Healthy Foods and Habits for Optimal Eye Health - Dr. Michael Ruscio, DNM, DC

Healthy Foods and Habits for Optimal Eye Health

The Role of Omega-3 Fatty Acids, Lutein, Eye Yoga, the 20/20/20 Protocol, and Other Remedies in Preventing and Alleviating Eye Conditions With Dr. Neda Gioia

Optometrist and nutrition specialist Dr. Neda Gioia of Integrative Vision believes that healthy eyes start with a healthy body. So what are some healthy foods and habits you can adopt to protect and preserve your eye health? Dr. Neda not only shares why it’s critical to eat well, reduce screen time, perform eye exercises, and choose the right supplements, but also how you can begin making these necessary dietary and lifestyle changes to reduce or prevent ocular and neurodegenerative diseases. Listen in to learn more.

In This Episode

Intro… 00:08
Introducing Dr. Neda Gioia and the importance of eye health… 00:44
Can you exercise your eye? And is actually effective?… 05:43
Zoom fatigue… 10:28
Using the 20/20/20 rule for good visual hygiene… 13:59
Is it worthwhile to reduce flicker and blue light?… 18:01
The study-backed effect of vitamins on macular degeneration… 21:15
Where to start from a dietary perspective… 29:18
The benefits of focusing on your health earlier rather than later… 32:48
What you should (and shouldn’t) incorporate into your diet for ocular health… 37:52
Dr. Gioia recommends two eye-specific supplements… 43:49
A closing note about the importance of eye care for overall health… 44:49
Where to find Dr. Gioia… 46:13
Outro… 48:03

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Hey everyone. Today I spoke with Dr. Neda Gioia and we discussed the topic of eye health. Now, Neda is an optometrist. She graduated from Rutgers University with a BA in biology and psychology followed by a doctorate in optometry at SUNY college. And she also is trained and certified in functional medicine and has performed a fellowship in ocular wellness and nutrition, as well as being a certified nutritional specialist with a degree from Western States. And today, as you can probably expect, we cover this balanced perspective between conventional optometry and functional medicine. And the one thing, amongst all of her other good points that I think she makes, is that we should be looking at eye health as a facet of neurological health and potentially at eye health as a window into neurological health and neurodegenerative diseases. So we outlined and covered a few very interesting topics; nearsighted versus farsighted and the merit that exercise used to correct nearsighted or farsightedness hold.

Also the screen pandemic that has been paralleling the COVID pandemic as everyone has shifted from whatever they were doing before to a very screen-based Zoom-based office and work model. And we talked about this visual hygiene practice called 20/20/20, which I definitely hope you will take a moment to start practicing, and also the merits of flicker reduction software. As well as, you’re probably expecting, what sort of functional medicine and nutritional interventions—like Lutein, Zeaxanthin, Omega 3s—can we use to reduce neuro and especially, ocular diseases and promote health as best as possible. And we outline some dietary approaches, specific foods, and specific supplements that you can use. So with that, we will now go to the conversation with Dr. Neda Gioia and hopefully you will find it insightful. Alright, here we go.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

Hey everyone. Today I spoke with Dr. Neda Gioia and we discussed the topic of eye health. Now, Neda is an optometrist. She graduated from Rutgers University with a BA in biology and psychology followed by a doctorate in optometry at SUNY college. And she also is trained and certified in functional medicine and has performed a fellowship in ocular wellness and nutrition, as well as being a certified nutritional specialist with a degree from Western States. And today, as you can probably expect, we cover this balanced perspective between conventional optometry and functional medicine. And the one thing, amongst all of her other good points that I think she makes, is that we should be looking at eye health as a facet of neurological health and potentially at eye health as a window into neurological health and neurodegenerative diseases. So we outlined and covered a few very interesting topics; nearsighted versus farsighted and the merit that exercise used to correct nearsighted or farsightedness hold.

Dr Ruscio:

Also the screen pandemic that has been paralleling the COVID pandemic as everyone has shifted from whatever they were doing before to a very screen-based Zoom-based office and work model. And we talked about this visual hygiene practice called 20/20/20, which I definitely hope you will take a moment to start practicing, and also the merits of flicker reduction software. As well as, you’re probably expecting, what sort of functional medicine and nutritional interventions—like Lutein, Zeaxanthin, Omega 3s—can we use to reduce neuro and especially, ocular diseases and promote health as best as possible. And we outline some dietary approaches, specific foods, and specific supplements that you can use. So with that, we will now go to the conversation with Dr. Neda Gioia and hopefully you will find it insightful. Alright, here we go.

