out there. Most GP doctors and non specialists continue to spread, for example, androgen induced, era throws, okay, you know what, forget this one. This is a very long detailed one I'm not going to get into I'm going to shorten it to HRT and cardiovascular health. Is there any concerns? Generally,

Dr. Tiffany Di Pietro: 46:18

no, here's the thing with testosterone, I'm going to focus on testosterone that person was talking about the thing with testosterone is we tend to overdo it. Because men feel fantastic when they're on all this testosterone. There's also something to aging, right? If you're 65, and you feel like you're 20, it's kind of not normal, I don't want you to feel like an old 65. But I also don't really want you feel like you're 20 Because the way you feel and what's going on physiologically inside your body are very different. So my rule of thumb with testosterone is then really the guideline rule of thumb as having low levels and having symptoms. So you're fatigued or you have a low sex drive, you know, these kinds of things. And this is this is when it calls for appropriate testosterone supplementation. By appropriate I mean, we supplement it within normal range. It can be the upper limit of normal range, but we don't want to go super therapeutic with testosterone.

Philip Pape: 47:12

PD range, don't go into PD range. Yeah, yeah, the reason

Dr. Tiffany Di Pietro: 47:16

is, I can guarantee you testosterone levels are too high cholesterol goes up, blood pressure goes up, higher risk of clotting, pulmonary embolisms coronary clots, big risk. That's why you see the hemoglobin go up so much. And that's a real risk. I've had multiple patients in my practice, end up with open heart surgery, and they had zero risk factors other than inappropriate testosterone supplementation at younger ages. So I have I'm not one of those, I don't have a problem with it. But it needs to be done appropriately. And you have to be very careful weighing the high from the symptoms and what's is causing some metabolic derangement in the body. It's kind of flip flopped for women a little bit. There's no real studies that say like, if you're on estrogen, you're going to decrease your risk of heart disease. It also doesn't increase it. And so for women, we really treat symptoms, not so much numbers, we don't want to over over overdo it. But for women, it's very much symptom driven terms of hot flashes and fatigue and insomnia and things like that. But we do know unequivocally that women that get estrogen treatment and perimenopause and menopause have a lower and somehow still have a lower incidence of heart disease, they have a lower incidence of high cholesterol, lower incidence of hypertension, long term, and most definitely lower incidence of osteoporosis. So it kind of cuts both ways, a little bit differently than than men and women.

Philip Pape: 48:35

No, that's good to know the difference. And I wasn't aware of that at all. And yeah, testosterone. On the men's side, it's still controversial for lots of different reasons, especially in the world of lifting where men what would love to be diagnosed and low testosterone so that they can go on supplementation. One more thing related to that. This gentleman is talking about poli sci fi media, which I think is like a blood cancer related to this. I don't know where that comes into it. Poli

Dr. Tiffany Di Pietro: 48:59

Sci Fi news. And he's probably referring to having an elevated hemoglobin from the testosterone. So that's where the risk is. That's where the real you know, so it's just interesting to me that some men, they want this testosterone to be so high and and I'll go like, literally give blood it's like, well, just think about that, from a common sense perspective. Like how good do you think it could be to give yourself something where you have to go give blood because of the adverse effect it's doing in your body? Right? Yeah. So it's kind of like a common so if you're if your testosterone so high, where you have to go give blood, you're overdoing it. Okay,

Philip Pape: 49:30

his last part of his question was a potential preventative measure of giving blood regularly power read donations, so you know that you know, this stuff, probably overdoing it. Yeah. Okay. No, that's good to know. I think that's all I have there. So you know, I do like to ask guests, Tiffany, because this has been super enlightening. There's a lot of moments of where I learned, I'm sure and like the calcium score or things like that. Is there a question you wish I had asked in this conversation? And if so, what's your answer?

Dr. Tiffany Di Pietro: 49:57

Probably. Do I take my own advice? Oh, Oh,

Philip Pape: 50:00

sure, let's go there.

