Michelle McMacken, MD, Plant-Based Nutrition

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michelle-mccrackenMichelle McMacken, MD, is a board-certified internal medicine physician and Assistant Professor of Medicine at NYU School of Medicine. An honors graduate of Yale University and Columbia University College of Physicians and Surgeons, she has more than ten years’ experience practicing primary care, directing a medical weight-loss program, and teaching doctors-in-training at Bellevue Hospital Center in New York City. Dr. McMacken is an enthusiastic supporter of plant-based nutrition and is committed to educating patients and doctors about the power of healthy eating and lifestyle modification. She has a Certificate in Plant-Based Nutrition from Cornell University.

TRANSCRIPTION:

Caryn Hartglass: My guest has arrived, and I want to take advantage of that. So let me introduce you to Dr. Michelle McMacken. She is a board certified internal medicine physician and assistant professor of medicine at NYU School of Medicine, an honors graduate of Yale University and Columbia University – College of Physicians and Surgeons. She has more than ten years’ experience practicing primary care, directing a medical weight-loss program and teaching doctors in training at Bellevue Hospital Center in New York City. Dr. McMacken is an enthusiastic supporter of plant-based nutrition and is committed to educating patients and doctors about the power of healthy eating and lifestyle modification, and she has a certificate in plant-based nutrition from Cornell University. I do too. [Laughs] Thank you for joining me on It’s All About Food.

Dr. Michelle McMacken: Thank you for having me. It’s great to be here.

Caryn Hartglass: Yeah, well, I met you – if you remember – at the VegNews Comfort Food Shindig, which was a fabulous Manhattan event.

Dr. Michelle McMacken: Sure was.

Caryn Hartglass: And what I loved about meeting you was you have an infectious smile. Maybe infectious isn’t the right word. [Laughs] That does have a negative connotation, but at least it’s a smile. It just came out of me. I realized what I was saying.

Dr. Michelle McMacken: I know what you mean.

Caryn Hartglass: It makes other people want to smile back. That’s what infectious means in this particular case. And your energy just was bouncing off the walls, and I was so excited and thrilled to hear that you are a medical doctor, here in New York, doing wonderful things. Thank you so much for that.

Dr. Michelle McMacken: Oh, thank you.

Caryn Hartglass: Now how can we clone you? [Laughs]

Dr. Michelle McMacken: There’s actually – as far as – as far as physicians who are interested in how food and lifestyle habits can actually promote healing, true healing and getting to the root cause of disease, there’s really a growing movement in this area and something I’ve been really lucky to be a part of, particularly through the American College of Lifestyle Medicine. And as far as plant-based nutrition and veganism, there’s also a growing movement, I believe, maybe it’s – maybe it’s just I’ve reached out to a lot of vegan doctors, but…

Caryn Hartglass: It is growing in New York.

Dr. Michelle McMacken: Yeah.

Caryn Hartglass: Maybe not as much in Mississippi but definitely in New York.

Dr. Michelle McMacken: Right. Well, I think it is – I think things are getting off the ground and hopefully will just keep expanding.

Caryn Hartglass: I don’t know why this flashed into my mind, but when I was 15 years old, that’s when I first got the idea not to eat animals. I was in school. There was a friend of mine named David, and he announced he was vegetarian, and I think I told this story last week on the show, but he – I saw him 20 years later and said he was like the reason for my life’s path. And he said that he had only been vegetarian for a week, but the real part of that story is my mom was concerned about what I should eat. And at that time, I was still eating dairy, so she just kept saying, “Eat more cottage cheese!” which we’ve learned later wasn’t the best thing. But she cared and she brought me to our physician, and he was always slim and tan and very … well, I’ll just stop at that, but he – my mom asked him if it was okay if I didn’t eat meat and his response was, “You should eat meat because that gives the opportunity for more cows to live.” And that was his… [Laughs]

Dr. Michelle McMacken: Oh, that is so surreal.

Caryn Hartglass: It was his knowledgeable advice to me, and I’m happy to say I didn’t listen to him.

Dr. Michelle McMacken: You trusted your instincts. You had good instincts.

Caryn Hartglass: But it’s just an interesting perspective and so clueless.

Dr. Michelle McMacken: Yeah, I mean I think it reflects, to some degree, the fact that in terms of medical training, I mean what people have heard is actually true, that doctors get something like fewer than 20 hours in their entire four years of medical school education, and very little is folded into their residency or their post-graduate training. And so unfortunately I think doctors are, on the one hand, not that much more knowledgeable about healthy eating than the average person, and they’re subject to the same misunderstandings and media pressure and marketing pressure as everybody else. And on the other hand, they’re actually expected to be an authority, so patients come to them and then they’ll ask a question like your mom did of your doctor, and then sort of what the doctor says goes. And there’s not, unfortunately, a lot of basis for a lot of those recommendations.

