Dr Rudrani Banik: I call myself an integrative ophthalmologist, so yes, I have the traditional ophthalmology background, I've been trained, I do surgeries, but on top of that, I've also trained in integrative and functional medicine. And that allows me to really dive deeper into some of these, these counselling strategies that I think are really for the long term, what people need to hear.
Dr Rupy: Welcome to the Doctor's Kitchen podcast, the show about food, lifestyle, medicine and how to improve your health today. My name is Dr Rupy. I'm a medical doctor, I also study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me on this podcast where we explore multiple determinants of what allows you to live your best life. And remember, you can sign up to the doctorskitchen.com for the newsletter where we give weekly recipes plus tips and hacks on how to improve your lifestyle today. And my guest is the incredible Dr Rudrani Banik. She is an award-winning associate professor of ophthalmology, that's eye surgery, at Mount Sinai Icahn School of Medicine. She also serves as principal investigator for five multicentred clinical trials in neuro-ophthalmology as well. She's a member of the American Academy of Ophthalmology's exam development committee and helps set the standards for board certification in her field. She's also sought out as an expert in the media and has been featured in every publication you can imagine, The New York Times, Good Morning America, CBS Evening, on TV. She applies the complementary and alternative medicine principles in conjunction with a conventional medical approach to treat chronic diseases affecting the visual system. And this unique approach to managing conditions such as dry eye, macular degeneration, blepharitis, even things like multiple sclerosis and myasthenia gravis that can affect the eye, and uveitis and other autoimmune conditions is really groundbreaking. And we have a fantastic conversation about the different nutritional principles as well as lifestyle principles that can affect a multitude of different conditions that affect the eye. In today's episode, we talk about how nutrition affects overall health, but particularly visual health as well. What steps people can take to optimise their eye health, and as a byproduct of that, you're looking over your overall health, which is why I wrote an entire chapter on this on my last book, Eat to Beat Illness. What foods can help protect against things like cataracts, macular degeneration and glaucoma, as well as the conventional treatment options that are there and available for us. And we're so lucky to have that, particularly in the UK and the US, because a lot of countries have cataracts as the number one cause of blindness, whereas actually it's a very easy procedure, relatively easy procedure, I should say, to correct in our countries here. We also talk about the different types of mechanisms behind degeneration of the eye, macular degeneration of the eye, as well as the commonly held beliefs about blue light. And she goes into a bit of detail about the different types of wavelengths of blue light and why environmental light might be an important factor when it comes to reducing the chances of our children needing to have glasses. I think you're going to find this a really interesting conversation. We go into a whole bunch of topics. It's really going to be a resource for people who are interested in nutrition beyond just for obesity or weight loss. Nutrition is far, far beyond that. And Dr Banik is a true believer in the food as medicine movement and one of the pioneers, I think, out in America. So please do check her out and make sure you get a copy of her book. We'll put a link to it. It's all about macular degeneration and that'll be on the show notes, the doctorskitchen.com/podcast. Give this a five-star review if you enjoyed it. Please share it as well with anyone who you think could benefit from it. Basically, it's all of us. We are all going to suffer eye disease if we live long enough, but we can certainly stave off disease with our lifestyle and food. Without further ado, please listen to, please enjoy, I should say, to my wonderful conversation with Dr Roni.
Dr Rupy: Listen, I've been really excited about talking to you about this subject of eye health because, as I said before we jumped on the call, I wrote a chapter based on eye health in my last book, Eat to Beat Illness, which is basically all about trying to encourage people to think of their eyes as the window to their overall health, as well as cherishing the importance of it. And I don't think a lot of people recognise that blindness is a very common condition in latter ages, and building the foundations for a healthy body also pertains to how we can look after our vision. And when I heard about you and your work and stuff and what you're doing in New York, I just thought it's fantastic. So thank you so much for for jumping on the podcast. It's a pleasure to have you here.
Dr Rudrani Banik: Oh, thank you so much for having me and I really have to applaud you for addressing eye health in your book because as you mentioned, many of us take our vision for granted. And unless there's a problem, we don't really think about it. So but it is so important to be proactive and to to prevent problems because many eye conditions are are preventable.
Dr Rupy: So let's jump into that because not to start on a really dark note, but the one of the leading causes of blindness is preventable. And there are a number of different reasons behind that and a number of different conditions as well. So why don't we jump into something that you see most commonly in your clinic based in New York?
Dr Rudrani Banik: Sure. So I see a wide spectrum of disease, but one of the most common things I see are cataracts. And cataract is a natural part of the aging process. And what it actually is is the lens inside the eye that helps us to focus. When we're young, the lens is clear, it's transparent, but as we get older, it begins to opacify and it starts to get a little bit yellowish or brownish and then basically it's it's blocking light rays getting into the eye into the retina. So it begins to cloud vision and it's almost like looking through a dirty window. You know, if you have a clear window, it's nice and crisp, but once it becomes a little bit blurry, then what one is seeing is is just it's not clear, it's it's dimmer, the colours get muted. So that's one of the most common conditions I see. It is related to aging, but there are numerous studies that have shown that with with proper diet, it is possible to delay the progression of cataracts and perhaps even delay surgery. So here is it's a prime example of how our our nutrition and our lifestyle is just so important to help to maintain vision.
Dr Rupy: This is this is a really important point I think because most people when they think of cataracts, they think, oh, that's something that you get in older age, you go to the doctors, they refer you to an ophthalmologist, you do a quick surgery and then you get your vision restored again, which is an incredible feat of modern medicine. But if you think about the degree to which cataracts affects blindness around the world, it's still the leading cause of blindness globally. What is the mechanism behind how the the lens gets cloudy itself and where does nutrition interact with that and how can that prevent it?
