Many thanks for this very informative interview to busy internal medicine doctor Judy Brangman, MD, who works as a hospitalist physician. If you have ever wondered about what kind of difference you could make in a career in medicine or other health professions, this interview is for you!
How long have you been vegan? What inspired you to transition to a plant-based diet?
I decided to try a vegan diet because I had started to gain a few pounds, and I noticed that all of my vegan friends were slim. So I initially did it to lose the weight. I had gained 10lbs weight, which doesn’t seem like a lot, but it was enough in my mind to make a change. Also, my mother had been saying for years that if I stopped eating dairy that my acne and nasal congestion/allergies would resolve. So I tried it for a month at a time, off and on, but never really committing. I slowly started to incorporate more plant foods in my diet starting in 2012. My acne went away when I quit dairy. I prefer to use the term whole food plant based, and I have been WFPB since about 2013.
What does it mean to be an internal medicine doctor? What kind of patients do you see, and in what setting do you normally see them?
Great question! So medical school is four years and after medical school you do a residency. A residency is sort of like on-the-job clinical training, so you are not in class most of day as you are in medical school. Depending on the residency you choose, it is 3-5 years or so. Then after residency, you can choose to do additional training to specialize, which is optional (fellowship). Internal Medicine residency is 3 years and we treat only adult patients. I see patients in the hospital, so anytime an adult patient comes to the emergency room sick and needs to stay overnight for more treatment, then the emergency room (ER) doctor calls me to continue the care.
What are some of the experiences you had in your education leading up to becoming a doctor, and how do these experiences relate to your lifestyle choices?
I have always had a more holistic view of medicine and healthcare, and been passionate about health and wellness. In my family, we grew up mostly vegetarian, eating a lot of fruits vegetables, with little to no fried or processed foods. My mother seldom even allowed us to eat junk food, and my sister was vegan at one point as well. I worked as a clinical lab technologist before deciding to go to medical school. It was during medical school that I became more interested in ways to actually prevent disease and prevent the suffering and loss of life that I was seeing regularly in healthcare. But it wasn’t until residency when I first started to learn about the health benefits of plant-based nutrition.
What does it mean to have your certification from the American Board of Lifestyle Medicine? How did you obtain this?
The American Board of Lifestyle Medicine had the first board exam in 2017, and I was in that first group to sit for (and pass) the exam. We had to learn the material, study, write a case report, complete in person and online coursework, and sit for an exam. Traditional medical training provides very little education in the topic of lifestyle medicine. Most physicians and providers who took the exam work in a variety of specialties and settings and use the knowledge gained in their current jobs rather than doing just lifestyle medicine.
If nutrition is so important to health, then why aren’t more doctors recommending that their patients follow plant-based lifestyles?
Most doctors (and people in general) don’t know the benefits of a whole food plant-based diet. Physicians get little-to-no nutrition training in medical school or residency. Other allied health professionals may get some nutrition training, but it’s not in favor of plant-based nutrition. The mainstream view is almost obsessed with protein and has the mindset that the only quality protein sources are animal-based. Even the dietary recommendations from American Diabetic Association and American Heart Association have not been plant-based. In more recent years, however, mainstream medicine has started to embrace it, but slowly. For example, the American Diabetic Association lists plant-based diets as showing “positive results in research” in its 2018 Standards of Medical Care, and the American Institute for Cancer Research’s (AICR’s) “recommendation for cancer prevention is to eat a plant-based diet.”
As a young WFPB doctor, how much do you think your lifestyle choices influence your interactions and relationships with your patients and colleagues? Do you receive a lot of backlash?
Physicians who have poor lifestyle habits are less likely to counsel patients on healthy habits. Since I am plant-based, I can reassure patients who are hesitant about it that it is a healthy way to eat. I have not received any backlash. I don’t recommend for my patients to become vegan per se, because there are lots of unhealthy vegan foods. I ask them questions about their diet—for example, how many fruits and vegetables they eat in a day—and physical activity levels. Based on that, we come up with a way to improve both of those aspects of their lifestyles. Aiming for 150 minutes of physical activity per week and at least 5-6 servings fruit and vegetables a day has been shown to have huge health benefits. I encourage patients to make at least 1⁄2 of the food on their plant fruits/vegetables (especially vegetables).
To what extent does your lifestyle influence the way you treat your patients in comparison to how other MDs treat their patients?
There is definitely a difference. Because I have studied nutrition and how lifestyle choices cause at least 80% of chronic diseases, I strongly advocate for patients to change their lifestyle. I am also more open to them trying lifestyle changes first for 1-3 months (in certain cases, if medically appropriate) rather than going directly to prescribing medications alone. I use prescriptions with lifestyle medicine, and this combination works best for the patient. Patients will have more improvements in, for example, blood pressure and diabetes this way.
Do you believe that many of your patients’ health conditions are directly related to their lack of good nutrition?
Absolutely! I think of it as “genetics loads the gun, but lifestyle pulls the trigger.” However, most healthcare professionals and patients think that genetics is the main factor in development of disease and don’t see their diet as something that can prevent disease or alter the disease course. Studies have shown that most chronic diseases are related to poor nutrition. There is even evidence that poor nutrition and lifestyle choices play a role in the development in certain cancers (colon, breast, prostate, lung).
Do you think you have great influence upon your patients’ nutritional choices? What advice do you normally give to patients about their diet?
Yes, I think patients take advice from their physicians more than we think. When I was in the clinic doing primary care, my patients would often come back at their follow-up visit and discuss how they have been trying to eat more fruits and vegetables or walk more. Most patients do not want to take medications. If we gave them options on non-pharmacological ways to treat obesity, diabetes, hypertension, and heart disease, most patients would greatly appreciate it. My patients have had good results when they make lifestyle changes and have been able to reduce medication doses, and in some cases, discontinue some medications.
How receptive are patients to your lifestyle advice?
I ask open-ended questions to gather how receptive a patient is. If they are not receptive at all, then I don’t push it. Some are not receptive at all, and others are very receptive. Most seem to think it is all genetic and that there is nothing they can do. Also, meat and dairy is a cultural norm, and so is being overweight and obese. When I discuss with my overweight and obese patients about weight, some feel that a medically normal body weight for them would make them look too skinny and “sick.” So they may think their weight is fine, since everyone in their family is that way. The patient has to be ready to make a behavior change. However, I do give the information and recommend eating more fruits and vegetables and reducing meat and dairy with every patient.
What is the best part of your profession for you?
I love being able to interact with so many different people of different backgrounds and walks of life. I love being able to influence others to make better health choices. I also love that my job is challenging, and there are so many settings that I could work as an Internal Medicine physician.
What advice do you have for vegan and vegan-interested teenagers who would like to become doctors? Is this a career open to only near-perfect students?
I would say that one should enjoy science and reading a lot, be willing to sacrifice time with family and friends to study, and have a desire for lifelong learning. You do not have to be a straight-A-student in high school or college to get into medical school or be a good doctor. However, good grades will make you more competitive to get accepted into medical school. The American Association of Medical Colleges (AAMC) publishes average grade point average (GPA) and MCAT (medical school entrance exam) scores and statistics for medical schools. I would recommend having extra-curricular activities outside of school as well.
If someone doesn’t want to become a doctor, what other health professions can influence people’s food and other lifestyle choices for the better?
One can consider physician assistant. It is shorter time in school, and you can work in many of the same settings as a physician. There are so many other careers such as registered dietician, nurse, nurse practitioner, or plant-based chef. Or one can do health and wellness on the side and teach cooking classes, do public speaking, or have a website and social media account.