An Interview Series with Dr. Andrew Freeman, cardiologist at National Jewish Health
Dr. Andrew Freeman, aka “the Vegan Cardiologist,” has had great success not just treating, but actually curing, his cardiology patients through a combination of traditional Western medicine and a focus on exercise and a heart-healthy diet. Here’s what he had to say about what made him a convert, how patients react, and ways to keep them compliant.
Rebecca Beattie: What got you interested in the link between lifestyle and heart disease?
Dr. Freeman: I got basically no nutrition training even in cardiology fellowship, so I got into practice and started throwing pills at people’s problems, but it never felt great that people weren’t actually being cured. When I finally started to spend some time looking at the link between nutrition and heart disease, I was blown away. I had no idea that this stuff even existed. So I started doing it myself, and it’s been about 5 ½ years at this point where I’ve been on a fully plant-based diet and exercising regularly.
I started recommending lifestyle changes as a treatment for my patients, and for the first time ever I could see “cure” as a possibility as opposed to just control of disease. That was all it took to get me really hooked. A lot of people still see this as extraordinary or crazy, but when you’re looking at things like bypass surgery, which is more crazy? Opening up your chest wall, rearranging all of the arteries to the major organ that keeps you alive? Or drastically changing your diet? You have to decide what’s right for you.
RB: What do you tell patients to get them on board?
AF: I try to practice in a very evidence-based way with patient centeredness, and I never insist on a patient making these changes. I usually ask permission first, which is a key thing I learned along the way.
When I first started, I’d see somebody who had a five-vessel bypass, and ask them what they had for dinner and they’d say “oh I had hot dogs with nachos” and I’d say, “look, you can’t eat that anymore, you’ve had a five-vessel bypass,” sometimes even twice. They would say “okay thanks very much” and then they’d go to the patient advocate and ask for a new cardiologist. So now I ask “can I be critical of your diet?” 99.9% of the people do say yes, but I think they need to feel empowered that they have a choice.
I also tell people that the USDA dietary guidelines that were put out in 2015 only recommend three healthful diets. One is a plant-based diet, the second is a Mediterranean diet, which is a predominantly plant-based diet, and the third is a so-called “Healthy American Diet.” No one really knows what the third one means, but if you read it carefully it’s also a predominantly plant-based diet. So everyone is saying the same thing, just in different ways.
RB: What sort of resistance do you encounter from patients, and how do you overcome that?
AF: Food is like a religion for people. When you criticize grandma’s brisket, you’re challenging a history, a lifestyle. People have a huge emotional tie to the scents, smells, and tastes of things – you get an amygdala response. So it’s a challenge.
I use a form of motivational interviewing to get people to make these changes. I’ll ask somebody who’s in their sixties, “do you want to be Grandpa Paul in the corner that nobody wants to be near, because you’re miserable on oxygen, and you can’t stand up because your legs hurt? Or do you want to be Grandpa Paul who’s 85 dancing at your great-granddaughter’s wedding?” And they all look at me and say, “I’ve never thought of that!”
I had a patient recently who was in his late 30s, single guy, truck driver, smoked a lot, ate very poorly, and he said to me, “I don’t really care. It doesn’t matter to me.” But then he got a girlfriend, and he came to me and said, “Doc, I have erectile dysfunction. What do I need to do?” All of a sudden, the cigarettes went. He stopped eating processed foods. He wanted to improve his quality of life, and I would argue sexual health is part of that. So whatever it is that motivates somebody, grab onto it and help them to make the changes.
Overall, we need to remember that change is hard, both for patients and physicians. Lifestyle really needs to be incorporated into every single visit. It doesn’t have to be an extensive thing. Just ask “what did you have for dinner last night? Or two nights ago?.” It’s a simple question, but the goal is to continue to implement the change.
RB: What resources do you provide patients to help them adhere to this lifestyle?
AF: First, let me say that I think it’s inherently irresponsible to tell people to change their lifestyle, and then not give them the support or resources that they need. It’s also hard to tell people to do the behavior if you’re not modeling it yourself.
For the exercise component, I do a program called “Walk with a Doc” which is a really neat program. We walk with our patients in a local park, and we have enough docs in the Denver area that we do it almost every week.
For the nutrition part, since most doctors don’t have any nutrition training, I would encourage them to spend some time reading the literature and watching documentaries like Forks over Knives or Eating you Alive. Those documentaries work well for patients too, because people like to watch movies instead of doing a bunch of reading.
I have packets that I put together that include things like a vegetarian starter kit that I got from the Physicians Committee for Responsible Medicine (PCRM) and a local vegetarian starter guide that I think is put out by the humane society or PETA. I also tell people that there are vegan cooking schools that you can do online or locally, and that your library has a wealth of resources. So there are many options out there for people who are willing to give this a try.
One other thing that I want to be sure my fellow physicians are aware of is that in 2011, CMS approved what’s called intensive cardiac rehab, which is different than traditional cardiac rehab. Intensive cardiac rehab is nine weeks of twice-a-week, four-hour sessions which include: an hour of exercise, an hour of plant-based nutrition with a meal provided, an hour of stress relief in the form of cardiac yoga, and an hour of group support. The outcomes are so good that it’s fully covered by Medicare. And, it reimburses well, so I’m not sure why it’s not available everywhere. But it really works, so I want readers to at least investigate starting such a program in their own neck of the woods.