A Doctor's Journey to Regenerative Agriculture

In early February 2026, Fireberry Provisions hosted a gathering of people to discuss regenerative farming, real food, and faithful stewardship of land and community. Shirley McElhattan, M.D., Tierra Verde's business manager, had a chance to talk about her journey from practicing medicine to farming.

In this talk, she covers that journey, including her core beliefs about the practice of medicine, how those beliefs were formed, the current state of health care today, and the contrast of her prior practice to what she does now with TIerra Verde Farms.

The transcript adapted from Shirley's talk is below the video. To watch Shirley's presentation, click on the image below.

A Doctor’s Journey to Regenerative Agriculture

Last night at the dinner, someone asked, “are you still a doctor?” And I thought about that for a minute. I was like, hmm…I have a medical degree. I matriculated from medical school. They don't take your MD away. There are initials after my name, although I rarely use them. So that won't change.

I'm still licensed to practice medicine in the state of Pennsylvania. I will probably continue that. That's easy. It's an every two-year research thing. It's really just about writing a check. I am board certified by the Board of Internal Medicine, at least until I'm 60, because that's the next time I'm supposed to take my board exam. It's an every 10-year thing, and I'm not sure that I'm going to do that. That's a big thing.

So, yeah, technically, I'm still a doctor, but I think what they were asking is, “do you still practice medicine?” That's what this is about.

What I'm going to talk about today is my core beliefs about the practice of medicine, how those beliefs were formed, the current state of health today, and why I think that is. What did my medical practice look like when I was practicing conventional medicine? The difficulties I faced in that practice. Why regenerative agriculture would make sense to someone who's practicing medicine, and then what my medical practice looks like now.

“It’s hard to improve on the natural order of things.” This is my core belief that I have about everything, really, including medical practice. That's kind of strange since, you know…doctors typically intervene. I'm a doctor who believes that it's intervention, it's hard to improve on what you come in the door with. It's hard for me to make that better. And I step back on why do I believe that? How did I come to that? I think that I developed that growing up -- it's hard to improve on the human body's ability to adjust, adapt, and heal itself.

I grew up in a rural community. This is the covered bridge in my neighborhood growing up. We grew up very blessed. We ran, we played, we left the house at dawn, and we came back at dusk, often battered and bruised. And we were told, “you're fine.” And we were fine. We rode minibikes down the road to the trail, crashed them. They couldn't be driven. We pushed them home, and heard, “you're fine.”

When I was eight years old, I fell off of that covered bridge. I walked home, told “you're fine.” In the middle of the night, I woke up at like 2 a.m. I could not sleep. I was in terrible pain. I was not fine. I rubbed my shoulder. But immobilization, rest, and I was fine.

I remember the doctor saying this is going to heal back stronger than it was before you broke it. And I was just like, “is that possible? That's crazy.” So I think just growing up in this environment, I learned just the remarkable healing powers of the human body.

I need to caveat this with, I am not saying there are not good interventions in medicine. I am not saying that we should always ignore our symptoms and our concerns and our problems. Do not hear that in this talk. There's amazing interventions and amazing advances in the practice of medicine.

What I'm saying is the core belief of our bodies being amazing on their own is kind of the foundation. I learned throughout, and you learn that the more you practice medicine, it's kind of backwards. For me, through college and medical school and practice, it was continuously reinforced how amazing our bodies are. Our bodies are an incredible machine, and it's really hard to improve on that.

When I was a resident, I was in the cardiac ICU, and we had this patient who had heart failure. He was volume overloaded with too much fluid. And so we would give him medication – diuretics - to get rid of the fluid. But then we'd go too far, and he was dehydrated, so then we'd have to hydrate him. And then he was overloaded, and then we would have to diurese him. And this was like a back and forth, back and forth.

