 |
|
|
Nutritional Therapy
for
Dry Eye Syndrome
Dry eye syndrome (DES) is the most common complaint to eye doctors. If you’ve ever experienced dry eyes, especially while trying to wear contact lenses, it is very distracting, aggravating, and a real nuisance.
The typical symptoms of DES include dryness, irritation, grittiness, burning, and difficulty reading for extended periods of time. Strangely enough, excessive tearing and watering are also indicative of DES. In extreme cases, light sensitivity, pain and diminished vision can result. DES is particularly common among peri and postmenopausal women; there is a gender bias and a hormonal aspect to this syndrome.
How empowering would it be to have the proverbial "three easy steps to end dry eye" to offer your clients? How much more so if those steps avoided the use of any artificial tears, drugs like corticosteriods, or surgical procedures such as punctal plugs that prevent tear drainage from the punctum?
None of the above is permanent, and medical solutions don’t reach the core of the problem. Only restoration of proper structure and function to the tear film will provide a permanent resolution to DES. After repletion, diet and lifestyle have been assessed and addressed, only then should we consider using remedial means to alleviate dry eye such as topical lubricant eye drops, corticosteroid eye drops, oral anti-inflammatory drugs or surgical methods like insertion of punctual plugs.
DES is best addressed first by nutritional therapy, supplementation and lifestyle education; particularly as there is a strong correlation between DES and systemic inflammatory processes such as diabetes and auto-immune diseases like rheumatoid arthritis.
In our experience at Medical Vision Center and Nutritional Visions Natural Health Center in Morton, Washington, the patients who take a diligent, disciplined and educated course of action to rectify their DES show remarkable success in eradicating the root of the dysfunction and thus effectively resolve their symptoms. We can’t treat the eye naturally without raising the general level of health in the rest of the body; patients like this added perk.
We will discuss a few strategies the Nutritional Therapy Practitioner can employ as part of the total body care NTP’s provide that will restore structure and function to the eye. First let’s look at the different characteristics of DES, common causes and the ocular layers that make up the tear film.
There are two types of dry eye:
-
Aqueous (water) insufficiency which causes a decrease in tear production
-
Tears that simply evaporate too fast.
Dry eyes can result from:
-
Aging
-
Being in a peri-menopausal or post-menopausal status
-
Deficiencies in fatty acids and vitamins and minerals
-
Long-term contact lens wear
-
As a side effect of many medications
-
LASIK or cataract surgery
-
Diabetes, rheumatoid arthritis (RA), and systemic inflammatory diseases
Environmental impacts affecting DES:
The tears are made up of three different layers: mucin or mucus layer, aqueous or water layer, and lipid or fat layer.
- The mucin layer which touches the cornea nourishes the front of the eye. This layer serves as an anchor for the tear film helping it adhere to the eye and keeps the eye moist.
- Aqueous from the lacrimal gland forms the middle layer of tear film incorporating the water soluble components of the tear film. It provides moisture, oxygen and nutrients to the cornea.
- The lipid layer is produced by the Meibomiam glands of the eyelids. It is our front line of defense against evaporation, infection, solar radiation and injury to the outside of the ocular surface. It creates a smooth surface for light to pass through the eye. It also keeps the tears from evaporating maintaining the structural integrity of the tear film, and provides a smooth tear film over the cornea when we blink.
Each of the three layers is driven by nutrition. Each has varying concentrations of vitamins and minerals which promote proper structure and function of each of the segments. Educated Nutritional Therapy Practitioners understand how to restore and/or maintain structural integrity in order to influence function at each level of the tear film. Repletion of nutrients that saturate ocular tissues is vital for influencing structure and creating proper function. As a result vision is improved and contact lens wearers find a more comfortable fit.
The concept of repletion cannot be overemphasized. On the ocular terrain, the cornea is two thirds of the refractive power of the eye. We must nourish all the layers that make up tear film. If the refracting surface doesn’t have integrity, good vision is not likely even with glasses or contact lenses.
Each of the three layers has special requirements to do their individual jobs:
-
The mucin layer requires Vitamin A in (the form of retinol) which plays a central role in the development of the mucin of the tear film. Vitamin A deficiency is a cause of Goblet cell atrophy and loss of the important innermost lubricating mucin layer.