Dr Ruscio:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Michael Ruscio today here with Dr. Neda Gioia and we are talking about eye health. This is something that we had discussed several years ago, and I think it’s definitely an important topic. Everyone wants to be able to see well. So, Neda, I’m glad to have you here to do round two on this very important topic.

Dr Neda Gioia:

Thank you so much, Dr. Ruscio, for having me on the podcast. I do think that this is an element that’s needed in the functional medicine community, and outside of that as well.

Dr Ruscio:

There’s a lot of things regarding this topic that we could dig into; there’s glaucoma, there’s retinal damage, there’s just nearsighted/farsighted and the whole debate over [whether] exercises are adequate. Is there a short bullet list of the topics that you think we should cover to maybe give people a, “here’s what’s on offer” for the rest of the discussion that you can lay out and then we can tick those off one by one?

Dr Neda Gioia:

Absolutely. I do think if you clump everything together with vision being such a high order sense and wanting to preserve it, obviously, there are few common threads that we see with all eye conditions. And I think, being in the functional medicine world, it’s really polyphenols and specific carotenoids that help support ocular health. The eye is a part of your brain, essentially. So neurodegenerative disease is very directly related to eye disease. And we do see an increase of that, unfortunately, in our general population. So yes, we can get into more details, but there are some common threads. And that’s the part that I really feel excited about.

Dr Ruscio:

Are there some common conditions that you think people are being underserved regarding conventional eye care?

Dr Neda Gioia:

Conventional eye care is really big in terms of the general, population of the US. I mean, we have upwards of a hundred million eye exams a year and these touch points are really, really big. And because ocular nutrition, even though it might sound very new to the audience, it’s been around for quite some time. And there’s a higher acceptance within practitioners that provide eye care that there is a role with nutrition for teaching our patients how to better serve those eye conditions that they have, whether it’s advanced or early onset. So yes, that is definitely needed.

Dr Ruscio:

And I guess to come to one of the questions I asked a moment ago, I’ve seen different courses that offer exercises that can help retrain the ocular muscles so that if you’re nearsighted or farsighted, you can correct your vision. And certainly this appeals to me. I hear and I understand the argument that we’re looking at screens all day, right in front of our faces, and we’re not really having this ability for the retina and the eye to have to stretch the lens or allow the lens to relax so as to change the focal point at which we’re trying to focus on, therefore the muscles become lax or too tight, and therefore the vision is skewed. So exercise as a therapeutic for that makes sense. But this is not something I’m doing clinically. I don’t know if these exercises land for 1 out of 10 patients, for 7 out of 10 patients, or if there’s just any other points of saliency here that you feel are important to mention.

Dr Neda Gioia:

Absolutely. With myopia being increasingly high globally on an alarming rate (that’s another word for being nearsighted), we can’t really just blame our genetics anymore because the rate is way too high. So the question becomes our day-to-day use of our vision has really shifted big in the past 20/30 years, especially with the technology boosts. So now we have this focal length that we just keep using over and over again, whether it’s at your desk or even just in an office setting, a home setting. And our ratio to outdoor usage of our vision has significantly reduced. So the question becomes, is it environment, is it genetics? And I mean, I think it’s pretty obvious and we’re more and more accepting that a huge part of it is environment.

Dr Neda Gioia:

So ocular exercises have been around for a long time. It was actually my university that I studied optometry was one of the early adopters to vision therapy, which, basically you’re teaching the eyes to work cohesively for ocular motor function, for vision strength, etc. And now you circle back to, “what if I don’t have a classic lazy eye or something that has to be therapeutically managed, but I’m just overwhelmed with how I’m using my eyes repeatedly for hours upon hours at the computer?” And that has really launched a lot more questions since the pandemic.