Caryn Hartglass: I started out my adult career in – as an engineer. I had a masters’ in chemical engineering. I was in the semi-conductor industry, and one of the first things I learned that was really important, at least to get the confidence of my clients and colleagues, was that if someone asked me a question and I didn’t know the answer, I said, “I don’t know.”

Dr. Michelle McMacken: Humility is a very good quality.

Caryn Hartglass: “But I’m going to do my best to find out for you,” and whenever a doctor gives me an answer that I know is wrong, I think of that. Why can’t you say, “I don’t know?”

Dr. Michelle McMacken: Well, it seems so – first of all, I agree with you, of course, but it also just seems so – I think even doctors realize that they should know the answer to that, and to say, “I don’t know,” to every single question about food would be, frankly, really almost an embarrassment about their training. And it’s not – it’s a broad problem. It’s not an individual’s issue. It’s a broad issue.

Caryn Hartglass: Okay, so you’re doing this wonderful thing. You received a grant to study and teach plant-based nutrition to other doctors. Can you talk about that?

Dr. Michelle McMacken: Yeah, so this is something I’m really excited about. Basically just to give you a little context, I myself have been vegetarian for decades, since I was 13, and then eventually became vegan about eight years ago now. And really unfortunately it didn’t really – my own choices didn’t really spread into the way I practiced medicine at first, and I kind of kept it to myself and kind of worked through changes in how to modify my own lifestyle as far as becoming vegan and really was very extremely grateful that I had made that decision. It was really the right decision but didn’t really incorporate it into my practice until a couple of years ago when I went to this American College of Lifestyle Medicine meeting, and I saw that there’s a huge community of physicians out there that not only really care about using healthy eating and exercise and stress reduction to help get to the root cause of disease but to – there’s a segment of those that are also very interested in plant-based nutrition. And so I can’t even tell you how empowering it was to see all these other people that were – that sort of thought like me and ate like me and I just felt so empowered to kind of come back to my job and start putting this into practice. And it’s because I work in an academic center and I’m responsible for teaching medical students and doctors in training, I thought: this is the perfect opportunity to take what I’ve learned, and just three years ago, I would have – I didn’t know much more than anybody else about nutrition. I made a choice being vegan because I just couldn’t – I kind of – putting foods on my plate that required so much cruelty and so much harm just was not in-line with my values. But as far as the actual nutritional benefits, I really didn’t know that much, and so as I learned more and as I did my own research, I thought this is wonderful. I can actually start educating other people because the science is profound. And if you start dipping your toe into the pool of that science, you can’t believe how much there is and it’s just – I think people like to think nutrition is so complicated, but it’s really not. Most of the roads lead to the same place, and there’s, yes, some little controversies at the extreme, but the themes are – the themes are broad and the consensus is broad. So around that time that I came back from that conference and got really excited, I applied for a grant to – so that I could sort of legitimize my study of the – of nutrition and evidence based nutrition and then develop a curriculum that I could teach to my – starting actually with my faculty colleagues because my colleagues who are also physicians and at the same level of training as me are also responsible for teaching. So I thought: well, let’s start with the people that do the teaching, and then we can kind of evolve this into teaching others. And so we’re about to roll out – this is – I got the grant together with another colleague of mine, a fellow vegan physician, and – and we’re going to be rolling out the curriculum this spring.

Caryn Hartglass: Wow, so is this a curriculum for physicians …

Dr. Michelle McMacken: Yes.

Caryn Hartglass: … that are already physicians?

Dr. Michelle McMacken: Yes, so the first phase will be we’re teaching our colleagues who are also supervisors like us, and so people who have gone through all of their formal training and are now in the role of teaching other people. And I also give lectures to doctors in training, and I coach them one-on-one when they see patients and sort of at every opportunity trying to get the message out there about healthy eating.

Caryn Hartglass: Was there any pushback against this program doing something like this?

Dr. Michelle McMacken: No, quite the contrary. I have found that every time I’ve given a lecture or talked about nutrition in the context of a particular patient, people have – other doctors have just been so excited to learn and actually quite humble about their lack of knowledge around it. And I think if you present things in a way that keep it very simple and very practical b we don’t have a lot of time and we don’t have a lot of resources and just things that people can actually do, and also keep it – keep it light. Keep it so that there’s this sense I think that when you teach people about a new drug, they’re able to maintain. As a doctor, they’re able to maintain a distance between themselves and the patient because they’re not going to be the ones taking that drug, at least not right now. Whereas with food, everyone eats so it necessarily sort of hits home, and I think it conjures up a lot of feelings around everyone’s personal decisions. So I think keeping it, acknowledging that discomfort but keeping it light and keeping it humorous and just providing evidence based information is really useful.