Dr Rudrani Banik: Yeah, no, it's a great question. So so the lens becomes cloudy because of oxidative damage. And what oxidative damage is is basically our body generates free radicals in the energy production process. So we all have free radicals within us which can damage our cells, it can damage our DNA. So these lens cells become oxidized with time by free radicals. And it's almost like if you think of water and metal and oxygen coming together and creating rust, that's an oxidative process. So something analogous happens in the eye, in the in the lens. And the way to try to prevent that is to have plenty of antioxidants available to try to mop up those free radicals, to try to prevent that damage, to neutralize that damage. And so there are the studies that have been done in terms of prevention of cataract really focus on antioxidants from nutrition. And the the best antioxidants out there are the common vitamins that we've all heard of. So for example, vitamin A, vitamin C and vitamin E, these have all been looked at in terms of cataract prevention and and absolutely they are useful. Now, again, it's not going to prevent cataracts during completely during the course of one's life. Eventually, all of us will get cataracts. It's a fact of life, but it can certainly delay the onset. The other thing that can cause oxidative damage is light. So in particular UV light. Now we're all exposed to UV light from the sun, but certain wavelengths of UV light, for example, UVA and UVB can potentially cause damage to our eyes and specifically our lens. And so that's another thing we all can focus on in terms of prevention of cataracts is to make sure when it's super bright and sunny outside that we do have UV protection. So whether you're wearing sunglasses or a wide brimmed hat or some kind of visor, I always recommend to my patients when they're outdoors to wear some kind of sun protection.
Dr Rupy: And I think this really does speak to the beauty of lifestyle medicine overall because I think a lot of people have heard about how smoking can definitely increase the likelihood of cataracts or progress cataract formation that's going to be inevitable in all of us. And yes, UV exposure, but also diet, and that's something that we do three times a day or sometimes less or sometimes more. And we really do have the ability to change the progression of disease with our fork. I wanted to touch on diabetic related cataracts because although it's similar, there there is a slightly different mechanism from my understanding of how diabetes in particular can lead to the formation of cataracts.
Dr Rudrani Banik: Yes, absolutely. So there are many types of cataracts and a diabetic cataract actually looks a certain way. It looks different than an an age-related cataract, for example. And so often times in diabetes, what one will see is we'll see spokes, these whitish spokes that develop in the lens. And the reason as you had alluded to that these cataracts develop is glucose dysregulation, basically. So when there's too much glucose in circulating in our bodies, it actually it actually goes into the aqueous chamber, which is the the front part of the eye, and it gets absorbed into the lens and the lens begins to swell. And that swelling of lens fibres leads to this opacification that we see as those radial kind of spoke-like diabetic cataracts. So it's it's definitely related to blood sugar control. Now, unfortunately, if you know, if if you have diabetes and if you were not in control and now you're in control, those changes once they develop, they are not reversible. I wish they were, I wish that there were some way to dissolve a cataract once it's developed, but despite some claims out there, I know I have some patients who ask me, oh, I saw these drops, it says we can I can dissolve my cataract. Can I just use that instead of having surgery? I wish that that actually worked, but it worked, there are some compounds that have been used in animal models to try to reverse cataracts or dissolve cataracts, but when they've been tried in humans for whatever reason, the results don't carry over. So we're not seeing that same benefit. So, but I you know, that being said, I do think that probably within the next five to 10 years, there's a lot of work being done on agents that can be given either as a drop form or as an oral form that can potentially help to reverse cataracts. So I do think that there will be something on the horizon that we can all look forward to. But as you mentioned before, surgery, if one does need surgery, it's it's highly technologically advanced, highly, you know, successful and most people who end up getting cataract surgery see very, very well. Actually, my father just had cataract surgery last month and and he basically went from not being able to drive properly or read properly to now seeing basically 20/20. So it's pretty miraculous the technology that we have now.
Dr Rupy: It is really incredible, isn't it? And I think, you know, it's it's one of those surgeries that really gives people their life back. I'm privileged to have looked after patients in primary care because I'm trained as a general practitioner as well. And the difference in their psychology as well as their their physical ability as well is just miraculous. And that's just something that we wouldn't have had a few decades ago. And and to your point about the drops as well, I think it's kind of a shame, isn't it? Because these claims that you find on the internet, on the media, it kind of muddies the water when we like to talk about lifestyle medicine and we like to talk about, you know, the different carotenoids and zeaxanthin and all these different components in our highly accessible foods that can improve and prevent being touted as, you know, curals and panaceas. It's, you know, it's a tricky toe to to get the balance.
Dr Rudrani Banik: Yes, yes. And and as you mentioned, there is a lot of misinformation out there. So I do encourage everyone to go to trusted sources. Um, most governments do have websites where they talk about various conditions, including eye conditions. So if you have questions, if you have uncertainties, please go to a trusted source.
Dr Rupy: And and to another common condition that we see, it's the commonest cause of blindness in Western society or industrialized societies, acute macular degeneration. Something again that we've developed some incredible medicines for. But what is the difference, the different types of macular degeneration and and what is there if anything in lifestyle that we can do?