-
The lacrimal gland’s secretions are promoted by micronutrients like zinc, magnesium and Vitamin C, B6 and niacin. Amazingly, the lacrimal gland has hormone receptors in it and tear film is influenced by hormonal fluctuations.
-
The oily layer needs essential fatty acids, both Omega 3 from flax, fish oils and algae, and Omega 6 in the form of evening primrose oil, borage oil or black currant seed oil in order to create structural integrity in its segment of the three part layer that makes up the ocular terrain. Inflammatory cells take up GLA, convert it to DGLA, which in turn is a potent inhibitor of arachadonic acid (AA) conversion into inflammatory messengers.
Zinc is a major player in construction of a healthy corneal surface having the highest concentration in the entire body in the cornea of the eye. As we know, many are deficient in zinc. We can administer the Zinc Challenge test as one measure in assessing the integrity of the cornea. Maintaining healthy terrain on the ocular surface is more important than we realize.
If DES goes untreated, it can cause fluctuations in vision, and the cornea can become scratched, scarred and ulcerated. Zinc sufficiency is a good place to start. There is Comprehensive Metabolic Profile testing available to determine where to focus repletion efforts most effectively.
Bioindividuality is key when considering treatment options for DES; strategies become complex when we factor in:
-
Smoking which disrupts the way carotenoids are used in the eye and the smoke itself being an irritant exacerbating DES
-
Inflammatory, allergenic and/or nutritionally deficient dietary pattern
-
Gallbladder surgery and subsequent diminished fat processing
-
Gender bias to DES with predilection to peri and post-menopausal women
-
DES occurring secondary to systemic illnesses such as Diabetes or Rheumatoid Arthritis (RA)
-
DES as a result of prescription and over-the-counter drug use.
-
DES in post surgery (Lasik, PRK and Cataract) patients
Reducing systemic inflammation becomes the number one therapy for treating DES which has an inflammatory component.
We teach a modified Mediterranean diet, removing gluten, dairy and known sensitivities to reduce inflammation. The Hale Project reported in JAMA in 2004, confirming the success of the MeDi diet and lifestyle (non smoking, moderate exercise and whole foods, largely plant based diet) in reducing mortality and morbidity from all causes after ten years adherence to the MeDi in individuals aged 70-90. What a successful lifestyle program! What is good for the body is good for the eyes.
Initially a healthy inflammatory reaction serves purposes of tissue isolation and protection from further injury so that the body can initiate a healing response. However, an inflammatory response that does not turn itself off upsets the balance in our body. Through the modified MeDi, our goal is to limit systemic inflammation by calming inflammation signals. One particular Medical Food we prescribe employs selective kinase response modulation to calm inflammation systemically which has a positive impact on supporting proper tear film layers as well as the whole system.
Combined with the MeDi, currently the most effective treatment for DES we’ve used is a combination of Omega 3 and Omega 6 fatty acids, a blend of A, D, E, C and the cofactors B6, Biotin, magnesium and zinc. Getting the materials to the "jobsite" is only half the picture. Transporting them to their optimal location is the rest of the goal. Adding digestive enzymes assures proper digestion and assimilation.
Gender bias and DES:
In a March 2007 study out of Bologna, Italy researchers determined that "subjective symptoms, tear production and stability, surface dryness and inflammation were significantly related to hormonal fluctuations in the menstrual cycle in perimenopausal women. In particular, the impairment of these functions appeared to be related to the estrogen peak occurring during the follicular phase, especially in patients with dry eye."
Hormone balancing is an often overlooked aspect of repletion. Both peri and post menopausal women report an increased incidence of dry eye. Recall that there are hormone receptors in the lacrimal glands which respond to support. We also know that DES is correlated with hormone replacement therapy (HRT) use in postmenopausal women. Now that synthetic HRT has fallen out of favor, we can impact dry eye by aiming to regulate estrogen, progesterone, DHEA and testosterone naturally. I would encourage everyone to read Douglas Hall, M.D’s. excellent article entitled Nutritional Influences on Estrogen Metabolism: A Summary to master this important and often overlooked aspect of repletion.
The concept of macro and micro nutrient deficiency secondary to systemic disease and its impact on DES is fascinating to consider. DES can accompany systemic diseases like diabetes and RA. DES is acerbated by prescription and OTC drugs and can also emerge as the result of multiple micronutrient deficiencies that occur as a result of their use. The resulting deficiencies can manifest as ocular disease, visual dysfunction or ocular conditions such as DES.