Dr Neda Gioia:

The pandemic really changed our perspective of how we use our eyes. And I will tell you within a year, the complaints have changed a lot because now even going into the office has reduced. And just the fact that you’re commuting, when you commute you’re going outside, you’re multitasking, but when you’re home, you really restrict your use of your vision. And end of day, fatigue and strain have become more of a commonplace complaint. So now we have this new way that we’re using our eyes and all of these strategic therapeutic muscle relaxing exercises that we might have been using for, again, a lazy eye. Much might be circling back to help relax people’s vision as to this new way of using.

Dr Neda Gioia:

And I mean, I did a video on eye yoga. And I am not the expert on eye yoga, but if you sat down and you looked into your extreme gazes, you rarely use that in your day-to-day life, right? It kind of hurts and I have patients do it just to really expand how they feel by the end of the day, reduce that one focal length, monotone usage of their vision and it makes a difference. Now, are we saving vision in the sense of ocular disease per se? Probably not. But it’s more of a symptomatic comfort. And also reducing myopia issues, which is a huge problem with ocular disease, because it actually is a risk factor for ocular disease, just being nearsighted. So you will see more and more exercises being recommended or at least suggested by practitioners for patients who don’t even have a lazy eye. And it’s going to only increase in terms of these suggestions.

Dr Ruscio:

Right? Well, I love that term and that thought of “eye yoga.” And you make an excellent point, which is now people are going to be on screens more than ever, because even people who worked in office and had, let’s say, meetings with other people are now still maybe doing the meetings but they’re doing them via Zoom. Which I have found Zoom fatigue to be a very real thing. I remember when we pivoted to all tele-health due to the pandemic. I went from having some in-office visits to some tele-health visits and kind of this back and forth oscillation in a clinical day, to all day on Zoom. And that was one of the reasons behind why we switched to truly tele-health rather than video health, because doing 12 visits a day on Zoom I found to be exhausting. And I think it’s because you’re just focused on the eye of a needle or the eye of a camera the entire time, whereas when you’re looking at a person it’s much more appropriate to look at them and look down and look up and there’s all this focal accommodation.

Dr Ruscio:

But maybe you could speak to “Zoom fatigue” as something that I’m sure some people here have found themselves as frustrated as I’ve been when using Zoom. Any thoughts you have on that?

Dr Neda Gioia:

Yeah. Zoom gets a little more difficult because you’re actually not just reading something. When you read maybe an email or whatnot, it’s very stationary, right? The words are static. In Zoom meetings there’s a dynamic movement and that actually can disrupt some people’s vestibular feelings too. It’s not just the actual vision part, but it’s the movement part that throws people off over time, after 20/30 minutes. And it’s usually multi-screened or you’re having little pods of people, perhaps if you have two or three or four people on the Zoom, and then once you get to 10 people, it’s very difficult to track that movement. And it’s very unnatural. So Zoom fatigue has multi reasons, but one is it’s actually that movement versus it being static.

Dr Neda Gioia:

And then also the fact that people pay attention with Zoom videos versus an email. For example, when you read an email you might be in a relaxed state to some degree. When you’re in a Zoom, you’re almost on stage. When you go on stage, your brain tells your eye, “I’m on stage.” And when your brain tells your eye that it’s on stage, your eyes typically blink a lot less—we go into this almost stress point of stay alive, stay awake, don’t miss anything. And when you start blinking less, that actually reduces your tear quality because blinking is like windshield wipers, we want to spread the nice tears. And when our blink rates reduce by 50% or even more, then that fatigue really sets in even more.

Dr Neda Gioia:

So that’s another problem with Zoom. You’re on stage even more so than just an email that you’re doing. So absolutely there needs to be breaks. There are some great tips for “visual hygiene,” we call it. We have dental hygiene, right? We don’t talk about visual hygiene. Where the 20, 20, 20 rule, steps that when you’re on some sort of screen for 2 hours you really need a good 20 -30 minutes off.

Dr Ruscio:

So what is the 20/20/20? I’ve never heard that.

Dr Neda Gioia:

That is one of the biggest campaigns that we had in eye care. And it was not a functional medicine or a holistic kind of mindset, it was in general eye care. And 20/20/20 is 20 minutes of consistent near work, especially on digital devices, 20 seconds of visual unlocking—so now you’re looking across the room—for 20 seconds and typically it’s 20 feet, as far as you can look, whether it’s out of a window or the far end of your room. And I always add another excess, another add-on, which is try to fit in some excess of blinking during that 20 seconds.