Dr Rudrani Banik: Oh, there's so much we can do. And actually, I'm glad you brought this up because I'm in the process of writing a book on macular degeneration and using nutrition and lifestyle to prevent or delay progression of macular degeneration. So let me just first explain what it is. So macular degeneration is a disease of the retina, which is in the back of the eye. It's the neural layer that helps us to capture light signals and then transduce them into electrical signals that our brain can process. So basically what happens is there are deposits that form underneath the retina in macular degeneration. And these deposits, they initially start off as as basically lipid deposits. So fat deposits or some form of cholesterol deposit. And then what happens is the body creates this inflammation around that cholesterol deposit. And then there's this cholesterol deposit and then from underneath the retina, these new blood vessels begin to form. And these blood vessels are not supposed to be present there. And the when the new blood vessels form, that's when people actually experience vision loss. So there are two types of macular degeneration. There's the dry form and then there's a wet form. And the dry form is when simply one has deposits and there may be few deposits or there may be numerous deposits. So there's early macular degeneration or or moderate macular degeneration. But when it becomes the wet form, when those new blood vessels begin to form, that's much more an advanced stage of disease and that's when people experience vision loss. So it is possible for someone to have dry macular degeneration and have no symptoms whatsoever because it has not gotten to the point yet where vision would be affected. But once, you know, those blood vessels form, blood leaks out, fluid leaks out, protein leaks out. So for any of your audience members who are familiar with the term leaky gut syndrome, this is actually a form of leaky eye syndrome where you have fluid that's not supposed to be there and and that blood, there's a blood retinal barrier, it's a very tight barrier that gets disrupted and that's when the vision loss happens. So what can you do to prevent it? Well, I do want to first say that there are certain risk factors that we can't modify for macular degeneration. So those risk factors are age. So the older people are, the more likely they are to develop it. So usually above the age of 70 or perhaps 80. The other risk factor is genetics. So there is definitely is a genetic predisposition, but but what I want people just to realize is that there are numerous genes that have been linked to macular degeneration, probably over 50 genes that have been linked to macular degeneration. Some have to do with cholesterol metabolism, some have to do with inflammation and complement. But we don't really know what these genes do yet. So this is a very early stage of research and even though we've identified, okay, these are the markers, these are the genetic markers, we don't know what they mean. So simply because you have a genetic marker for macular degeneration does not necessarily mean that you're going to progress to develop it. So there are plenty of people out there, myself included. I actually did I had a gene test done and lo and behold, I had one of these markers and it initially it, you know, freaked me out, but then I kind of calmed myself down and said, wait, you know, I don't have a family history, I'm, you know, I don't have many of the other risk factors. Some of the other risk factors also include female sex. For whatever reason, females are more prone to developing macular degeneration. Perhaps it has to do with longevity. We still don't quite know yet. And another non-modifiable risk factor is pigmentation. So there are definitely many population studies that have been shown that have shown that people who have lighter eyes, lighter coloured hair and lighter pigmentation are perhaps more are are more prone to developing macular degeneration. So basically, blue eyes, green eyes, hazel eyed individuals are more prone and it probably has to do with the pigmentation in the retina and the protective effect of pigmentation. So, so those are the the non-modifiable risk factors. But what can we do that's modifiable that we can use to prevent? What are the tools in our our dispensary to prevent macular degeneration? Well, number one is smoking. So you had alluded to this with regards to cataracts, but smoking is one of the largest risk factors for macular degeneration. That's been shown in twin studies, many population studies where one twin smoked, the other did not smoke and the twin who smoked was much more prone to developing advanced macular degeneration. Another modifiable risk factor is body weight. So there are studies that have shown that people who are who have elevated body mass indices or who are obese or even moderately overweight are more likely to develop macular degeneration. We don't know exactly why that is, but it there definitely is is that association. And then the other risk factors include lack of proper nutrients in your diet. So again, there are many studies out there looking at people's diets. People who had more um carotenoids from fruits and vegetables in their diet tended to fare better with less advanced macular degeneration. People who had more healthy fats in their diet. So for example, healthy omega-3 fats also had less risk of macular degeneration. So there are absolutely many things we can do even if we have a genetic risk factor, if we have a family history of it, to prevent it from developing. And and that's really what my book is about is what can you do proactively to prevent this horrible blinding condition.
Dr Rupy: I think that's you touched on so many things there that really resonate with me and I think will resonate with a lot of people that whilst there are some non-modifiable risk factors, i.e. age and genetics, there is a plethora of different modifiable risk factors. So smoking being one of the biggest and I I doubt anyone listening to this smokes, but perhaps they have parents or some colleagues that do smoke who they can perhaps, you know, say, listen to this podcast, you might want to find out about risks of other things, as well as obesity, hypertension and and diet. And a couple of things that have come out from a few trials that gained a lot of attention in the media a few years ago, the AREDS one and the subsequent AREDS 2 trial, brought to light a a a bunch of different carotenoids that we find in a whole bunch of different fruits and vegetables, dark leafy greens, but also, you know, butternut squash or different sort of yellow and and orange coloured vegetables, as well as the long chain omega-3s that you mentioned as well. So DHA and EPA being the ones that we want to look out for because DHA is a major structural component from my understanding of the retina and EPA may even have a signalling role with regard to influencing retinal function. I was wondering on the basis of those findings and everything else that you've done in your extensive research and for your book, I'm assuming as well, what are the types of foods that you recommend that could potentially be really pivotal in in preventing this from from occurring?
Dr Rudrani Banik: Yeah, so um, so wonderful question. So uh, the green leafy vegetables are just so important and the reason is because they have two nutrients that most people probably are not familiar with and they include lutein and zeaxanthin. And these are actually um carotenoids or um they're called xanthophyll carotenoids, xanthophyll meaning yellow pigmented carotenoid. Carotenoids are a form of antioxidant. And these um these are particularly important for eye health. And the reason is because our retina typically is a privileged site, but we have these pigmented molecules actually in the retina. They reside in the retina just in the location where macular degeneration develops. And the reason why I believe nature put these molecules there is to act as natural filters of of blue light and UV light as well, as well as natural antioxidants to protect our delicate retinal cells. And so lutein is um is found in many of the leafy green vegetables. So spinach, kale, any kind of green, so whether that's collard green, turnip greens, dandelion greens, Swiss chard, these are all wonderful sources of lutein. And I meant I forgot to neglect to mention kale, but kale is also probably one of the highest um uh has one of the highest concentrations of lutein. Um, and then um zeaxanthin is a cousin of lutein. Uh it's a similar molecule, but it's it's concentrated most right in the macula. So if you were going to put your your money on a particular um antioxidant or vitamin, zeaxanthin would be my would get my bet because of its location and it's very, very potent in terms of quenching those free radicals of preventing that oxidative damage. And zeaxanthin, um it it is found also in the leafy greens, but it's also found in a lot of the yellow and orange pigmented fruits and vegetables that we have. So for example, corn or maize is a wonderful source of zeaxanthin. Um orange peppers, even yellow peppers, um and uh and the uh the other um vegetables that you had mentioned, for example, squash, pumpkin, um these are all wonderful sources as well. Paprika is also a great source. So as a spice, um it's it's a wonderful way to kind of add some extra zeaxanthin to your food.