Caryn Hartglass: Okay, so in Dr. McMacken’s world of planning a future educational path for doctors, would you include this nutritional training after doctors became licensed to practice or before?

Dr. Michelle McMacken: Oh no, I mean I think this has to start from day one in medical school. I think we’re looking at a situation where we have to change the entire paradigm of medicine. It’s not just teaching nutrition. It’s leaving space for people to understand that when we use pills and procedures and surgeries, a lot of the time, we’re not getting to the root of the problem. We’re treating symptoms and for some people, that might be what they want, but there are plenty of people that are open to learning how they can actually be empowered to change their lifestyle and just need to have instruction and support on how to do that. And at a minimum, have sort of back up by their doctor even if their doctor can’t explain exactly how to do it. Have their doctor say, “Yes, I think that’s a great idea. Go for it.” So I think we have to change the entire paradigm, and I think that has to happen in a multi-faceted way, and it does have to start from day one of medical school. So it’s not just the nutrition training. The other thing is it’s not just facts. It’s not just teaching people animal protein is directly linked with causing diabetes. Every time I tell that to another doctor, they’re surprised. Patients haven’t heard it. Doctors haven’t heard it, and it’s been out there in the literature for a very long time, and a lot of studies support that. So that’s a fact, but then how do you sit down in front of a patient and actually translate that into a behavior change? That’s another skill, and so this is going to – we’re going to have to address this on multiple levels.

Caryn Hartglass: Yep, okay. Well, we’re starting and putting it out there to the universe and that’s good. There’s just so much that a doctor has to learn in medical school, so how do you add more to that?

Dr. Michelle McMacken: Yes.

Caryn Hartglass: But that’s not your problem.

Dr. Michelle McMacken: Well, it is and it isn’t, but you’re absolutely right. There is. It’s like how do you fit in yet another body of knowledge, but I mean we’re facing a situation where I think something like 75 percent of our healthcare costs are because of chronic disease, which is – most of which is foodborne. Heart disease, diabetes, obesity, many cancers, stroke, Alzheimer’s; the list goes on and on.

Caryn Hartglass: In my world, when people finally get the power of good nutrition and we’re all eating more plants and less animals, if any animals at all, and all of a sudden, all these chronic diseases go down to a low murmur, then what our medical practitioners can work on is all those mysterious things.

Dr. Michelle McMacken: That’s right.

Caryn Hartglass: I mean not just broken arms and legs but all the mysterious things, and we can get really good at solving those problems, which are now so masked because you don’t know. Is this a chronic food related illness or something mysterious or a combination? It’s a mess. So let’s rid of all of the type 2 diabetes, which we don’t even call “type 2” anymore. Or no, we call it “type 2.” What we used other call “adult onset diabetes” because now children have it.

Dr. Michelle McMacken: Right.

Caryn Hartglass: And heart disease, gone. My cousin, she – I saw her recently and she said she was diagnosed with cardiovascular disease, and her doctor told her: take these drugs and you can’t reverse it, but at least you can slow it down. And I looked at her and said, “Are you kidding me?” What sand has his head been in and for how long?

Dr. Michelle McMacken: Yeah, it is really shocking, as I said before, when you start to read what’s out there and frankly, things that have been out there – I mean Dr. Caldwell Esselstyn’s book on reversing heart disease, I mean that information has been out there for a decade.

Caryn Hartglass: I mean especially when Clinton, when Bill Clinton got the message, that was on major news. I thought everybody heard it.

Dr. Michelle McMacken: Yeah.

Caryn Hartglass: Okay, phew. All right. [Laughs]

Dr. Michelle McMacken: Slowly. Slowly but surely.

Caryn Hartglass: Yes, well, I’m very excited to hear that more doctors are learning and want to learn about plant-based food. I have so many doctors’ stories where … hmm, they could have used this a long time ago. And some of the responses I remember getting from some doctors was really not believing that patients wanted to hear this information, that they wanted things quick and easy. And I believe not that we’re all sheep, although many of us are. If we hear the right information often enough from our doctors and everyone else, we’re going to get it and want it. And by the way, it’s delicious. You’re not deprived. You’re not suffering. The side effects are all good. You look younger. You feel better.