Dr Neda Gioia:

So for kids, what we were doing during the pandemic is giving them like a target picture on the far end of the wall. So whether it’s their favorite cartoon character or whatnot, so while they’re Zooming and computer-focused, they can focus far away and really unlock their accommodation. And in addition to that, during that 20 second break, to really pump your eyelids, because we have these mechanisms that add tears to our eyes and the oils that really protect our tears for evaporation and dryness, which kids are increasingly getting, unfortunately. We’re seeing more dry eye in an age bracket that shouldn’t have dry eye. So yeah, the 20/20/20 rule is pretty standard in terms of visual hygiene, especially in electronics. So if you haven’t heard of it, it’s a big one.

Dr Ruscio:

Yeah. That’s great. And I’m just kind of doing a self audit of my desk space. And one of the things I’ve always done with my desk is position it in front of a window, so that if I’m pausing from typing or anything screen-focused, I can look up and look out and not just have like a wall right in front of me. And I never had a reason for that other than it just seemed intuitively more pleasurable to look out a window than look into a wall. But I guess I’ve been sparing my eyes to some extent by doing that.

Dr Neda Gioia:

Yeah. And we had this talk, I did a few webinars when the pandemic hit, for kids. These students, they had their desks against the wall. So it’s like, “where’s your stimulation?” It’s all within two feet. Your visual stimulation is so, so nearsighted, which is against nature. We’re not made to be looking that way. And of course, glare issues, positioning your monitor far enough from your eyes, not having it too close to your face, and other things that will help relax the eyes during these times of stress. Because it’s really stressful after 2/3 hours. It’s not natural.

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Dr Ruscio:

Do you feel it worthwhile to use a device that reduces flicker? I have this program running on my computer called “Iris” and it is a part blue light filter. Although during the day I don’t filter blue light and I’d be curious if you agree with that, is one question. And then the other is, do you think flicker reduction is something that’s worthwhile?

Dr Neda Gioia:

I think it’s very worthwhile. I think what we’re going to see within the next 5-10 years from the computer companies is how to optimize these screens where we have less of that flickering, which can induce things like migraines, visual discomfort, etc, as well as blue light emission that’s unnatural from screens. A lot of this digital exposure is new to your practitioner, it’s new to the patient, and we are just on the cutting edge of learning about what this is doing to us metabolically. And of course, blue lights, one of the biggest hot topics too, when COVID hit, where the questions were just streaming in of, “what am I supposed to do?” And I mean, with your background, you are aware that blue light is a stimulator to reduce melatonin release from the pineal gland. So absolutely, I think apps—like Iflux is another app that adjusts screen tone, flicker reduction, etc.—I think there’s no harm in starting those apps and implementing them as we really embark on reduction from the companies themselves where they’re optimizing these screens with the LEDs as we go forward.

Dr Ruscio:

Yeah. In retrospect, I don’t know if this is because I’ve become healthier over the past maybe five years or so, but when I was writing the boo—this is back in, boy, from about 2015-2018—there was a lot of times where my eyes would just feel exhausted. And I think I can loosely track the use of a flicker-reduction device to really having no eye fatigue now. And I still spend a whole heck of a lot of time on the computer. So yeah, I mean, just my n-of-1 observation seems to have reduced that eye strain for me.

Dr Neda Gioia:

Yeah. And the sensitivity is different for everyone. Vision is not just vision, it’s actually perception as well—that visual processing. And you’ll have a patient that is highly, highly sensitive to just moderate amounts of blue light emission from their screen, a flickering from the screen. And then you’ll have another patient that has a much more higher sensitivity threshold. So there is a component of all this where every patient’s obviously different, everybody’s sensitivities are different. So you might be one of the sensitive ones to the flickering and that’s not unheard of. I find a lot of my patients who have migraine issues, it’s from the flickering, when they get it right after computer use.

Dr Ruscio:

Right. Right. Yeah. Well, that’s one simple hack for people if they want to deploy that one. As is the 20/20/20. Now you had mentioned earlier, and I’m sure you’re probably interested to unpack more about ocular nutrition, neurogeneration, and how this connects to eye disease. Where do you want to start here?

