When you hear terms such as lifestyle medicine or plant-based doctor, names like Ornish, Esselstyn, McDougall, Greger and Barnard are evoked—and with good reason. These pioneering doctors have quite a catalog of groundbreaking research, thought-provoking books and informative media appearances in their many combined years of medical practice. Some of us have even been lucky enough (or unlucky enough, depending on the reason) to have shaken the hand of, spoken on the phone with or exchanged emails with one of these great doctors; but the truth is, there is practically no chance any of these physicians are, or will be, our family physician.
Your family physician probably hasn’t written a book, you didn’t see them on Netflix and they aren’t speaking at the next VegFest. He or she is a member of your local community and is the person that administers your annual physical, monitors your blood pressure or checks your A1C. They’ve all said, “It’s a virus, and it just has to run its course,” more times than we can count. These doctors are on the frontlines of our nation’s health crisis, dealing with patients on a local level. And it’s very unlikely that your family physician eats or recommends a plant-based diet.
Dr. Alex Freeman is one such family physician. He doesn’t have a bibliography, a filmography or a website with his upcoming tour schedule. He’s a second generation, a family physician working with patients at Freeman Family Medicine in the relatively small town of Conway, Arkansas.
...and he is plant-based.
Like most native Arkansans, Dr. Freeman grew up eating the standard American diet, but shortly after completing his residency in 2011, Freeman began to question his ‘healthy’ diet. Based on a friend’s recommendation, Freeman watched the documentary, Forks Over Knives, and while a diet transformation wasn’t imminent, the science presented in the film was impossible to ignore. It took another two years, several books and a few more viewings of Forks Over Knives before Dr. Freeman would finally give a plant-based diet a trial run.
So, in 2014, under the time restraint of Lint, Dr. Freeman spent 40 days and 40 nights eating a plant-based diet. He quickly became a believer. “I felt I’d turned a corner, and I couldn’t go back. I don’t know that I felt dramatically better, but I didn’t feel bad to begin with. It was really about prevention. Twenty or thirty years down the line, I want to feel as good as I do now. I want to stay healthy; I’m not trying to reverse anything.”
It’s not at all surprising that it was after medical school that Dr. Freeman discovered a plant-based diet–he’d learned essentially nothing about nutrition in medical school. What little he could remember about nutrition education was incorporated into other courses. Similar to most medical programs, there was no stand-alone nutrition course. “I don’t remember any nutrition lectures, and I certainly don’t remember hearing the words plant-based—or vegan for that matter,” he recounts.
Now, Freeman is doing what he can to combat the lack of nutrition education in medical schools by introducing a plant-based diet to medical students who come through his office in the summer. Students are shown a little window into what it’s like to speak with patients about a plant-based diet. Freeman recommends students watch Forks Over Knives–that way, at least it’s not a foreign idea upon completion of medical school. Dr. Freeman has planted a seed, and hopefully, it grows.
Dr. Freeman’s father (also a family physician) was taken aback by Alex’s plant-based shift; however, both his parents have since been convinced. In early 2017, Dr. Freeman and his parents embarked on a plant-based continuing medical education cruise. The cruise featured lectures by Dr. T. Colin Campbell, Dr. Caldwell Esselstyn, Dr. Michael Greger and Dr. Joel Kahn as well as really good, healthy plant-based food. At the end of the cruise, Mrs. Freeman said, “Well, I guess we’re going to have to give this a shot.” Now both father and son recommend a plant-based diet to their respective patients.
Freeman Family Medicine also has a dietitian who meets with patients once a week. The Freemans pay for the dietitian out of their our own pocket rather than charging the patients. Dr. Freeman urges patients, “Just go see her; we won’t bill your insurance. It’s free.” The dietitian is excellent at meeting patients where they are, diet-wise, and she encourages them to make incremental changes.