Dr Rupy: I didn't know that about paprika. That's amazing. I'll remember that one.
Dr Rudrani Banik: And then there are also some other um some other herbs or condiments that also are rich in in lutein and zeaxanthin. So they include parsley and cilantro. So, um, you know, if you're cooking, uh just, you know, sprinkle some of those on your on your food as well or or add them and that will give you that extra boost for um for lutein and zeaxanthin. Now, it's it's kind of unfortunate that um in our in the traditional diet, Western diet that most of us have had or have or have, um we're very deficient in these eye health vitamins, both lutein and zeaxanthin. So, um the the the estimated recommended intake of lutein is about six, six and a half milligrams a day. And most people on Western diets only get about one to two milligrams a day, which is really very unfortunate. And then in terms of zeaxanthin, um the the estimated, there is no dietary reference out there, but the estimated amount is about one to two milligrams a day and most of us don't even get that. So if even if you could make small changes to your to your diet, um what I love to do is I love smoothies, particularly green smoothies, and that's a wonderful way to get some of these eye health vitamins in all at once. So, you know, you pack in a few cups, maybe three cups of spinach or kale in with some fruits that you like, for example, berries or mango or whatever fruit you like, add in some chia seeds to get your omegas and there you go, you have a great eye health smoothie and it's, you know, it's a wonderful way to get pack in those nutrients.
Dr Rupy: How do you, I'm really intrigued, how do your patients respond to you talking to them about food in this context? Um when I mean, you're conventionally trained, you're a professor of ophthalmology, you have a thriving practice in New York, and then you start talking about all these different coloured vegetables and and the the basis of why you're talking about that. How how do people respond to that?
Dr Rudrani Banik: Oh, I think I think um they they many of them seek it out actually. You know, there are many ophthalmologists, many wonderful ophthalmologists out there and I have wonderful retina colleagues um who who I work with. Um but in reality, in a typical ophthalmology practice, um unfortunately, it is a high volume patient uh practice most most often. And often times anywhere from 40 to 80 patients are seen in one day. So the doctor really only has a few minutes to spend with each patient. And of those few minutes in terms of the time spent on counselling about nutrition and and lifestyle, maybe it's one or two minutes only and your doctor may tell you, okay, eat some leafy greens, stop smoking, lose some weight, do some exercise and come see me in three months. Uh that's typically the the counselling that's given. But what I do is I really delve a lot deeper into the specifics of, you know, which types of vegetables and why and how should you prepare your food and how much of it should you eat? Should you have it every day? Should you have it a few times a week or, you know, what's the the goal? So that is really the basis of what I do. Um I call myself an integrative ophthalmologist. So yes, I have the traditional ophthalmology background, I've been trained, I do surgeries, but on top of that, I've also trained in integrative and functional medicine. And that allows me to really dive deeper into some of these, you know, these counselling strategies that I think are really for the long term, what people need to hear. And that's why I decided to write my book because again, in most ophthalmology practices, the time spent on counselling is so limited, but if there is a resource that people can turn to that will give you, okay, these are all the the fruits and vegetables with this amount of lutein and this amount of zeaxanthin and this amount of vitamin A and this amount of omega-3s, then at least people have something to refer to and then they can begin to plan out their diets and and just live more healthily.
Dr Rupy: Absolutely. I couldn't agree more. And I think um a lot of people are going to be after that book. I'll make sure that we put links to it in the podcast show notes when it's out. I'm constantly asked about, you know, what to eat for, you know, is there any evidence for? And I think, you know, I mean, I'm doing my master's in nutritional medicine at the moment at the University of Surrey and um I've also done some functional medicine training and I think it really does give you a good framework for like you said, um changing that patient doctor dynamic and the way you explain how to make lifestyle changes so they can go away and do these sorts of things yourself. You sort of need to be like part health coach, part doctor, part nutritionist all in one. Um and and functional medicine and and other modalities do give you that that sort of toolbox. Um I I wanted to ask you about myopia in particular. So this is something that's quite um I mean, I I've been wearing glasses since I was seven. Um we know that there are certainly associations with higher educational attainment and the likelihood that you're going to need glasses. Is there anything um beyond education and beyond, you know, reading and looking at screens that may answer the question as to why we see this a lot more in countries like the USA, um China and the UK? I saw myopia being the need to to have glasses just for the listeners, the need for glasses to to um to look at things at long distance.