Dr Neda Gioia:

I think the first part of my introduction to this is the validity that no one wants to lose their vision. I think you put anything out there, one of the senses that is really high level, its vision. And with the increase of almost every eye health condition and the projections being so sad, in all honesty, by 2050, whether it be glaucoma, age-related macular degeneration, diabetic retinopathy, which all of these conditions have some sort of connection to general health. I think we’re on the cusp of really introducing ocular nutrition earlier on before these conditions get so advanced. And with more and more practitioners being well versed as to how to do this, or really getting their patients on board with improving antioxidants and polyphenol ingestion, etc., at the earliest time that they can, we can help mitigate these numbers.

Dr Neda Gioia:

I think it’s paramount for eye docs out there—and we’re getting quite a few that are really on board with this—to just introduce how to reduce risk factors. Whether your mom has macular degeneration or, “oh yeah, my uncle has glaucoma.” You’re getting a routine exam every year. How can we boost your ocular nutrition, your ocular antioxidants, and know that we’re helping that foundational piece to prevent eye disease as you hit your 50s, your 60s, your 70s? Because socioeconomically vision loss is not a good thing. You can’t drive. You can’t work. Your dependency on outside care goes up exponentially. And the younger you start, we know that it’s better.

Dr Neda Gioia:

Now, the studies, I would say at this point in time, are solid enough for a doctor that is proactive to really put these nutritional pieces into a daily practice. And it all started with ARED study for macular degeneration. And that’s been out for many, many years now where we solidified and we said, “listen, if you put a certain eye disease (macular degeneration) on this vitamin cocktail—and it wasn’t even the best vitamin formulation, we can go nuts about stripping it in terms of the formula and the amounts, etc.—it still showed a 25% roughly reduction of vision loss in intermediate-advance dry macular degeneration to wet macular degeneration. Now, we have vitamins that make formulations from this study and it’s been out for a while. So I find that more of the foundational piece of: why not go further? And that’s where functional medicine comes into play. And nutrition comes into play.

Dr Neda Gioia:

Where we had this really great study that, frankly, proves that there’s something else in the eye that’s really related to our general lifestyle and nutrition. Why not go further? Why not start our care earlier to prevent eye disease? And I’m lucky that I have a practice that is really focused on ocular disease prevention. And unfortunately, some patients already have an ocular disease and want to help support with different lifestyle changes, nutritional changes, supplement changes, but the demand is very high on the patient side in terms of vision preservation.

Dr Neda Gioia:

And it’s becoming more of a commonplace, where these questions are being asked younger and younger, “how can I keep my eyes healthy?” And even if we went to the generic, “stick to a Mediterranean diet with good antioxidants, maybe a good foundational supplement,” if that’s all we needed to give to most of our patients, and had more of our allopathic physicians giving those recommendations, we would probably reduce a lot of health conditions just by doing that.

Dr Neda Gioia:

I think with eye care though, we tend to be seen as a specialty. You think of me as a specialist of eyes. And we see ourselves as primary care. So there’s a disconnect with vision. And I oftentimes have gotten patients, “you don’t need to know about that…you don’t need to know about my general health, my medication.” Well, listen, all of those things affect your eye health. And as eye doctors, we are poised to really give higher level primary care advice, and whole body health advice just through our ocular exams.

Dr Ruscio:

And the cocktail in this study that you’re referring to (the AREDs) was Lutein, Zeaxanthin, and Omega 3 fatty acids? And do I have the right formula here for my quick PubMed search?

Dr Neda Gioia:

So there was like two phases with the ARED study. The original one actually didn’t even have Lutein and Zeaxanthin, as funny as that sounds. It was Vitamin A, D, and it had a betacarotene kind of component. They fixed that, they boosted that, they added the Lutein and Zeaxanthin on phase two. They did have an omega3 component, which was found to not help, but that is a very controversial kind of arm to that study. But really it’s vitamin C, vitamin E, zinc, and copper. Lutein and Zeaxanthin was really the foundational pieces to that vitamin. And as I said, it’s only gotten better since 2006. It was a National Eye Institute-funded study, and I believe it was 4-5,000 participants. So yeah, again, I don’t see it as the end-all of ocular nutrition, it just really validated our conversation here. And it validated my colleagues who are really proactive in ocular nutrition research, whether it be for brain function, because remember the retina is a part of the CNS.

