A HEALTHY DIET: THE PROVEN ENHANCEMENT FOR DRY EYE TREATMENTIn the prevention and treatment of dry eye syndrome (DES), is a prudent healthy diet more effective than oral supplements that contain Omega-3 and Omega-6 fatty acids? To answer this question, we’ll explore:
All vitamins are equally essential for the eyes, vision and tear film. Why is it, then, that some vitamins appear to be more important than the others? For the most part, there is a scarcity of four major vitamins in the diet and hence in the body due to food processing: Vitamin B6 (Pyridoxine), Vitamin B9 (Folic Acid), Vitamin C (Ascorbic Acid), and Vitamin B12 (Cobalamin). Vitamin B6 and Folic Acid are intimately connected to the remodeling and repairing of tissue. Potassium and other minerals are also required for a normal tear film. Additionally, the mucous membranes of the eye have a high requirement for folic acid. Research published by Lane, Hart and Josephson reported the depression of tear-film break-up time (TBUT) to be less than 10 seconds when the ratio of sucrose intake/food-folic-acid intake > 6x10-2 teaspoons/microgram. Simplified, this means that ingesting six teaspoons of table sugar per day requires 1,000 micrograms of folic acid to prevent the TBUT from dropping below ten seconds. For comparative purposes, a can of Pepsi delivers 9 teaspoons of sugar. The team of Lane and Hart also reported that depressed intake of food-potassium (as from fruits and vegetables) of less than 2,500 mg per day was likely associated with reduced TBUT. Other minerals measured in tears and considered essential for maintenance of corneal epithelium integrity are calcium, magnesium, and sodium (Graeme Wilson et al, 1983). Does Vitamin B6 (Pyridoxine) help treat DES and protect the tear film? Most of our patients need supplemental pyridoxine. First, check whether the patient has been taking mega-doses of “Vitamin B6” or has DES due to other factors. As little as 3 mg can be useful if taken at the time of ingesting denatured protein. However, at least 50 mg is recommended and has been shown to be effective if taken within 12 hours before ingestion of major cooked protein (Lane, JACN, 2005; Lane ARVO, 2006; Emily Chew, 2009). Daily dosing in excess of 200 mg per day is not recommended and may produce undesirable neurological effects. Are Omega-3 and/or Omega-6 fatty acids beneficial in treating DES? The answer for most of our DES patients is yes. Though if the patient has already been taking Omega-3 supplements for many months with adequate (400 mg or more) docosahexaenoic fatty acid (DHA) and (400 mg or more per day) eicosapentaenoic fatty acid (EPA) or has been consuming small fish at least once per week, then it is possible that the DES may not be due to Omega-3 deficiency. We recommend measuring the fasting blood concentrations of Omega-3, Omega-6, saturated and trans-fatty acids. Then look at the ratio of blood plasma concentrations of (DHA + EPA) / Arachidonic Acid. Too high a concentration of DHA + EPA promotes hemorrhaging. Additionally, too high a concentration of Arachidonic acid as an end-product of Omega-6 metabolism promotes blood clotting. Proper balance is the key. Should protein supplements be used in treating tear film? My research at Columbia evidenced that intake of too much denatured protein (>300% RDA for protein) had an adverse effect on the tear film, disturbing it beyond excessive alcohol intake. This was, more often than not, the same case with excessive intake of saturated fat and cholesterol—two other significant factors regarding tear film. Powdered protein supplements, taken for "body building" but without replacement vitamin B6, were a special problem in young people. Is inflammation healthy or unhealthy? There is no question as to the involvement of inflammatory processes in DES. Entire books have been published listing nutrients which help to quiet inflammation; however, such suppression is not always healthy. Inflammation is an important aid in the repair of tissues and systems. It helps to provide the scaffolding and fluid that assists in the repair and remodeling within the body. Under normal conditions, healing will take longer when normal inflammation is thwarted. Almost all non-toxic fish, colorful vegetables, and ripe fruits that we can consume are relatively anti-inflammatory in their effect. Anti-oxidant vitamins and certain minerals, including selenium and chromium, are considered to be relatively anti-inflammatory and they do deliver essential nutrients to the tissues. Good nutrition is a key component in the successful reduction of inflammation. Dietary Intervention Can Help An alternative measure for recovery and prevention of DES is a well balanced diet. Here are some key points to help in planning patient diets.
Type 2 (non-insulin-dependent) diabetics, depending on the severity of their condition, may not be able initially to handle a markedly increased intake of fruit. However, they may benefit from a gradual increase in fresh fruit, if monitoring blood sugars, and especially from increased intake of fresh, raw vegetable salads without dressings. At the minimum, introduction of daily raw salads as a complementary therapy improves the effectiveness of oral supplements. It appears likely that DES oral supplements that include vitamins B6, B9, and C will demonstrate enhanced ability to turn around DES. The key message is that a simple dietary therapy is the best alternative treatment for DES. It has resulted in a high recovery rate for all patients, regardless of the severity of their DES. More on the web at: www.NutriOptom.com. Dr. Lane is Director of the Nutritional Optometry Institute and a Fellow of the American College of Nutrition. For further info or correspondence, see http://www.nutrioptom.com. |