Dr Rudrani Banik: Yes, yes. So myopia is uh is basically nearsightedness and um it's it's truly becoming an epidemic. Um currently, it's this is these numbers are staggering. So 30% of the population is myopic. And it's estimated that by the year 2030, so just a decade away, 50% of the world's population will be myopic. I mean, just staggering numbers. And um the rates really are much higher in certain countries. Um but I think globally it is an issue. So the rates are definitely higher in Asian countries, uh China, Singapore, Taiwan and we don't exactly understand why. There may be a genetic component, but um they've really done a lot of studies specifically in children to see what the risk factors may be for this worsening myopia epidemic. And what happens in myopia is basically um it has to do with the shape of the eye, the curvature of the cornea as well as the length of the eye. And in myopia, the length of the eye begins to extend. So it's a longer eye than normal. And we think that due to prolonged near work, that that uh that excessive um strain on the eyes, basically it's a process called accommodation. Our eye muscles are constantly working to help us to focus up close, that causes the eye to lengthen. And usually this happens during childhood, but it can extend into the teenage years and into the um young adult years. And usually myopia stabilizes by one's mid-20s or so. Um so that's, you know, if you do have progressive myopia, you do have some uh kind of reassurance that eventually it will stop progressing and and that's about the time it should stop. And so what are the factors that may lead to to progression of myopia? As I meant, as you mentioned also, excessive near work. But um but in terms of treating myopia or preventing progression, there are some interesting studies that have been done that actually looked at children and their um their outdoor time. And so there was a really interesting study that came out of China that looked at um the amount of time children spend outdoors. And it was found that those who spent two hours or more outdoors, playing outdoors, actually had a decreased rate of progression of myopia. So we don't know if it's simply by eliminating the near work that we're doing, whether it's on our device, on a screen or reading, um or if it's something to do with light, sunlight. So not all sunlight is harmful. Um I had mentioned before UVA and UVB rays with their potential oxidative risks, but we also our bodies need sunlight. So you don't want to block out all sunlight. You want to get out there, you want to get your vitamin D, you want to perhaps get this benefit for your for your eyes from being out in natural sunlight. So, um we're still kind of learning more about that relationship between outdoor time and prevention of myopia. There's also some interesting work being done with specific types of drops to try to prevent progression of myopia. And um some of your audience may have heard of this drop called atropine. Uh atropine basically um it prevents that uh accommodation, it prevents um the focusing up close. So um low dose atropine, so one can still focus, but with low dose atropine, it prevents that constant constriction of a particular muscle in the eye, which is called the ciliary body. And um in some early studies, it's been shown to prevent myopia in children. So we'll see how that goes. Um it's certainly not um yet standard of care. There are some clinical trials going on, large scale clinical trials to really see what dose is best and for how long. But I think that that may be part of the treatment strategy in the future um is to use a drop perhaps to prevent this progression.
Dr Rupy: That's awesome. Yeah, I mean, I I I read similar studies actually, uh based out of Sydney, um where they looked at kids who spent more time outdoors versus those who were indoors and doing a lot more accommodation style uh work and um worsening or better outcomes in terms of myopia. So I think uh it's more of an uh an advert for getting your kids outside and playing and, you know, making sure that they're doing outdoor activities. Um and uh there's some, yeah, I I didn't know that about atropine actually and how that could become the standard of care to prevent uh progression. That's super, super exciting. Is there anything in in the way of diet? I remember there was a study I came across by uh Lauren Cordain, who's a bit of a low carber. Um he's a professor of nutrition at one of the universities, uh suggesting that there may be a link with the amount of sugar in diets, um and perhaps there's a reason as to why you don't see uh rates of myopia in traditional hunter gatherer societies. Obviously, there's a whole bunch of confounders there. They spend a lot more time outdoors, they come from a particular type of genetic uh ancestry, um they have a whole bunch of other things going on. So it might not be the sugar, but um is there anything like that that you've come across at all?
Dr Rudrani Banik: So I have not uh read that study, but I will definitely look into it. Um in terms of um the hunter gatherer, you know, question, I think it's a very interesting um evolutionary question. So uh or or topic because um if you think about it, we we our eyes were not really designed to focus up close for extended periods of time. Our eyes were really designed to look in the distance to, you know, perhaps target um uh you know, uh animals if we're if we're hunter hunters, um and and protect ourselves by by really being focused in the distance. So, you know, in over time, our society has moved really towards much more near work. So not just uh on digital devices, for example, but just reading. You know, reading did not exist in the hunter gatherer times. So, um so this is really something that our eyes um were were physiologically not designed to do for prolonged periods of time. Yes, hunter gatherers did, you know, do do some, you know, up close work absolutely, but not to the extent that we're doing. And um and I just wanted to to throw this, you know, into the conversation. Um if you think about the amount of near work that we do on a daily basis. So, um the estimates are that um near work in terms of on a screen, uh most adults spend about 10 or 11 hours a day in front of a screen. And again, that number is mind-boggling. So you think about how how long your eye muscles are constantly accommodating. Um and children also, uh the estimates are that children spend about six, six and a half hours a day on a screen, whether it's for school work or entertainment, um you know, whatever the reason is, this is our society. And um and it's it's a lifestyle change really. It's how we have evolved and uh there's actually a very cute cartoon that that I like to share with my my my students, um of, you know, the the evolutionary process, you know, of hunter gatherers to having weapons, to having tools. And now we're at a desk or hunched over at a desk or we're like this with our phones with our necks flexed down and it's a change in posture, it's a change in our our demands for our bodies and not just our eyes, but our entire bodies. So, um I don't know what where that's going to lead us, you know, let's say a few hundred years down the road, you know, how is that going to impact our bodies? Um we'll see.
Dr Rupy: Exactly. And I think we're seeing the results of that uh unfold in a whole bunch of different specialties and why perhaps lifestyle medicine is taking off so much. Um to the point about blue light, I think that's a really good segue into some questions that we do get about blue light um from um devices and also uh UVA, UVB in the environment as well. What is the verdict on that? Is it uh something that um you think is good for us, bad for us or does it depend on uh the source and the dose?