Dr. Michelle McMacken: That’s right. I just – sometimes I just want to sing at the top of the mountains, like it’s all good. [Laughs] It’s all good, but I haven’t had that experience at all when it comes – that is a common misconception that patients don’t want to hear it, but that has not been my experience whatsoever. Maybe a handful of people who said, “I really don’t feel like changing right now,” and they’ve sometimes under extraordinarily different – difficult social circumstances. But the majority of people want to hear how they can help their body heal. They live with terrible chronic pain – arthritis, inflammation, high blood pressure, tons of pills. They want to hear how they can heal, and then the challenge is helping them do that.

Caryn Hartglass: How’s the food at Bellevue Hospital?

Dr. Michelle McMacken: [Laughs] I pack a lunch most days. I would anyway. It gives me more control and lets me eat exactly what I want to eat. But hospital food, in general, is a huge issue in every hospital that I know of.

Caryn Hartglass: I had my own big hospital experience in 2006-2007. I had advanced ovarian cancer, and I experience some local hospitals – Brooklyn Hospital, Richmond Hospital in Staten Island. They were disastrous, and then I ended up happily at Mount Sinai, and they had much better food, but still I had problems with them and that was nine years ago. Recently another cousin unfortunately has ovarian cancer, and I spent some time with her when was visiting – when she was at Sloan Kettering, and people may know Sloan Kettering is not my favorite hospital, so I’m sure some people love it. But I have not had good experiences there, even nine years after my own experience with my cousin; I didn’t really particularly care for what was going on. But the cafeteria was pretty awesome. Tofu, beans, salad bar. I could eat happily there and did, and their menu even had some pretty nice vegan options where they used the word “vegan.” [Laughs]

Dr. Michelle McMacken: That was nine years ago?

Caryn Hartglass: No, this was this year.

Dr. Michelle McMacken: Oh, I was going to say.

Caryn Hartglass: Well, I mean it’s progressive now.

Dr. Michelle McMacken: Let alone nine years ago.

Caryn Hartglass: No, no, no, no. Now.

Dr. Michelle McMacken: That’s wonderful!

Caryn Hartglass: So that was very encouraging.

Dr. Michelle McMacken: That is – that is very heartening.

Caryn Hartglass: Very encouraging.

Dr. Michelle McMacken: I mean places – everyone’s going to have to get on board. I rode Amtrak yesterday, and I saw they have now two vegan options on the Northeast Corridor. I hope they keep them, but I immediately wrote to them and said, “Thank you.” I mean consumer demand is what’s going to drive this thing.

Caryn Hartglass: Yes, and we want it! Get it! We want it!

Dr. Michelle McMacken: There are a lot of us.

Caryn Hartglass: I’m going to give my sister credit for the meals on Amtrak. I’m sure she’s not the one, but we all …

Dr. Michelle McMacken: Oh, did she?

Caryn Hartglass: No, she traveled on Amtrak a few years ago, and the food was horrible and she let them know. And we have to let food suppliers know what we want. That’s all. They have to know. Don’t be shy.

Dr. Michelle McMacken: That’s right. You have to speak up.

Caryn Hartglass: Speak up. Okay, I am getting so hungry. [Laughs] Which is really good because I was just talking earlier about I’ve had this bad cold, and on Christmas Eve, I had no appetite and it was really sad, but it’s great to have an appetite and love the food that you’re eating. All right, let’s – speaking of loving eating, let’s talk about your weight-loss program. [Laughs]

Dr. Michelle McMacken: Who doesn’t love to eat?

Caryn Hartglass: I do.

Dr. Michelle McMacken: I know I do too.

Caryn Hartglass: I love eating, and I love eating whatever I want, whenever I want, as much as I want and I can.

Dr. Michelle McMacken: Yeah, yeah. It’s pretty – it’s phenomenal and it’s a pretty – it’s been a pretty well-kept secret, but I think the secret’s getting out that when you’ve – when you’re eating mostly unprocessed, whole food, plant-based diet, you really – you never have to get out a Fitbit, count your calories or measure portions.

Caryn Hartglass: Portions are big.

Dr. Michelle McMacken: Right.

Caryn Hartglass: It’s big food.

Dr. Michelle McMacken: When you’re hungry and it’s – and it’s really great, and plus you feel great while you’re doing it, and you don’t feel deprived. I’ve been directing a medical weight-loss program for ten years, and the focus of our program has always been lifestyle change. It’s not been pills, and it’s not been surgery, although we work side-by-side with a bariatric surgery or a weight-loss surgery program. And I have to say the first, I don’t know, seven years of directing the program, I – we all followed a very traditional model of helping people reduce portions and …

Caryn Hartglass: [Chuckle]

Dr. Michelle McMacken: … Exactly.

Caryn Hartglass: I was rolling my eyes.