Dr Neda Gioia:

We’re having a lot of conversations about dementia, a lot of conversations about Alzheimer’s, and the ocular tissue is a very good target for brain health because they’re about the same. A lot of the components that pass the retinal-blood-brain barrier can also pass the brain-barrier too. So the ARED study, again, was more foundational and now we’re trying to take it to the next level. And we even have a society dedicated to ocular nutrition that [is] nonprofit and there’s a lot of high level work that’s being done, as we speak, in the sense of research and implementation into clinical care.

Dr Ruscio:

Where do you think people should start from a dietary perspective? One of the things that I think is important to acknowledge is that just getting to any diet beyond the standard American diet, where you’re not going to be eating way too much processed carbohydrates, you’ll be getting in [a] healthier intake of meat, fish, fruits, and vegetables, is probably going to be a huge step forward. And—I’m making a little bit of an assumption here but I feel like it’s probably a safe one—in that a decent subset of these people who are experiencing ocular disease, knowing the connection between diabetes and neurogenerative conditions, are probably diabetics and prediabetics. And if we just get people’s blood sugar regulated by anything beyond a crap diet, we’re probably taking a massive step forward. But yes/no on that? And where do you like to start from a dietary perspective?

Dr Neda Gioia:

So there’s a twofold dietary situation. So I think you are probably experienced and some of your listeners are probably experienced, where if they have a more or functional-medicine-centric clinic, they might be going into more invasive diets, whether it be ketogenic, whether it be SIBO type diet, etc. Now, if we’re talking about the mass population, where do we want to focus our goals? Yes, it would be your classic, time and time again, your classic Mediterranean diet with a high level of polyphenols, specific carotenoids for ocular health, would be your generic starting point for eye health. And do I think that that’s where we need to stop? No. The problem is, and everyone knows this, you can say it ’til your face is blue to your patient, but they don’t have the tools to continue that path.

Dr Neda Gioia:

So where we might stand in terms of introduction of a diet or a lifestyle plan, because we really don’t want our patients on just diets, we also need to provide tools for them to keep it going. It’s not easy to change your diet. It is not easy to just become healthy overnight. But when you hear it from your more allopathic physician, maybe they can plant a seed. Then maybe we can do some sort of collaboration with a health coach or nutritionist that would be willing to give the patient those steps to further their education on a classic Mediterranean diet and actually have some sort of success with it.

Dr Neda Gioia:

Long term, though, I have plenty of patients that eat the very well and they still have macular degeneration. Why is that? So that’s where functional medicine can come into play. So now does a Mediterranean diet work for all health conditions? No, it doesn’t. Are there food sensitivities? Is there leaky gut syndrome? Is there issues with their microbiome? Is there issues with absorption of certain carotinoids? And the answer could be yes.

Dr Neda Gioia:

So there are patients that I feel that are very good candidates for a full functional medicine type of analysis versus more of a wide-range Mediterranean nutritional protocol.

Dr Ruscio:

No, that makes complete sense. You start with the basics and then from there you look for, said loosely, what’s broken and then go to fix that. And normally when you fix something that’s in need of repair upstream, let’s say the gut as one example that I know this audience understands the importance of, you may improve absorption, systemic inflammation, and then all of a sudden you see something happen like chronic asthma improve, chronic brain fog improve, chronic insomnia improve. And something that we don’t really pay much attention to in the clinic or see much of it, is ocular disorder. So it’s cool to hear that you’re also seeing this kind of “intervene upstream and watch the downstream side effect” observation in your clinic.

Dr Neda Gioia:

And that was one of my main goals with our office. I created almost like a beta type here. What I wanted to do is really start a practice that had general eye care as its overall goal, so we’re not a unique office where we are just functional medicine. I found that what ends up happening, or slowly I’ve been seeing, is patients try A, B, C, D, and might go to functional medicine after they’ve tried A, B, C and you’re catching things a little bit later in the game. Makes things harder. With what I’m trying to really prove and show is that if we can just have our average patient walk in the door and introduce them to nutrition and lifestyle versus them seeking it, how many people can we curb earlier on that might have been coming to us later if we were just a certain niche.