Dr Rudrani Banik: Yeah, so love that question. Um so I think I'll I'll just take a step back first and explain about the different wavelengths of light so that we're, you know, we're all kind of understanding what blue light is exactly. So there's there are many different wavelengths of light. There's UV light, which is short wavelength. There's visible light that we can see, so between the violet to red spectrum. And then there's long wavelength light, which is infrared light. So, um short wavelength light, UV light tends to come from the sun. There's UVA, UVB, UVC. The atmosphere um basically filters out most of the UVC rays, which are the most harmful. So fortunately, we don't get exposed to those as long as the ozone layer is intact. Um but uh UVA and UVB rays are not good for us and we should try to prevent that damage as much as possible. In terms of visible light, so blue light is on the shorter end of the spectrum. And if you wanted to get technical about it, it's between 400 to 500 nanometers in terms of the wavelength. And the shorter the wavelength, the more energy the light has and the more potential damage it has. So, um so because um uh we are exposed to all of this blue light. So blue light we get from many sources. We get it mainly from the sun. Actually, the sun is our highest uh emitter of blue light, but we also get it from a lot of artificial light sources. So from our screens, our screens emit blue light, um our um light bulbs emit blue light. So uh LED lights and CFL lights, even though they are definitely much more energy efficient than incandescent lights, these um these artificial light sources emit quite a bit of blue light. So we are getting bombarded with blue light all the time, whether it's natural light or or artificial light. So I did want to mention here that the light that we get from our screens and from our light bulbs is slightly on the longer end of the blue light spectrum. So it's not that short blue wavelength light between 400 to 450. It's usually about 460 to 475. So it's it's a little bit safer. Um and so, but then so there was a a an alarmist headline that the blue light from your screens is going is killing your eyes. You're going to we're all going to end up with an epidemic of blindness because this blue light is going to be killing our eyes. And so let me explain a little bit about what that study was about because perhaps many people are concerned about it. They've heard about this study. So what the researchers did was they took a petri dish, they put some cells in the petri dish and they exposed them to high, high levels of blue light. And lo and behold, those cells died. And then the researcher said, oh, blue light at, you know, at these concentrations is going to kill your retinas and we're all going to go blind. So let me break that down a little bit. So the cells that the the researchers used were not retinal cells at all. They weren't even eye cells. They were cervical cancer cells. So they basically took a cervical cancer cell line that grows very well in a petri dish and they exposed them to blue light and they died. And so these cervical cancer cells don't have the inherent protective mechanisms that our retinas have. They don't have lutein, they don't have zeaxanthin to protect them. And they also don't have some of the other metabolic processes that go on in our retinal photoreceptors to prevent them from blue light damage or UV damage or oxidative damage. So, so, you know, it's really no surprise that those cells died. So the bottom line is there is no study out there that shows that blue light will permanently damage our vision. There is no study that shows that we are going to go blind from blue light exposure. So I just want to make that very clear.
Dr Rupy: I'm so glad you broke down that study because I don't think anyone would have realized, myself included, because I didn't read the study. I just heard the headlines and I was told by my ophthalmology friends that I shouldn't worry about that and that was completely, you know, just the fact that it's a lab environment, but the fact that they use cervical cells without, like you exactly eloquently pointed out, without the machinery to deal with blue light because that's not what it was intended for. Um it just makes it so much clearer now for and I think a lot of our listeners will appreciate that.
Dr Rudrani Banik: Yeah, yeah, it's it's something that even many ophthalmologists are not aware of that that the type of, you know, the way the study was performed is not um it's not replicating what happens in real life. And uh and our bodies have a tremendous capacity to heal and to prevent against oxidative damage as long as we provide our bodies with the nutrients that that they need that it needs basically. So, but I I do want to mention a couple of other things about blue light. Um so you had asked before, is it harmful or helpful? So blue light is actually it's important for our bodies to be exposed to blue light. And the reason is because um our sleep wake cycle is determined by blue light exposure. So, um the sun, again, it emits quite a bit of blue light. When it rises in the morning, it's emitting this blue light. It's basically telling our bodies that it is time to wake up, it's time to get going, get up and get going with your day. Um and then as the the course of the day goes on, as the sun goes through the horizon, the amount of blue light emitted by the sun actually decreases. And so then it's telling our bodies, okay, it's time to slow down, it's time to wind down and perhaps get ready for bed. And so, um so there's a natural cycle of blue light emitted by the sun and that's intended to tell our to regulate our circadian rhythms. And when we are exposed to blue light from not natural sources, but artificial sources, for example, screens, um it does disrupt our uh circadian rhythm, our blue our um sleep wake cycle. And so it is important to try to limit the amount of blue light that one is exposed to uh towards the latter part of the day, uh really the the two hours before bedtime, I would say, it's really important to try to limit that blue light. And there are many ways you can do that. Um I have a lot of my patients ask me about blue light blocking glasses. I know it's a hot item. Um there are many manufacturers now of blue light blocking glasses. Even your optician will probably ask you, you know, do you want this blue light blocker put on your glasses? Um uh that definitely can help. Um uh the what everyone should be aware of that there are different grades of blue blocking glasses and um not all blue blockers are made the same. So for example, um uh if you put on a blue blocking pair of glasses and you look at a screen with something blue on it, if you can still see the colour blue, then that blue blocker is not blocking out 100% of the blue light. And there was a very interesting study done by Consumer Reports, which is a um uh a magazine here that um that basically rates different products. And so they took the top the top three best-selling blue blockers on the market and they tested them for how many, you know, which of those blue blockers actually did what they were claiming to do. And only one brand actually blocked out uh about 97% of the blue light. The other two brands only blocked out about 30 or 40% of the blue light um that was coming from screens. So, um so just be be aware of that that not all blue blockers are made the same. Uh there are other ways to block out blue light. Uh personally, I like to use a uh blue light filter app, something that you can download to your phone or your tablet or your computer. And automatically, this is this is a pretty cool thing. Um the app knows which time zone you're in and it knows when the sun is rising and when the sun is setting. So basically, two hours before the sun is scheduled to set, it begins to dim the amount of blue light emitted by your screen. And so it really helps in terms of right before bedtime, if you're doing a lot of work on a screen, it really helps to block out that blue light to help your sleep. Um and then of course, there are screen protectors that you can buy, um basically um filters that you can put on your screen externally that can also do the same thing. But personally, I like the app because um because it's it's pretty sophisticated in what it can do and it it kind of takes the guesswork out of it, you know, you just kind of it's it's on autopilot, so you don't have to think about it and your screen is just doing it automatically.
Dr Rupy: Absolutely. Yeah. I I I think I have the same one. The one I use is called Flux. Um and it just changes wherever I am in the world and it just knows when the sun's setting and that's kind of like my cue to to me because I tend to work quite late, um which I shouldn't do, um that I should be kind of like winding down, going to bed because it's not just the blue uh that stimulates your brain. It's also what you're doing on the phone as well. Um you're scrolling or you're replying to emails, you're actually still stimulating your brain and that's going to have a detrimental impact on your sleep quality as well. So I'm always reminding myself as well as other people to be mindful of the fact that um use of any digital devices, um blue emitting or not is is not going to be great for your overall um sleep quality.