Dr. Michelle McMacken: She was rolling her eyes. And so around the same time that I had this sort of epiphany around using lifestyle as medicine, I said, “Well I’m going to – this is – I’m rolling this out to every aspect of my life and every aspect of my professional practice.” And so I’ve been exclusively counseling on transitioning people to plant-based diets in the weight-loss program, and I have to say that both in my daily regular internal medicine practice and in the weight-loss program, people just lose weight without really trying. And I think there is – for some people, there is a fear. I think for some people, there is a barrier that they don’t want to go on a plant-based or vegan diet because they’re worried about losing weight, and that’s a separate issue which I can address. But for the vast majority of people that I take care of, there is an interest in losing weight for their health and for other reasons. So it’s a welcome surprise to see that they come back to see me a month or three months later, and just almost like accidentally, they’ve lost ten pounds and they feel more energetic. They’re sleeping better. They’re no longer constipated. Their blood pressure’s better. Their pre-diabetes has gone away. It’s just you name it and it’s better. So it’s just extremely rewarding.

Caryn Hartglass: Yes! Okay, is there a structure to this obesity plan, like the first things you tell your clients to eat or not eat?

Dr. Michelle McMacken: Well, I spend a little time going over the broad principles of what is – what’s an animal-based food? What’s a plant-based food? What do I really mean by those things and dispelling the notion that it’s a diet that they’re going to follow temporarily, that this is more of a lifestyle change, and it’s something that has been shown to be sustainable and should be sustainable for them in order to reap the benefits long-term; and that there’s a number of diet, “diets” out there that I could prescribe for them, where they would lose weight in the short-term, but it wouldn’t do them any favors in the long run. They would gain the weight back. They would increase their risk of heart disease and other complications. So we are – we are targeting long-term health with a nice side effect of weight-loss. So I go over those basic principles, and I also go over the principle that it’s not about adding any one particular little magic food to your unhealthy diet. If you continue eating what you’re eating and you eat some Goji berries …

Caryn Hartglass: You were reading my mind. That was exactly the food I was going to say.

Dr. Michelle McMacken: [Laughs] It’s always the Goji berries. No, I mean so it’s not about addition of any one particular food. It’s about the broad eating pattern. What is your overall pattern of eating? So after those – after I sort of go through that basic information, I actually then turn it over to the patient because I always want to start from where they’re starting from. So I take a detailed history around what the foods are that they like, and we hone in on the plant-based foods that they already like, and of course, I’m looking at this through a nexus of socioeconomic challenges, culture, language, and I mean I treat a very diverse patient population. So half the time, I’m on Google images trying to figure out what food somebody’s talking about, but we start from there. I figure out what are the plant-based foods that are minimally processed that we can start with and just start expanding those on the plate and crowding out some of the other foods and getting people to understand that they shouldn’t be filling up on foods that don’t promote health. And take it sort of one day at a time. I know there’s a whole philosophy out there, and there’s a number of programs where people kind of go all out, and that’s amazing if you can do it. But you need a lot of support, and you need a lot of – sometimes almost like an emergent situation or someone who’s just really, really motivated and really ready. For the majority of people that I take care of, it’s more about a gradual progression and starting to really move towards a plant-based diet over the course of weeks or months.

Caryn Hartglass: I coach people on moving to a plant-based diet, and I’ve seen that as well. In fact, I was just thinking of this recently. When I first started, what – what I wanted – really wanted to do was some sort of like Vulcan mind meld and just give them all the information I possibly could, and I’m talking about my life. I’ve spent decades absorbing this information, and you just want to get it to them right away, but people can’t – most people can’t take it all in all at once. You have to go really gently, and there are a lot of reasons for that because it’s a lot of stuff, but they have their lives. They have their jobs. They have their families. They have their kids. They have all kinds of activities. There’s just so much going on. So slow and steady I think works best for people. Is there like a timeframe? Do you find how long it takes most people to get it?

Dr. Michelle McMacken: There is no average timeframe. I mean some people are just – I saw a patient in July who she was just ready, and she had already done her research and said this is – I want to go on a plant-based diet, which is my dream. Have a patient like that. Great! And we went through some resources and some strategies, and then the next time I saw her, she had done it and already had lost a lot of weight. And then there are people who don’t – they come to me wanting a diet. They have a lot of – they’re on a totally page. They want pills or a diet, and so then we – there’s some activation energy just around getting over those philosophical differences.

Caryn Hartglass: So this weight-loss program, do people still have to see you like they’re going to a doctor’s visit for this program?

Dr. Michelle McMacken: They sell me like they’re going to a doctor’s visit

Caryn Hartglass: Right, so how often can many of them see you?

