Becoming a Physician 'Healer' Using Food as Medicine
By Jaimela Dulaney, MD
I was born and raised in West Virginia eating the Standard American Diet. Mine was the country version with garden-raised vegetables, farm-raised animals and fruit that was in a pie. Sugar and white flour were the main staples that were purchased. Both of my grandmothers had diabetes and my first exposure to medicine was riding in the backseat of the car many nights taking my grandmother to the hospital in heart failure.
I became a physician with the passion to prevent and eliminate the suffering associated with lifestyle-related diseases so that other families would not have to endure what I had experienced.
After going to medical school at West Virginia University and finishing a residency in Internal Medicine and fellowship in Cardiology at the University of Pittsburgh, I felt quite comfortable diagnosing and treating those diseases we now call lifestyle diseases: hypertension, diabetes, hyperlipidemia and cardiovascular diseases.
In other words, I felt comfortable performing diagnostic testing, intervention and titration of medications to stabilize those diseases.
I never expected to reverse those diseases once diagnosed, but was hopeful that I could improve the quality of life of those afflicted. And perhaps, if one exercised and ate modestly enough they could prevent or delay those diseases in the first place. In fact, I ran marathons to set a good example for my patients and framed my t-shirts and medals to encourage others to try. (To date, I have not had one patient run a marathon at my suggestion but am confident it will happen one day!)
While in the catheterization laboratory I met a technician, who shared with me that she ate a plant-based diet. I was amazed that she thrived consuming a diet comprised exclusively of plant foods. She suggested I read the book by John Robbins,A Diet for a New America. In one weekend I read that book cover to cover and was amazed to learn about factory farming, about what mono crops had done to family farming and about the ill health associated with eating animal products. I was convinced and switched to a plant-based diet. It was not as easy as I thought, because my family was not as convinced when I relayed the information. They were quite happy with the Irish-Italian home cooking that my mother was so skilled at preparing, and my father was a hunter no less. Going it alone was not that easy, but I continued to present information hoping to sway them to my plant-based way of eating.
As with most big changes in life, a perfect storm helped set things in motion.
My family’s health started to fail: My mother was diagnosed with lymphoma, and my father was suffering from dementia. In searching for resources, I came across the documentaryForks over Knives. Dr. Caldwell Esselstyn, who was featured in the film, became my mentor. His works rang dear to my heart: If I educated my patients and family, took time to listen to and support them, and showed them how, they could adopt a plant- based dietary lifestyle and reverse their lifestyle diseases, as well.
Because of my parents’ ill health, I prepared plant-based meals for them. My mother did remarkably well with her chemotherapy and recovered. She has become quite the accomplished plant-based chef and is still very active at 84 playing golf and doing Zumba.
Dementia, however, is a relentless disease and once in full force it’s hard to stop. As a physician it is a terrible blow to be unable to heal one’s family members. My dad taught me compassion and patience and demonstrated bravery and strength throughout his life and with his illness. As a daughter witnessing this, and as a physician, I became even more committed to educating my patients about prevention of this terrible illness.
I began by discussing lifestyle medicine and plant-based nutrition with all my patients. They came to me for medication titration and procedures, not for a nutrition lecture. Some were shocked and most skeptical. I gave them books, articles and documentary suggestions. I had a few people give it a go, but few could sustain the changes. I decided to begin a nutrition class by offering an evening course. We had room for 16 patients in each class consisting of six sessions. Patients would pay for the course up front to assure attendance, and they could bring their spouse for free. If they missed a class they could make it up the next session. This was to give them every chance possible at success. I started by bringing food to sample and gave a white board discussion with handouts. Then I started doing cooking demonstrations. We menu-planned together, and one class was a grocery store shopping session. We traveled up and down the aisles learning about new vegetables and sharing how to prepare them.
For the first time in my practice, patients started losing weight, their chest pain resolved, their diabetic neuropathy went away and their cholesterol levels normalized. I discontinued more medications for patients than I was starting! I will never forget the look on one patient’s face as I discussed how a plant -based diet can reverse diabetic neuropathy. He said in amazement, “I have had foot pain for the past 10 years, and now I’ve not had pain in my feet for the last two weeks.”
To say that I was encouraged would be an understatement!
Because of popularity, we offered a second night of classes and they filled to capacity. The problem was when a course concluded, and patients went on vacation and visited family, they slowly went back to consuming animal products (meat, fowl, fish and dairy), so their blood pressure and cholesterol would start to creep back up.
As healthcare and insurance regulations continued to change the practice of medicine, sustaining a solo practice was becoming ever more difficult.
Ultimately, I decided to follow my passion for prevention and lifestyle medicine and changed my practice model. In July of 2017 we launched a membership practice offering nutrition classes and lifestyle coaching to all our patients, including primary care and cardiology services. In October, we became a full membership practice.
We now have three levels of nutrition classes that meet weekly: an introductory course on plant-based nutrition; an intermediate course where we focus more on troubleshooting and menu planning; and an advanced course where we do more complicated recipes and explore different cuisines’ plant-based style.
I do a slide presentation for each class discussing the science of plant-based nutrition as it relates to various lifestyle diseases. We also discuss the social aspects of eating plant-based, which is by far the biggest obstacle. A registered dietitian is available to all members for consultation, menu planning and coaching.
We meet with each patient to define his or her goals for optimal health and wellness. This includes mobility and movement screening with education to improve exercise capacity and mobility. We discuss the importance of strength and flexibility to prevent illness and skeletal deterioration. We assess their social connectedness and offer yoga, Pilates and other social-networking opportunities. The weekly nutrition classes have become a sense of community to allow sharing of recipes, health successes and potlucks. There is a private Facebook page and private web content page that also allow interaction and information.
Members have normalized their HgA1Cs, cholesterol and blood pressure. Their exercise capacity has improved, as has their sense of wellbeing.
By limiting the number of patients in the practice, office visits are no longer rushed and same-day appointments are available. Their wellness visit on average is an hour and a half. Follow-up visits are not rushed and last as long as needed.
I have more than 20 90-year-old patients that were grandfathered into the practice with no membership fee. I have three 100-year-old patients as well. One still drives to the office.
If someone has a strong desire to be a part of the practice but cannot financially afford it, we have scholarship slots available. If a patient requires hospitalization, I am their admitting physician and direct their care.
The change has revitalized my practice and it is a pleasure to come to work each day. It is very satisfying to be able to reverse and prevent the same lifestyle diseases that I had only envisioned preventing and treating at the beginning of my career.