Dr Rudrani Banik: I just wanted to add one more thing. Um since we're talking about blue light, blue light, even though it won't permanently harm our eyes, it can certainly cause short-term symptoms uh that fall under the category of digital eye strain or computer vision syndrome, which uh perhaps uh some of your listeners have heard of. So, um so absolutely blue light is linked to short-term issues and uh many patients may have symptoms like light sensitivity or eye fatigue, eye strain, dry eyes, perhaps even headaches. So, um so absolutely it is important to kind of be mindful of the amount of blue light that you're getting, um particularly at nighttime to prevent some of those symptoms. And and I like this this cute little rule which is called the 2020 rule to prevent against digital eye strain. So basically, um if you are, you know, working for prolonged periods of time at the computer, um set your timer every 20 minutes, just take a break. Take a 20 second break every 20 minutes, close your eyes, let your eyes, you know, just relax from that exposure, lubricate your eyes and then start up again. So 2020 rule, remember that.
Dr Rupy: I I really try and do that myself. So I I have a 20 minute timer on my phone to break up my working hour into into chunks and that hopefully, well, anecdotally for me, that helps me um kind of stay focused and become a lot more productive because I guarantee and I'm sure a lot of people can resonate with this. If you try and work for an hour or two hours in one big chunk, you'll get distracted, you'll go on social media, you'll check your emails, you know, if you give yourself a chunk of 20 minutes, okay, I'm going to do work for 20 minutes, I'm going to write this essay, I'm going to do whatever I'm doing, and then give myself a break and you look into the distance, you give yourself a breath, you walk around. Um it's definitely good for productivity as well as your eyes as well. And that's a really good rule. I'm definitely going to definitely going to use that. Absolutely, absolutely. Um one thing I I'm constantly asked about is um uh along with digital eye strain and and headaches and and that kind of stuff is uh dry eye. Um and if there is a nutritional component to dry eye. Is there anything that people can do to prevent um things that cause dry eye? And there's a whole plethora of different things that can be responsible for this symptom as well.
Dr Rudrani Banik: Yes, so dry eye is a very common condition and it actually happens across all age groups. So not just, you know, one would think perhaps it happens to people as they get older, but um certainly children, teenagers, young adults can get dry eye as well. And there are many, many causes of dry eye. So it's it's it is important to try to uh to hone down and pinpoint what exactly is the root cause of the dry eye. Um could it be excessive screen time? Uh could it be something else? Maybe there's something medical going on that could be causing dry eye. Uh there are some autoimmune conditions that can be linked to dry eye. For example, there's a a condition called Sjogren's syndrome, which is dry eye, dry mouth. Um that can cause dry eye. Uh rheumatoid arthritis is also associated with dry eye. Lupus is also associated with dry eye. So these autoimmune conditions are important to recognize as well as potentially um you know, uh playing a role in in dry eye. And then there are certain medications that also can cause dry eye. So there are many over the counter medications, um in particular, I'll just mention the um the allergy medications, many antihistamines can also lead to dry eye. So, uh so first it's important to figure out what could be causing your dry eye. And then um in terms of treatment, um you know, the the main stay of treatment is to lubricate, which means putting in drops, but there absolutely is a nutritional component to this as well. And um the reason is because um our uh glands within our eyelids, we have tiny little glands in our eyelids called mybomian glands. And each eyelid has about 20 to 30 of these mybomian glands. And they're very, very small structures and they secrete oils. And the oils are responsible for the surface of your tears and they help prevent the tears from evaporating. And the goal is to keep that oily layer intact so your tears don't evaporate and you don't develop the symptoms of dry eye. And so there have been studies done using omegas, particularly omega-3s uh to try to improve the quality of the uh oily surface of the tear film and to promote function of those tiny little mybomian glands. And um and so in terms of the studies that have been done, um there are some studies that are that have shown that dietary omega-3s are are are helpful in terms of the studies that have been done using a supplement for an omega-3, um maybe a little bit more controversial. Um there was a large meta-analysis done that showed that yes, omega-3s are helpful, um DHA, EPA. And then there was another study that was recently done called the DREAM study uh that was published in um JAMA uh last year, maybe two years ago now, that actually showed that um omega-3s as a supplement were not helpful for dry eye. Now, I just want to do break that study down a little bit as well. So, um the study was placebo controlled and the group that got omega-3s, they received it for um two years. Uh the the placebo group received an um an oil um a substitute which was basically olive oil. So not um not the omega-3 but olive oil. So, so that group did also get um some oil benefits. So we don't know if the study was didn't show any statistical significance because of the way it was designed or the placebo that was used. So just be aware that there is a little bit of controversy about supplements, um uh omega-3 supplements, but dietary, there is solid evidence that dietary omega-3s are absolutely useful and helpful in dry eye. So that dietary source may be fish, for example, uh salmon, um trout, even sardines, anchovies, um or um uh plant-based versions of omega-3s. So chia seeds, um flax seeds and walnuts are also great sources of omega-3s for your eyes, for dry eye in particular.
Dr Rupy: I think that'll be a really good sort of um uh a really good source of information for people to understand that it's not just about the drops. And like, you know, I prescribe the drops and we have hypromellose here, we have a whole suite of different drops and stuff. But if there's something that you can actually do with your diet to improve that and there's some evidence for it, then it's definitely worth a try. And if it's not going to benefit your eyes, it's certainly going to benefit your overall health as well. So taking a pragmatic approach is definitely something to entertain. Um I I would love to to end with kind of what you eat personally and how that reflects like uh how you're protecting your own eye health as well as your overall health as well. Like what does a what does a a plate or a dinner or a lunch look like for for Dr. Rudrani?