Dr. Michelle McMacken: I mean we are set-up so that people can see us every two to four weeks and less frequently as they lose weight to try to keep the weight off. But at the very beginning, you do need to be seen more intensely, and so that’s kind of how we’re structured. And I think in the ideal, the ideal model would be a combination of groups and individual visits. I know groups work really well for some people. We don’t have that as part of our program right now, but we have in the past and are hoping to have that again in the future.

Caryn Hartglass: Okay. I’m just breathing. Breathing is really good. I was talking breathing before. We just take breathing for granted so often. I just like breathing. Okay. You mentioned pre-diabetes before, and I know some people that have gotten this pre-diabetes diagnosis, and they think they’re okay, and my understanding is pre-diabetes really is too soft a term for what it is. How do you feel about pre-diabetes?

Dr. Michelle McMacken: I mean the last time I reviewed the literature on this, I think what I saw was that about – on average, about 40 to 50 percent of people with pre-diabetes go onto develop full-on type 2 diabetes. However, you’re right. It’s not just a number on your blood test results where you’re fine, and then one day you cross over to the line and you’re not fine. You have type 2 diabetes. It really is a continuum of metabolic disease, and so we’re seeing in people that have pre-diabetes some of the same consequences that people with type 2, full on type 2 diabetes have. So for example, some of the nerve inflammation and nerve damage that people have, what’s called peripheral neuropathy or diabetic neuropathy, we’re seeing in people with pre-diabetes. So it’s not a quiescent state, but it is a wonderful opportunity to change things around because it’s one of the – it’s one of the disease conditions that’s most responsive to changing one’s diet and lifestyle. And the trick is just getting the right advice on what to do.

Caryn Hartglass: Right, so if you have a pre-diabetes diagnosis, I have Dr. McMacken here. What would you recommend, Doctor?

Dr. Michelle McMacken: So you – so I’m going to answer that question by telling you what’s going on at the level of your organs. So in the progression from pre-diabetes to type 2 diabetes, what’s happening is that your body is producing insulin, and we all produce insulin to help sugar in our blood go into our cells. As people become – go from pre-diabetes to diabetes, their body gets less and less responsive to the insulin. They’re sort of resistant to that insulin. It’s like the insulin won’t unlock the key to let the sugar into the cells, and so when that happens, if you eat something that has a lot of sugar in it, the sugar will then go into your bloodstream and will build up in your bloodstream and won’t go into your cells. So people always think that the problem is carbohydrates, but really when you look at carbohydrates, those are just more of a symptom of the problem. So if you reduce your carbohydrates, sure, your blood sugar will go down, but it’s not really getting to the root of the problem. What’s the root of the problem? That is the fact that our bodies become resistant to the insulin because of the fat in our muscle cells, which is directly related to animal protein and animal fats and also because some of the iron that’s in animal forms, what we call heme iron is directly toxic to our pancreas, the cells that make insulin. And there are a number of other reasons as well, but a lot of it leads back to animal protein. Study after study has shown that especially red meat and processed meat, which are foods like bacon, sausage, pepperoni, deli meats, hot dogs, things that people in our country eat sometimes twice a day, three times a day, these are the foods that are most likely to cause diabetes. It’s not the sugar in your coffee. It’s not the pastry. I’m not saying those things are good for you, but those are not the foods that are going to cause diabetes. In fact, when you look at foods that are most likely to protect you from diabetes, it’s carbohydrates. It’s whole grains so eating whole grain foods in their most natural form so brown rice, oats, barley, foods like that.

Caryn Hartglass: We’ve really screwed this up over the last few decades, haven’t we?

Dr. Michelle McMacken: Right, and so if you have pre-diabetes, focus on whole plant foods. Get your plant foods in their most unprocessed form, so simple foods that most of us are used to eating like old fashioned oatmeal made with – not with dairy milk but with either almond milk or water. Focusing on a lot of leafy grain vegetables. Beans are an amazing food for both people with – already have diabetes and pre-diabetes. They help lower your blood sugar. They have a lot of really healthy fiber, and leave animal products off your plate.

Caryn Hartglass: And I just want to take a brief break here and talk about Responsible eating and Living, which is my non-profit because I have a daily blog called What Vegans Eat and when Dr. McMacken was talking about oats, you can see almost every morning, I have oats in one form or another, and if you don’t believe that oats can be interesting or delicious, you can try any one of these. Many of them are linked to recipes. Some of them I just kind of discuss what – how I prepare it, but it’s either cooked or not cooked. It’s got loads of raw nuts and seeds and fresh fruit, maybe some dried fruit, shredded coconut, your favorite non-dairy milk, preferably unsweetened. And that’s it and it’s delicious.