Also, when you're doing this, you're depleting electrolytes. So we were chasing this guy with potassium and magnesium supplements, and it was just so much intervention. And the nephrologist said, “His kidneys work. Why don't we just back off and let his kidneys work?” So we stopped all intervention for about 48 hours. The fluids came into balance. The electrolytes came into balance. We have this amazing organ called the kidney that regulates your fluid and your electrolytes. And if they're functioning as they're supposed to, we can’t improve on it. All we can do is mess that up. That was such a formative experience, saying, “Let's just back off and see how this goes.”

The most important foundational belief is that we are fearfully and wonderfully made. And it's pretty hard to improve on that. So, if that's the case, that we're fearfully and wonderfully made, that our bodies are amazing machines, and that we can heal ourselves, then why are we so sick?

The current state of the union is that we're really sick as a society. There's a lot of illness. And I believe that's because we have strayed so far from the natural order of things. Our bodies are amazing in their ability to heal themselves and to adapt and adjust if we're living in the right substrate, if the natural order of things is occurring.

I mentioned earlier I grew up in New Wilmington among the Amish…like literally among the Amish. They were our babysitters. I experienced firsthand their farming, their life consistent with, as much as possible, the natural order of things. Farming was a very cyclical pattern with the seasons. They weren't eating avocados and they weren't eating strawberries in January. They ate potatoes in the winter, not broccoli. I I thought that's how it was done. I honestly didn't know there was a different type of agriculture. We bought our eggs from the local egg producer. We bought our milk from the local dairy farm. We bought our meat from the local livestock farm. I was ignorant about “conventional agriculture” at a ridiculous level.

I went to Penn State, an ag school. I remember my first trip to the dining hall. I was standing in front of the milk machine, and there was 2% and skim. I was like, “what is that?” Someone came up with me and said, can I help you? I'm like, “where's the real milk?” And he's like, “you mean the whole milk?” I'm like, “I guess. Is that what we call it? I don't know. I drank this type of milk. We had to shake the milk in the glass containers.”

It’s become sort of a battle with me. My kids drink whole milk. The pediatrician would show these growth curves and tell us our kids were the perfect height and perfect weight, and then ask if they drink skim milk. I’d say no and we’d have a battle over if they should have whole or skim milk. My kids are the right height and weight and they’re telling me that I'm not feeding them well. We agreed to disagree and moved on.

It's funny how skim milk has formed so many of my beliefs recently. I'm sure many of you know this as they just passed a law that allows them to serve whole milk in school cafeterias. It was previously against the law. My kids drank skim milk, strawberry flavored, chocolate flavored, and vanilla flavored skim milk in the cafeterias in school because they weren't allowed to have whole milk. It's crazy. If you're between 1 and 18 years old, 62% of the calories you consume are in ultra-processed foods. So when I say the natural order things too often no longer exists, and that's why we're so sick, I think skim milk is a great representation of that.

So anyway, that's kind of my foundational beliefs and how I grew up. I'm very fortunate that I had this kind of personal foundation, an educational foundation, and a faith foundation that allows me to recognize this, that we're not in the natural order of things. And so how did all of that kind of affect my practice of medicine when I was practicing?

I will say that I loved practicing medicine. I didn't leave it because I don't love the practice of it. I still believe - hear this - a relationship with a primary care doctor is the most important thing you can have when you're navigating the current medical system. There's a lot of things wrong with the current medical system, but one of them is the lack of relationships. Medicine is turning into a series of transactions with different specialists and I think that's why there's a lot of bad outcomes.

If you want to give up on the entire medical system altogether, I say please don't - please find a good primary care doctor and form a relationship with that person - that's more important than any super subspecialist fancy name on a building.

I love my patients. I love educating people about the amazing ways their body works. So how did I practice in the light of all this? I saw this super early on. I wrote this down. I have it stuck to one of my folders that I would take to work every day. “The art of medicine consists of amusing the patient while nature cures the disease.” This is the art of medicine. There's certainly science of medicine that requires medical care. But this is the art of medicine. Nature is amazing. “A tincture of time” is my favorite prescription. I prescribe this more than any prescription ever. That will cure many, many things. And again, if you have the foundational belief that I do, a tincture of time is a powerful tool and should often be the first one we use. Not always, but often.