Those with diabetes have a higher incidence of DES and are a great example of being aware that certain disease states will require repletion over and above a healthy population. Diabetics typically have about 30% less circulating Vitamin C than non diabetic individuals and less magnesium as well. They are already experiencing greater oxidative stress due to the disease process, and are compromised in vitamins and minerals unless they are supplementing or consistently eating exceptionally well.
Again, we see the effect of deficiencies or a "cascade effect" associated with systemic disease (one disease leading to another disease, condition or syndrome); an Indian study reported in 2006, Ophthalmic Epidemiology finds "Patients with RA in the Indian population have a significantly higher prevalence and severity of dry eye when compared to age- and sex-matched controls." We can assume these findings would cross ethnic boundaries. If we are in a pro-inflammatory state, we may develop other conditions.
Studies reporting on nutrition and supplementation impact on DES are encouraging and growing in number.
One 2006 study found that flax seed oil worked to reduce DES equally as well as the oral anti-inflammatory drug Doxycycline prescribed for severe dry eye. Colin C.K. Chan. MD speculated in the publication that the reason may be due to its anti-inflammatory, lipid modifying properties. He presented his ideas at the annual meeting of the American Society of Cataract and Refractive Surgery; mainstream exposure to nutritional therapies is occurring with more acceptance.
Often correcting existing imbalances between Omega 3 and Omega 6 from animal fat or vegetable oils will alleviate dry eye.
Typically, GLA should be taken in an equal ratio to EPA-DHA, in a background of flax oil. Studies report that Omega 3 and Omega 6 fatty acids in combination results in increased PGE1 which both stimulates aqueous tear secretion and reduces the production of PGE2 which acts as an inflammatory agent. (Wu D, Maydani M, Leka L., American Journal of Clinical Nutrition)
K.A.Trivedi and colleagues at Harvard Medical School in Boston, MA report, "Women with higher dietary intake of Omega 3 fatty acid were at decreased risk of developing DES".
An interesting study appeared in the March 2008 issue of Arthritis Research & Therapy 2008 that has the potential to augment dry eye therapy in RA patients. Results concluded that a "gluten-free vegan diet in RA induces changes that are potentially atheroprotective and anti-inflammatory, including decreased LDL and "The anti-inflammatory properties of the fatty acid GLA have long been known.
Recent studies report that oral administration of GLA and LA leads to a significant increase in tear concentrations of anti-inflammatory prostaglandin E1 and reduces the symptoms of dry eye. The aim of this study was to evaluate the effects of GLA and LA on tear production, tear fluorescein clearance, dry eye symptoms, and the ocular surface after PRK .
The researchers concluded that oral precursors of prostaglandin E1, GLA and LA, could be helpful in increasing tear production and clearance after PRK". Arch Opthal 2002 (PRK is a surgical procedure for the correction of vision, much like Lasik)
We have much at our disposal today in the form of research, healthy dietary options and supplements that can resolve even tough issues like Dry Eye Syndrome.
If you would like a copy of the nationwide teleseminar we did December 2007 on Nutritional Solutions for Eye Care, particularly ones that are untreatable with drugs or surgery like macular degeneration, please send a request and $5 (to cover shipping and the $1 CD charge) to Medical Vision Center and Nutritional Visions Natural Health Center, P.O. Box AC, Morton, WA 98356.
Kat Carroll, NTP and reviewed by Donald A. Carroll, OD, NTP
About the Author:
Kat Carroll is the mother of three, step mother of three, Amachi (East Indian for respected mother i.e. "grandmother") to three, and wife of one amazing man. We work in a Medical Clinic devoted to preserving & restoring sight using lifestyle, nutrition and supplementation as the basis of creating healing, alongside traditional medicine. My work entails personalized consultation with the practice as well as managing the office and working directly with patients. Healing is my passion, and words have much to do toward that end; thus the writing and opening Adytum ~ The Sanctuary at Mossyrock to friends, guests & family as a healing retreat for body, mind and spirit... www.thesanctuarybandbatmossyrock.blogspot.com
- 360-790-2011 cell
- 360-496-5140 office
- P.O.Box 1388, Morton, WA 98356 ~ office
- 186 Skyview Drive ~ Mossy
The statements and products shown on this website have not been evaluated by the US Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. The opinions expressed here belong solely to the author and are not necessarily those of NTPtalk.com.
|
|