Dr. Tiffany Di Pietro: 50:02

Yeah, generally I do, I try and eat, you know, and this is I think you have to practice what you preach. I generally eat very well. And there are days where I don't and there's days where maybe have some crap that day, because that's just how my life is going that day. And I just, I'm starving, and I don't have time to eat something great. But generally I eat well, generally, I try and exercise at least three times a week and I exercise exercise, you know, and I try to meditate, and I have a little meditation device that helps me meditate. Yeah, I mean, I am definitely a practice what you preach. And I and I bring that up. Because a lot of times people say, Oh, it's easy for you, because you know, whatever your thing and, but I need a but I make a very concerted effort. Like, I'm crazy. And I weigh myself every day, I get on the scale every day. And I like my numbers to be within a certain range. And when they're not, I do whatever I need to do to get them back down. Because that's what works for me. But yeah, I truly practice what I preach, I try and have a positive outlook on life. And again, I have days I've got bad eating days, I've got bad mood days, I've got bad everything days. But I think you know, being happy. And I can say this. Now I'm 38 I'm probably the happiest I've ever been in my life. Because I kind of just got this stuff figured out now. So I was giving a lecture to my eighth grade alma mater, which is so cute. And I was giving a speech. And I said in my speech, if it doesn't make you happy, make you money or make you healthy. It's a waste of your time. And that's just the truth, right? You have to go to work to make your money. And you have to, you know, you want to go to the gym because you want to be healthier you eat well, if you want to be healthy. Other than that, if someone or something does not make you happy, probably should get rid of it. Because happiness is truly number one.

Philip Pape: 51:48

Yeah, I totally agree. And I mean, you talked about before not being perfect. And just taking the micro steps, taking the little steps along the way. And anyone's listening who's like, Well, yeah, I'm far from what Tiffany is doing today. It doesn't matter you are where you are, like, just start taking those steps going forward.

Dr. Tiffany Di Pietro: 52:04

I'd say honey, my life seven years ago was a hot mess Express. So I you know, you gotta all have to improve that. You got to take those baby steps. But then once you get there, it's almost like that sense of like Nirvana and enlightening. Like, I can't imagine getting there again. Because once you get it kind of figured out what's important and not important in your life and not even talking to be like when you go around people and you're just feel their negative energy. Like just, you gotta go, they gotta go. I've gotten rid of people. Like, I don't have anything bad to say about you. You just can't be around you anymore.

Philip Pape: 52:32

Yeah, no, I can totally relate. I'm all about positivity. That's yeah, some people get sick of it. And I'm like, Well, you're not in my sphere anymore. I'm just getting. That's a yooper. Is that me, bro? Yeah, exactly. And it's funny because I'm 43 now and I tell people like I got in the best shape of my life when I was 40. So I mean, you know, at any age, you can start it took me forever to start figuring stuff out as well. It's right. Just curious about your exercise three times a week. What are you doing these days? So

Dr. Tiffany Di Pietro: 52:56

I actually have it behind me my little total. I'll total okay. I have my total I do that like once or twice a week and then I go to the gym with my husband, although I don't work out with my husband cuz he I jokingly call it his old man workout. He works out people a little bit older than him. It's kind of like their guy time they're working out. It's bullshit. They're not really. But I I go to the gym and I am so I walk it inclines, I'm not a runner. I never have been a runner. Again. Everyone's different, right? Like, I have the body of a runner, you would think I'm a runner, I cannot run. I get side splints and I've never been able to do it. So I walk inclines and I do a lot of high intensity interval training I do I really kind of focus on muscle groups. I do buys fries lunges all that kind of stuff.

Philip Pape: 53:38

Cool Awesome. Yeah no the walking yeah I don't like running either. I used to be anti running even in when I talked about not only do you not have to run you don't have to run ever used to be the running kills your gains thing that's that would to the opposite extreme of

Dr. Tiffany Di Pietro: 53:53

course. Running does do is it really can if you're especially on a treadmill if you're not running like outside and like terrain it will jack your knees. Oh yeah. Yeah, that heart Yeah, like Yeah, so thinking about the whole picture right? Like okay, well how can I keep my weight off get my cardiovascular and and not like, hurt something else and like, but okay, walking in inclines will do that. Right. So it's just, you know, it's what your individual goals. That's all some people might have a goal of I really want to run a marathon. It's very important to me. I want to do this. Yeah, exactly. I really have that desire. This.

Philip Pape: 54:27

Got a video issue again. Oh, all right. So, Tiffany, where can listeners learn more about you and your work? My

Dr. Tiffany Di Pietro: 54:35

Instagram? I guess. So my personal one is? Dr. Like Dr. Tiffany D Pietro di p i e TRL. My business one is D Pietro health. And my website is dp MetroHealth. How to think about that D Pietro health.com.

Philip Pape: 54:53

All right, Dr. Devaney, D Pietro at D petrol health and D Pietro health.com. I will put those all in the show notes. So let's They're just gonna find you. And this has been an awesome conversation. I'm glad I'm glad we met you came on here. I love your positivity, and so much wisdom. Keep doing what you're doing. And thanks again for coming on.

Dr. Tiffany Di Pietro: 55:09

Thanks for having me.

Philip Pape: 55:10

Thank you for tuning in to another episode of wit's end weights. If you found value in today's episode, and know someone else who's looking to level up their weights or weights. Please take a moment to share this episode with them. And make sure to hit the Follow button in your podcast platform right now to catch the next episode. Until then, stay strong.