So what did I do then, did I just do nothing? What I did choose to intervene, my favorite intervention was lifestyle. I was a huge proponent for lifestyle for the prevention and treatment of chronic disease. First line therapy of high blood pressure and diabetes and fatty liver disease is lifestyle. There are second line and third lines, but your first line is lifestyle. And that became harder and harder to practice. It's because you can't reimburse for that. There's a lot of reasons, but that's one of them. It doesn't make a lot of money. For a long time, I was still able to do it.

Covid, I think, opened a lot of people's eyes to a lot of things. During covid, I was still working at UPMC in regular primary care practice. Our advice during covid was abysmal. We all know now in retrospect, but some of us knew it in real time. And that was really frustrating.

I had a patient come to me who had quit jogging because he was afraid that when he would jog on the sidewalk he would pass someone that might give him covid, so he stopped exercising. No one was talking about exercising during covid…no one was talking about how metabolic health was the most important thing you could do. There were so many questions I got early on…crazy questions…should i take Advil and Tylenol or just Tylenol? Should I stop my ace inhibitor (which is the blood pressure medication that early on they thought might have bad outcomes if you were on it). Should I do all of these interventions? No one ever said becoming metabolically healthy is the most important thing you can do to improve your outcomes.

I worked as an inpatient hospitalist on a covid ward through the covid winter of 2020/2021. We could just spot the ones that weren't going to do well. The number one indicator of if you were going to do well was your blood sugar. It was nothing to do with age. People thought the old people were dying from COVID. Many did. But people who were metabolically unhealthy had the worst outcomes. And no one said it. Did you ever hear about your diet and about your exercise during COVID? And that's when I was just like, what are we preaching?

This is the current CDC recommendation for COVID prevention strategies: vaccines, hygiene, pure air, masks, and testing. This is all good stuff. I mean, these aren't bad things. But nowhere on there is “get metabolically healthy”. It's just not something our medical system talks about.

As I said I was always a big proponent of lifestyle for the prevention of chronic disease. This is my way of kind of saying that - in the absence of evidence of benefit, choose non-intervention. Basically, this was how I practiced. If you don't have good evidence that your intervention is going to be beneficial, don't do it. And I think the health care system currently is intervene first. “If we have an intervention, we should probably use” it instead of “do we know that intervention works?” That's why our relationship with a primary care doctor is so important, so you can ask, “what evidence do you have that this is going to really benefit me?”

And I think that's a very different way than most people know. People go to the doctors, they expect an intervention, they get an intervention, and they never wonder is there really evidence to this intervention?

I worked for UPMC for 20 years as a primary care doctor. I left there to work for a startup that was doing direct primary care, but for the masses. The model was great because it allowed us to have a lot of time with our patients. I was able to develop strong relationships with people. It was also very lifestyle focused. There was that year in between where I worked in the hospital during covid.

Ozempic was the final straw for me to leave medicine altogether. Ozempic is a great medication. Do not get me wrong. Diabetics, people with fatty liver disease, a whole host of other diseases…this medication is lifesaving and should be utilized. But when this came on the scene and started to be used for the general population, the conversation I kept waiting to hear was, “We have this great medication that can help this group of patients with disease. How do we prevent everyone else from ever needing it?”

When are we going to start talking about that? How do we put these people out of business? It's a great drug. I have prescribed it. I know people who use it. It has changed their lives. But why are we... The conversation became, “We have a fix - a fix for terrible lifestyle. We're done here! We'll just put every more people on this medication for the rest of their lives, and then we never need to worry about it again.” And when that conversation, to me, the most critical conversation of how we prevent people from needing this never came up, even in the new place I was working, I realized I can't practice like this anymore.

And this isn't the only example. This is where conventional medicine is now. We will just create more interventions for more problems and never worry about how to prevent that problem. So I left internal medicine.

So now, as I said, I'm still practicing medicine. What does my medical practice look like now? It looks like this. Food.