Dr Neda Gioia:

And that’s where I think eye care can come be really big, where we see ocular conditions at an early stage and really help start implementing nutritional interventions, etc., at an earlier part of that cascade to really help the patient. But they might not be seeking it. That was the whole point is that the patient is not necessarily seeking this advice, but didn’t even know it existed. And the outcome in a very short amount of time…I mean, I’ve been in practice for 16 years—general optometry, worked in three states, different clinical studies—and when I went through my functional medicine awakening for my personal health reasons (and that’s usually one of the reasons why docs end up in the functional medicine world) I said I could either just focus on nutrition, but how many people will I not be able to really help? And it’s a lot. And when I opened this practice up, it was six months before the shutdown.

Dr Neda Gioia:

So I set myself up for pretty much a disastrous cold-start practice from zero. Very challenging times. And we survived very well. And now I have patients reaching out to me from other states within a less than three year outcome. It’s remarkable. So again, right now we’re still at our early phase, but just setting the tone of this practice model that we, I hope, can really replicate in other offices or help other docs replicate nationally is very exciting to me.

Dr Ruscio:

Yeah, that’s super exciting.

Dr Neda Gioia:

Yes. Because why not? And a lot of people are like, “why would you do this?” I’m like, “why wouldn’t I do it?” I can give core eyecare. I’ve been doing this for a long time. But how many people ask me about a vitamin or a food? And if I don’t know the answer, I’m not going to say, “no, it’s not good for you,” or, “I don’t know, look it up.” I would like to give them sound advice because they’re not getting it anywhere else.

Dr Ruscio:

Right? No, this is a great point. And especially if, gosh, I’m assuming anyone and everyone, of course would much rather prevent an eye disease upstream than have to be corrective in nature. And pointing out just some simple, perhaps early indicators that they’re moving in the wrong direction, or just simple things they could do to be proactive. At least put someone in the position and to have the knowledge, and then they choose what they want to do with it. But, yeah, to your point, I think it’s really helpful of course, again, to be as proactive and preventative as possible.

Dr Ruscio:

And one of the things here with diet, I’m wondering, are you an advocate for the eating from the rainbow? Because I’m assuming this is how one could have a decent insurance policy that they’re getting a broad swath of antioxidants and polyphenols. Or is there a short list that you think people should be equipped with? Because that’s probably the majority of our audience are probably fairly dialed in with their diet, doing something like Mediterranean, paleo, keto, low FODMAP, maybe hopefully reintroducing some FODMAPs, if they’re starting there, focusing to some extent on nutrient density. So I would say this is like the varsity-level diet crowd. What else would you want people to know and incorporate into their diets?

Dr Neda Gioia:

So omega 3 fatty acids are underutilized in eye care in the sense of the patient side. We really support omega3. And the problem becomes right now the whole fish-oil-versus-flax-seed. ALA-based omegas is always a hot topic with patients because it’s not the same. But the DHA-specific in omega 3s is really, really well received, not only in the retina, but also for the ocular surface for dry eye disease. Omega 3s are also underutilized in terms of testing. Omega 3 is used allopathically—very, very much so in eye care. What I see is, patients, the target numbers. So we can go along the side of biohackers out there and optimizing your numbers, etc. What we don’t see serum testing or any type of testing in the omega 3 balance from general blood work. You might be lucky. You’re going to get your vitamin D status. Omegas are lacking with testing and we can test the RBC and see what your omega 3 value to [omega] 6 ratios are.

Dr Neda Gioia:

And that, I think, is a really nice target for eye health. As well as, I mean, you mentioned eating the rainbow. I mean, I think we’re learning that a lot more now in the general population where you want to eat the colors of the rainbow. Lutein, Zeaxanthin are carotenoid-specific in the green leafy vegetable family. So your kales, your spinaches, collard greens, yellow of a yolk even has really good amounts of Lutein, your bell pepper family, Resveratrol (which is another polyphenol) very good for eyes.

