How Plant-Based Nutrition Reignited My Passion for Medicine
Michelle McMacken, MD
Assistant Professor of Medicine, NYU School of Medicine
Director, Bellevue Hospital Weight Management Clinic
My path to medicine was a winding one. The daughter of two scientists, I was surprisingly drawn to the humanities, and I graduated from Yale University with a bachelor’s degree in English literature. I got my first real job as a writer-editor at the Centers for Disease Control and Prevention in Atlanta. For three years I looked on with admiration as my colleagues fought disease outbreaks and helped shape public health policy. Inspired by their work, I found myself contemplating a career in medicine and public health. So, in my mid-twenties, I quit my job, sold my car, took out more student loans, and went back to school to take basic chemistry, physics, biology, and organic chemistry – my first science classes since high school.
After completing my pre-med requirements and working for a year as a senior public health educator in the New York City Department of Health, I enrolled in medical school at Columbia University College of Physicians and Surgeons as one of a handful of ‘older’ students. Through my early experiences with patients, it became obvious that I was passionate about connecting with people and promoting health on an individual level – and so my original public health focus took a back seat. I pursued residency training in internal medicine so that I could be in a position to take care of each of my patients as an interconnected whole.
After my residency, I accepted a faculty position as a clinician educator at New York University Medical Center, with full-time clinical work at Bellevue Hospital Center. One of the largest safety-net hospitals in New York City, Bellevue is not only the teaching hospital for NYU School of Medicine, but it is a major referral center for medically complex patients, offering state-of-the-art medical care regardless of financial or insurance status. I practice outpatient internal medicine as part of a combined faculty-resident outpatient practice; my time is split between direct patient care and resident precepting. In addition, since 2005 I have directed Bellevue’s Weight Management Clinic, a program that emphasizes sustainable lifestyle changes for obese patients in our hospital system.
For the first few years of my primary care internal medicine practice, I managed chronic disease with the strategies I had been taught: a little bit of lifestyle advice, and a whole lot of medications, procedures, and surgeries. Day in and day out, I treated symptoms and blood test results related to diabetes, heart disease, high blood pressure, high cholesterol, fatty liver, osteoarthritis, and peripheral vascular disease — but I rarely got to the common root of these conditions. My approach was usually reactive rather than proactive. My patients didn’t get much better – the best I felt I could hope for was that their disease state was ‘managed’ and didn’t get worse.
Like most physicians, I had little to no nutrition instruction during my training, and I felt ill equipped to counsel my patients about their food choices. Even in my obesity program, I emphasized portion sizes and calorie counting over food choices and nutrient density. As I went about following traditional disease management strategies, I felt myself teetering towards the burnout that is all too common among primary care physicians.
At the same time, ironically, I started undergoing my own personal transformation related to food. After 24 years of being vegetarian, in 2007 I became vegan because I became more aware of the devastating impact of dairy and eggs on farm animals and the planet. I wanted to fully align my lifestyle choices with my values of reducing harm and maximizing compassion – the same values that were at the core of my practice as a physician. As a new vegan, I avidly sought out information about nutrition and began to fill in the large gaps left by my medical training. The China Study and Dr. Esselstyn’s Prevent and Reverse Heart Disease awakened me to the idea that many of the ‘chronic’ diseases I treated every day were not inevitable and incurable.
But even as I reaped personal benefits and began to recognize the potential wide-scale benefits of a plant-based diet, it was not until a few years later that I really started integrating the concept of food as medicine into my primary care practice. In 2013 I attended the annual meeting of the American College of Lifestyle Medicine, followed by the International Plant-Based Nutrition in Health Care conference in 2014. Joining these communities of like-minded practitioners and inspiring leaders gave me the confidence to make lifestyle change – especially a whole-food, plant-based diet – the centerpiece of my practice.
The results have been nothing short of tremendous, both for my patients and for me personally. No longer do I automatically reach for the prescription pad when I see a patient with diabetes and high cholesterol. I ask about food choices and find out what motivates my patient, whether it’s having more energy, reducing medications, being around for a grandchild’s graduation, or something else. I teach my patients about the benefits of a plant-centric diet and explore how they can start moving in that direction. Even if a patient is not ready to make changes, I emphasize the idea that food has the power to transform their health and is just as important, if not more important, than pills and procedures. I am practicing ways to individualize my counseling across a variety of cultures, social situations, and literacy levels.
I’ve found that many of my patients are hungry for the information I share. Most can relate to the idea of healing through healthy eating, and they want to learn specifically what to do. In just a short time, I’ve seen many patients avoid or decrease medications, prevent diabetes, lose weight, and reduce their cardiovascular risk by moving towards or fully adopting a plant-based diet. I’ve also gotten to know my patients in ways I never did before, back when I focused only on medications. And on the most personal level, I’ve resolved the dissonance I used to feel when I kept the benefits of plant-based eating to myself. My choices are unified with my professional message; I practice what I preach.
Now I’m committed to spreading the message of plant-based nutrition beyond my exam room. Last year, a colleague and I received a grant to develop an evidence-based nutrition curriculum for our faculty and resident physician colleagues. With fewer than one third of U.S. medical schools meeting the minimum standards of nutrition education recommended by the National Academy of Sciences, we have a lot of catching up to do!
I want to convey to my fellow physicians that food truly is medicine and that a great body of evidence supports using a whole-food plant-based diet for the prevention and treatment of our leading chronic diseases. I also hope to dispel common nutrition myths and teach basic, practical nutrition counseling skills for use in the primary care setting. It’s important to acknowledge that many physicians themselves do not practice healthy lifestyle habits, from diet to exercise to stress reduction. It would serve our patients well for more of us to become role models of health, but even if we cannot, we still have a responsibility to counsel our patients on the lifesaving tools of nutrition and lifestyle change. Most of our patients trust our advice!
It’s not an overstatement to say that plant-based nutrition has reignited my passion for medicine. I feel more connected to my patients, more optimistic about their potential to become well, and more fulfilled in my practice. I believe that the future of health care depends on the growth of the lifestyle medicine and plant-based nutrition movements. Our patients, our health care system, and indeed our very planet are in crisis. I am especially grateful to The Plantrician Project for helping lead the way and inspiring so many health care professionals to come together as a community to promote plant-based nutrition.
In our daily food choices, we have the opportunity to have a monumental impact not only on our own health, but also on the health of other sentient beings and the planet itself. As I say to my patients and my colleagues: Why not give this a try?