Instead of prescribing pills, I prescribe food. I take so many pictures of my food. My kids joke about that constantly…the phone eats first. I've always believed in food - real food, raised right - as the core to good health. I tell people I'm still in health, but I'm in upstream health now. So a lot of my advice now revolves around food. I knew all this intuitively, but I didn't have a name for this.

I listened to a book by Will Harris a couple years ago and found that all of these things I believe actually has a name – regenerative agriculture. I knew the principles deeply but just didn't know the name. The virtuous cycle, as he says, heals the land. It heals the animals. It heals the humans. It heals the communities. And I was like, that's it. That's it. And then we got in touch with Steve and Mel, the founders of Lamppost Farm, who all of you know. And hearing Steve talk about the relationships…it makes perfect sense.

It's not that weird of a transition from a doctor to a farmer when you believe all the things I believe. It’s funny because I talk to people-- we live now in the suburb of Pittsburgh - and I talk to neighbors or people, and they just have so many questions. “Wait, you did what? How? Huh?” They're confused. However, I talk to our customers, and they nod their heads and finish my sentences before I do because they know this as well.

Here are some of Zoe’s great pictures of our animals. I get to hang out with these guys all day. My practice of medicine now looks like hanging out with these guys in relationship with our customers. My role at the farm is that I spend a lot of time on my computer, which is not nearly as much fun. I run the commercial operations, so I'm in charge of our inventory and our social media marketing. Sometimes when I work in the store, I wash eggs. But primarily, I interface with customers. I'm the one who just phone rings, and I'm just like, literally, this is my phone buzzing right now. We're at farmer's markets right now. Most of the time of day my phone would start to buzz because people are running late to get their orders and that sort of thing. So I interact with our customers. And that's my favorite part about it.

This is where I'm really going to get emotional, so watch out. You thought that was bad before…wait until you hear this. We must be on some kind of mom's Facebook page or Reddit page. I don't know. These are special customers…moms with medically complex children who are tube fed. And our food is the only thing that kids can tolerate. I had one desperate the other day call me. She uses our ground products. They make the tube feeds for her child. She's like, “I'm running out of ground turkey. Are you guys open? I'll come to you.” Because we normally would deliver to a drop site for her. Our food is life-changing.

We have so many people-- I've talked to some people in this room-- with autoimmune diseases, and our food hasn't cured them necessarily, but it certainly allowed them to manage their disease way, way better. Inflammatory diseases are incredibly manageable if you eat a low-inflammatory diet. When I was practicing medicine, and I was trying to explain this to people, I would say, “eat food as close to the natural source as possible.” An apple is better than apple sauce, is better than apple juice, is better than an apple-flavored Jolly Rancher.

I think a lot of people are kind of catching on doing things like eating like a low-carb diet. But there’s still a bit to go to educate people around things like grass-fed and grass-finished beef. If you wouldn't eat Doritos, why would you eat a cow that ate Doritos? And that's sort of my way of helping them kind of make the next step into the, you know, what you eat is as important as what you eat eats, if that makes sense. Many of our customers already know this, though.

Many of our customers just eat our food because it tastes really good. As you guys got to experience last night, and again, I'm sure many of you already know. It just tastes better. It's more nutrient dense. There are a lot of studies on this now. A lot of the stuff is not proven yet. But if you just eat it, you can tell that it's more nutrient dense. It tastes better. It's so much more flavorful.

At Thanksgiving, the turkey always used to be the part that you had to eat. For me anyway, it was all about mashed potatoes and the gravy and the stuffing until I had turkey raised the way we do. And I'm like, “Wow, this is actually turkey. It actually has flavor. It's great!” But providing quality products that serve our customer needs is a joy. And then knowing that I'm simultaneously providing further long-term health makes it even better.

Food grown this way is still far too difficult to obtain and far too expensive. Our focus in Fireberry is bringing regeneratively grown meat to more tables in more communities. And my personal focus is on educating people to their health benefits. Steve likes to say this. I stole it. “I bought the ultimate value meal.” It is expensive, but when you think about it as a long-term investment and the health of the planet, the animals, yourself, and your communities, it's truly the ultimate value!