Dr Rudrani Banik: So first of all, I I do I'm glad you asked that question because I do want to mention that I used to have the absolute worst diet. Um five years ago, uh most of my life, I had the worst diet and it consisted of, and I'm not kidding, it consisted of pizza, ice cream and diet Coke. And that's all I would have for the majority of my my life, my adult life in particular. And I never once considered that my diet was negatively impacting my health. Um until I began to have some health issues and and that's really opened my world to the impact of the concept of food as medicine. Food is medicine and nutrition is so important uh for not just our eyes, but our overall health. So, um to answer your question, um so I um I uh have a plant rich diet. I happen to be vegetarian, but I like the term plant rich, which is basically it's not necessarily plant-based, but plant rich meaning I try to have five cups of different coloured fruits and vegetables every day. Um so it may be that green smoothie I have or it may be a salad, um uh and then some source of protein. Um egg is also a wonderful source, even though I'm vegetarian, I do have egg, uh a source of um uh protein, but also lutein and zeaxanthin because the egg yolk is very, very rich in both of those two eye health nutrients. And then I try to have a healthy fat as well. Um so I'm always cooking with healthy fats, but uh coconut oil uh is also a great addition. So MCTs, coconut oil, olive oil is also wonderful to to um to include in your diet. Uh you can take it straight or you can cook with it or add it, you know, add it to your salads, but but that would be kind of a a sample of what I eat. Now, um I I you know, some of my patients when I do tell them, you know, have five cups of vegetables a day, they do get a little overwhelmed. They say, wait a minute, wait, you know, I don't know if I can do that. But then I say, okay, well, let's let's take a step back and and let's let's talk about meal by meal. What can you do to get those nutrients in your diet? And and one quick and simple rule I like is, so most of us have three meals a day. So over the course of a week, that's 21 meals over the course of a week. Have a different colour with each meal. So you're getting in, you know, 21 different colours in your in your week. So different shades of green, uh different shades of yellow, orange, red, uh have some blues in there, have some berries, um have some eggplant, uh uh blues, blacks, um and and purples. If you have that rainbow of colours in your weekly diet, you will get all of those phytonutrients you need and keep your your body functioning properly. So that's my my uh my tip that I give my patients who feel a little overwhelmed with the diets that I give them.
Dr Rupy: Totally. No, I mean that that resonates with me absolutely. I'm I'm of the mantra of like just one more at every meal time. Like can you just get one more colour, one more plant in at every meal time. Even if it, you know, you're enjoying something like a slice of pizza, okay, fair enough, you can have pizza every now and then, but what are you going to have with it to, you know, to add to the nutrient density of your overall diet? Uh and I'm glad you you you mentioned the the previous diet because I think as as medics, we we all have pretty unhealthy lifestyles uh back in the day. Like before I got my own medical health issues over 10 years ago, I was having a quote unquote normal diet, which would have just been sandwiches, a bit of uh cheap cereal in the morning, um you know, pasta and for dinner and those in isolation are fine, but when it's cumulative and that's all you're eating and you're not having as many vegetables as you should be, then that's where you're setting yourself up for potential issues later on down the line. And I I realized quite quickly that my threshold for withstanding that sort of uh diet and lifestyle was a lot lower than my peers and and I got ill. So, um this it's interesting to note that everyone has their their own personal health stories as to how they got into nutrition and the food as medicine movement because like you said, it it is complete medicine and it's a a tool to have in our toolbox, whether you're performing eye surgery or working in the emergency department or uh you know, helping people with their psychiatric health. So it's it's brilliant to hear and uh I'm so glad that there's someone of your position as a professor talking about this to the new generation of medics.
Dr Rudrani Banik: Well, I'm glad you you uh you're such an advocate because it really is so important to get that information out there and to educate people and then to have those those people educate their families and their friends about this as well to spread that message because um it really I think is is the way our society needs to move to prevent these chronic diseases.
Dr Rupy: Absolutely. Well, I can't wait for your book to come out. I hope it does still pandemic pending. Um later on this year. Um I'll make sure to put a link to it in the show notes. Um and I just want to say thank you so much for spending the time with us here today. Unfortunately, we couldn't get you here to the studio where I cook for the guests as we have a conversation. Um but I would have made sure it would have been as plant rich as you can imagine.
Dr Rudrani Banik: Well, hopefully, perhaps one time when I'm visiting the UK, I would love to stop by and and that sounds wonderful. But thank you.
Dr Rupy: Of course, of course. Pleasure. I really hope you enjoyed that conversation. If I'm going to summarize our conversation, it is pretty much that all of organs are uniquely susceptible to oxidative stress, but particularly the eye, given its high consumption of oxygen and high content of polyunsaturated fatty acids. So you really want to try and get as many different colours as possible. It sounds simple, but it it really does have a lot of science behind it. And the vegetables that I like to tell people about are the ones that are high in highest in lutein and highest in zeaxanthin. These are carotenoids that you find in deep dark green leafy vegetables, but also the yellows, the purples, the blacks, parsley, basil, spinach, kale, peas, green pepper, lettuce, carrots, red peppers. These are all fantastic sources, but you can also get it, get other carotenoids as well as quality fats in eggs and egg yolks. If you're vegan or a vegetarian, you don't eat eggs for whatever reason, there are other sources in algae. There are short chain fatty acids that you can find in chia, walnuts and flax seeds, but I do actually recommend people take an algae supplement for the long chain omega-3s if you do have a completely plant-based diet because it's very hard to get those long chain fatty acids in in seeds. They don't convert very well. The other things that we talked about are screen rests, the 20-20-20 rule. So, you know, every 20 minutes, take, look into the distance at 20 meters for 20 seconds. I think that really does help me and it also breaks up my working day when I'm looking at screens when I'm working from home. So I think that's definitely something that I think everyone should do. We didn't go too much into the supplements, but her book and even my book actually do just talk about some supplements that you could use in conjunction with that too. Really hope you enjoyed the the podcast episode. Check out the show notes for all the links to Dr. Rudrani. Um and uh please give this a five-star review as well if you if you found it useful and do uh share it with anyone who you think could benefit from this information. Have a wonderful day and I will see you next week.