Dr. Freeman’s effort to edge patients toward a plant based diet has paid off. He recalled the story of one patient that turned to plant-based immediately. This patient was a man in his 70s whose A1C had been hovering in the prediabetic range for quite a while. Finally, it ticked up over seven, so he was officially diabetic. He came into Dr. Freeman’s office seeking an alternative to diabetic medication. Michelle, Dr. Freeman’s nurse practitioner, offered the patient a copy of Dr. Neal Barnard’s Program for Reversing Diabetes, which he promptly handed to his wife. His A1C is now within the normal range, he’s on no medication, he’s 50 pounds lighter and he’s in great shape.
Unfortunately, he’s the exception, according to Dr. Freeman. In his experience, most patients don’t jump on full board from the beginning. “Truthfully, it can be hard because a large part of a diet change is getting other family members to join in. You don’t eat alone. It’s a very social thing, and other family members are used to eating what they eat. People have kids, and they’re juggling a ton of things everyday—it’s hard to figure out how to squeeze a diet change in there,” explains Dr. Freeman. This is why Dr. Freeman encourages patients to bring family members, or whoever they’re eating with, along with them to the visit with the dietitian.
When detailing his general approach to transitioning patients to a plant-based diet, Freeman said he begins by asking if there is one meal per day that can be changed. Breakfast is usually the easiest one because it’s normally a person’s lightest meal of the day and requires very little creativity. Often, he suggests something like oatmeal, overnight oats or maybe a smoothie. Then later, patients are asked to change one additional meal on one day every two weeks or so. Eventually, it all just adds up.
In his office Dr. Freeman keeps a small library of plant-based movies and books which patients are encouraged to check out and take home. Books are suggested based on each patient’s individual needs– he doesn’t give each patient the same ‘prescription.’ Dr. Barnard’s s might be recommended to a patient concerned with diabetes while Dr. Esselstyn’s book, Prevent and Reverse Heart Disease, is suggested for someone with heart disease.
Dr. Freeman’s office features a bookshelf with a small library of various plant-based books, cookbooks and films. Patients are encouraged to check these out to help in their plant-based transition.
Surprisingly, many patients’ initial conversation with Dr. Freeman about a plant-based diet constitutes the first conversation any doctor has had with them about diet at all. “That’s because we’re simply not trained to do it. Patients trust us to give nutrition advice, but the truth is, we aren’t taught it, and very few of us really know much about it,” Freeman asserts. Also, there are still many persistent misconceptions about a plant-based diet. Freeman said he gets questions about protein, calcium and iron with seemingly every patient.
According to Freeman, a plant-based diet is usually brought up as part of a patient’s routine follow-up. A patient he sees once every three months because they have high blood pressure or they’re overweight will often ask if there is something more they could be doing. “Hey Doc, is there maybe something you could give me to lose a little bit of extra weight?” for instance. It’s not something which must be forced into the conversation—the opportunity most often presents itself.
Finally, Dr. Freeman offered some advice on how to speak to your doctor if you are interested in a plant-based diet: “I think you just have to be honest with your doctor and see how he or she responds. Some may not understand, but it’s hard to argue that a plant-based diet isn’t better for you, even if you are someone who is unfamiliar with the research related to it.”
Dr Freeman, doesn’t think you should run away from your doctor if they seem to be caught off guard with plant-based inquiries–it’s likely the first time they’ve heard anything about it. Furthermore, it really shouldn’t change how they treat you. “I don’t treat my plant-based patients differently than my non-plant-based patients. The recommendations are really the same,” insists Freeman. He said he may be less likely to recommend a statin drug to a plant-based patient with low risk, but he’s still going to recommend keeping up with the vaccination schedule or taking blood pressure medicine if your blood pressure isn’t controlled.
Most, if not all, doctors, are for patients bettering themselves. If you can improve your diet and it leads to needing less medicine, doctors are generally open to that. Most doctors believe they prescribe too much medicine, but as Freeman explains, “Because our patients aren’t healthy, we aren’t given much of a choice. I relish the chance to decrease the medication burden of our patients.”
Dr. Freeman is a pioneer in the field of family medicine. A plant-based family doctor in today’s world is, unfortunately, not the norm. Hopefully, the future will bring us more and more physicians who understand the benefits of plant-based eating.