Dr. Michelle McMacken: Now you’re making me hungry. [Laughs] I love oats too. I eat oatmeal almost every morning.

Caryn Hartglass: But you know it could be a brown rice cereal leftover from your brown rice the night before or milk …

Dr. Michelle McMacken: Quinoa porridge.

Caryn Hartglass: Quinoa, millet, buckwheat. I’m a big fan of buckwheat, and it doesn’t have to be grains either. You can have a salad for breakfast. That’s perfectly fine but carbs, there are good carbs and there are bad carbs, and you want to get the good carbs, right?

Dr. Michelle McMacken: Cheers to that.

Caryn Hartglass: Okay, so that’s all about pre-diabetes. I think – I think we need to change the name or something because it’s … it’s – what do I want to say? It’s not a safe diagnosis. You’re not in the safety zone. This is like yellow light, maybe even with some flashing red.

Dr. Michelle McMacken: Yeah.

Caryn Hartglass: Yeah, okay. So we just have, let’s see, maybe six minutes left or so. I want to know what does Dr. McMacken eat. What do you bring to lunch?

Dr. Michelle McMacken: Well, I have a lot of variety, but breakfast is typically oatmeal, typically have oats with …

Caryn Hartglass: And that’s not – I’m sorry to interrupt you, but that’s not the little pre-packaged oats in a bag that you add hot water to. So gross.

Dr. Michelle McMacken: No, I don’t eat those. I have usually an old fashioned steel cut or just regular rolled oats but the old fashioned kind. I’m a big fan of cinnamon. I’m a big fan of walnuts. Add raisins, pecans, sometimes fresh fruit. Just mix it up, just like you. We’re breakfast twins. [Laughs]

Caryn Hartglass: Today – I just have to say, you mentioned cinnamon, and I’m lucky because I love to cook and my partner, Gary, loves to cook, and we take turns or we do it together, and when one doesn’t feel like, usually the other does, vice versa, whatever. And he made the oatmeal this morning, and he’s really into cinnamon sticks these days. And he was saying that the cinnamon stick, he likes it so much better than the powder, and it just gives a great flavor, and then it’s kind of fun to suck on the cinnamon stick afterwards.

Dr. Michelle McMacken: Yes, I’ll have to try that.

Caryn Hartglass: It’s really good.

Dr. Michelle McMacken: The other thing I love to make are overnight oats. I don’t know if you like to make those.

Caryn Hartglass: Yeah, soaked oats. Mm hmm.

Dr. Michelle McMacken: Oh, so good, so I make them with some chia and a mashed up banana and some unsweetened almond milk and of course, the oats and some cinnamon. And then I sprinkle some walnuts or hemp seeds and fruit on the top. But – and for when I talk to patients about breakfast options, I always tell them I think there’s this unfortunate perception that being vegan/plant-based involves all these weird foods that you’ve never heard of. And so I do try to – I do try to – that’s why I kind of try to start with where the patient’s at to sort of demystify what this means. And so sometimes I hesitate to say, “Oh, use hemp seeds and chia seeds,” but as people grow into the process, they realize these foods are not that crazy and unusual. They taste great. They’re great for you, so that’s typical breakfast. Lunch is usually a big salad, but I find that if I just have leafy greens, I’ll be hungry within an hour, so I add a lot of bulk to it. I add a lot of – I’ll usually add like some kind of a cruciferous vegetable and broccoli. I’ll add certainly at least two kinds of beans. Sometimes I’ll even add tofu. I will put in a little bit of avocado and lemon as my dressing. Sometimes orange slices, just kind of really mix everything up. It’s usually in a spinach base or kale base, something like that. And then in the afternoon, I will have a fruit, sometimes some nut butter, a little bit of nut butter with it.

Caryn Hartglass: That’s always good.

Dr. Michelle McMacken: Dinner will be – I’m really into soups, like big, hearty stews.

Caryn Hartglass: Big soups. Dr. Fuhrman would be proud of you.

Dr. Michelle McMacken: I know. So channeling that. So yeah, that’s a typical day.

Caryn Hartglass: Yeah, and I mean you probably tell your patients this, but soups are probably the easiest thing to make. You start with a big pot. You just – you don’t have to sauté really anything. If you want, you can cook your mirepoix, your onions and carrots and celery, the things that really give it flavor. You can sauté them or not. Just throw them in and add a lot of water. Add your beans if you want to add a whole grain, and get creative. There’s just – you can make 400 million, trillion different varieties of soups.

Dr. Michelle McMacken: It lasts all week.

Caryn Hartglass: Lasts all week, yep. I made about – I measured it. It ended up being 12-cups of adzuki beans that I had started from dry and cooked and ended up with 12-cups. And it last all week, and we just finished it yesterday in a wonderful soup that Gary made, which we’re calling enchilada sauce soup. It tastes like enchiladas but it’s a soup. It was really good.