Dr Neda Gioia:

But I would say those are like the highest targets. I think what we also don’t understand is supplementation, which I’m sure your audience takes some supplements. I find that supplements that really have a super high level of betacarotene, which sometimes you find it as that vitamin A component, can conflict with Lutein and Zeaxanthin absorption, which not too many people talk about this. So you see supplements all the time with betacarotene. Betacarotene all over the place. And not that betacarotene is bad, but when we’re trying to supplement Lutein and Zeaxanthin in a patient, perhaps with early macular degeneration or they have poor serum levels of Lutein or have poor dark adaptability (which can be measured through the retina with a very simple light) or have a low pigment density in their eye (which also can be measured non-invasively), if you start really boosting the betacarotene or not paying attention to what they’re taking, that Lutein and Zeaxanthin actually doesn’t work as well.

Dr Neda Gioia:

So little things like that, but I would say the top is really your omegas, the polyphenols. Obviously Lutein and Zeaxanthin [are] being underused, under talked about, especially now with all of the conversations that we have about blue light and blue light mitigation. We talk about blue light glasses left and right. And you get ads everywhere. And we don’t actually talk about what carotenoids neutralize. Blue light can increase your oxidative stress in your macular zone. Now, we’re not talking about natural blue light that we get from the sun and your circadian rhythm and all those things that we want, but we’re talking about excessive artificial blue light.

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Dr Ruscio:

And is there a certain supplement formula, if someone was looking to add a broad spectrum eye-support to their supplement protocol, is there a certain formula that you like?

Dr Neda Gioia:

So there’s so many eye vitamins out there. I don’t like to be specific, but I do like a specific one by Jarrow, which is the blue-light-blocking formulation. That’s more of a maintenance of Lutein and Zeaxanthin. I would say for your average folk, it’s fine. In terms of multi…I like multivitamins that really hit all those marks, which EyePromise has a great multi eye formulation, that I use quite frequently for patients who really don’t want to go too detailed, as great eye support. But I would say those are the two.

Dr Ruscio:

Okay, great. Great. And what else? As we’re coming up on a close, anything else that you think is worth mention?

Dr Neda Gioia:

I think what’s really important here is we should start talking to our, or treating, our eye care providers as a part of the team. I think we have a lot more education than you would think in the natural or holistic space then a lot of other subspecialties. And to also really see eye care as whole body care, because there’s a lot of things that we can detect from a routine eye exam that really can show us how your overall health is.

Dr Ruscio:

Yeah. And I guess, like you were alluding to earlier, this could be a window into one’s overall neurological health, which, I mean, if you don’t care about your eyes, what about your brain? Kind of function from the same system.

Dr Neda Gioia:

Yes. There’s biomarkers being tested for early Alzheimer’s in the retina right now. So, yes, I would say that eye care is in a Renaissance right now. We are in a Renaissance. And there’s so much coming out. And I’m excited to be a part of this shift. And really giving ocular nutrition and functional medicine a highlight into practices fulfilled a lot of my goals.

Dr Ruscio:

Yeah. Well, I’m glad to see that you’re doing what you’re doing. And I’m sure that our audience will be interested by this. There’s almost for certain a subset who have this on their radar screens or do now. And now we have a good referral for people to get a good kind of holistic eye checkup. And by holistic, I mean whole body, because we’ve discussed the interconnectivity between all these systems. Is there a clinic website or anywhere else you’d want to refer people online if they wanted to hear more from you?

Dr Neda Gioia:

Absolutely. So my practice name is Integrative Vision. Our website is great, integrativevision.com. I also am a part of the Ocular Wellness and Nutrition Society; I sit on the board for them. So, we always feature some great new articles and studies. So Ocular Wellness and Nutrition Society is another website. And you could find us on Instagram @integrativevision, Facebook, all of the good stuff. But those would be the few points that I’d like to highlight.

Dr Ruscio:

Great. Well, this has been a nice refresher for me and has opened my eyes (and no pun intended there) to some of the importance of these facets. And again, I’m glad that you’re doing what you’re doing so that people can take care of their sight. Like you said, that would be (if I was hard pressed) I would give up smell or taste before, or touch probably, before sight. That would be the last one I’d want to lose. So you make a very, very compelling argument there. And again, [I] just really appreciate what you’re doing and taking the time to have a chat with us today.

Dr Neda Gioia:

Thank you so much for having me. And I’m excited to help out the audience and hopefully give them a little bit of some insight in this.

Dr Ruscio:

Absolutely. Thank you again.

Dr Neda Gioia:

Thank you.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DRRUSCIO.com.

 


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