Dr. Michelle McMacken: So what’s in it?

Caryn Hartglass: What’s in it? Well, he made it, and you can find the recipe at ResponsibleEatingAndLiving.com. It’s on the homepage today. [Laughs]

Dr. Michelle McMacken: I’ll definitely check that out.

Caryn Hartglass: But it’s something I didn’t realize a long time ago, but the sauces that come with an enchilada, it’s a tomato-based sauce, but what makes it different from an Italian sauce is the spices that you put in it. So it’s got the chili sauce and has the chili powder, the cumin and the other spices that typically spice up a Mexican dish. And some other recipes – some other ingredients that you’re going to have to discover by visiting ResponsibleEatingAndLiving.com. I’m not giving it all away right now here. [Laughs] I want some action. Okay, so we have about three, four minutes left, and favorite places to eat in Manhattan, the greatest city in the world for vegan food?

Dr. Michelle McMacken: And add Brooklyn.

Caryn Hartglass: Okay, New York City, five boroughs, including Queens where I live, where we now have Green Zenphony, and I was kind of sad because we have this place that showed up in the next town over to me. I live in Forest Hills, and in Rego Park, there’s a restaurant called Simple Veggie. It arrived a little over two years ago I think, and then they just sold it recently. I was very sad, but they brought in a group that I’m familiar with that had restaurants in a variety of places in New York. And now they’re in our neighborhood. It’s called Green Zenphony. They don’t have a website up yet. I keep slamming them for that because I keep posting on my blog about them, but I love big noodle soups, Asian noodle soups and they make the best.

Dr. Michelle McMacken: Oh, me too.

Caryn Hartglass: Come to Green Zenphony. Let me know when you’re there.

Dr. Michelle McMacken: Wait, what part of – where is it?

Caryn Hartglass: It’s in Rego Park. It’s right on the R and M lines, and it’s right near the biggest Macy’s in the country that has the most traffic apparently. [Laughs] It’s right there.

Dr. Michelle McMacken: Oh, interesting. So you can shop and get your soup.

Caryn Hartglass: Yeah, so Brooklyn, Manhattan, what are your favorites?

Dr. Michelle McMacken: So gosh, well, I have – I have lived in New York for 20 years, so I’ve really seen things evolve, and there’s so many to choose from. So I have always been a huge fan of the Blossom Restaurants, of course, and I also really like Avant Garden, which is one of the newer kids on the block.

Caryn Hartglass: We almost went there for the first time on two days before Christmas, and we were too sick to go.

Dr. Michelle McMacken: Oh, you have to go.

Caryn Hartglass: I know. We have to go.

Dr. Michelle McMacken: It’s a must-try. For special occasions, I’ve gone to dirtcandy quite a bit, and I really love their – her creativity around vegan options, and of course, I couldn’t – this list would not be complete without a mention of Champs and Champs Diner and as well as Terri Restaurant. I don’t know if you’ve been there.

Caryn Hartglass: Yeah, it’s fast food. Terri, yeah.

Dr. Michelle McMacken: Yeah, some really great stuff there. So those are some of my – the first few places that come to mind, but I have to say that I’m sort of a seasoned pro when it comes to finding vegan options on menus. And there are gems everywhere. There’s a Mexican restaurant right down in our neighborhood where of course, it’s not advertised as being a vegan restaurant, but there’s so many vegan options. There’s tofu sour cream and all these things. If you want them, you can have them. But just good old-fashioned beans and cilantro and great corn tortillas and tacos.

Caryn Hartglass: Yeah.

Dr. Michelle McMacken: So there’s just so much abundance out there. If I had to share that – if there was one message I’d like to share with people, it’s just abundance in every form. It’s abundance of compassion. It’s abundance of taste and abundance of connection with other souls that we share this planet with and the planet itself.

Caryn Hartglass: Michelle, you’ve been great this hour, and we’re at the end. So I wanted to thank you very much for joining me, and I’m so excited that you are a medical doctor. We need more of you. So thank you for training other doctors with your knowledge.

Dr. Michelle McMacken: Thank you. This has been really fun. Thanks for having me.

Caryn Hartglass: Great, well, I’m Caryn Hartglass. You’ve been listening to It’s All About Food. One more time, join me at ResponsibleEatingAndLiving.com. Lots of surprises there for you, always new things. And remember, not only do I want you to tune in love all the time, like here in this hour, but I also want you to have a delicious week. And happy New Year! See you in 2016!

Transcribed by Alison Rutledge, 4/7/2016

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