미등록시력 손실의 주요 원인 ‘황반변성'...예방법과 도움되는 음식은? [바이탈사인]

You don't need to be nearing your twilight years for the term macular degeneration to set your nerves on edge. Sometimes it's the secondhand torment of witnessing an older loved one's vision loss, like a father or grandmother, that instills in one premonition of their own vision failure. And the fear is not entirely unfounded. It's estimated that by 2040, 288 million Americans will have macular degeneration. It's currently the leading cause of vision loss for those 60 years and older. With that said, macular degeneration, alongside other hallmark maladies of aging eyes, like cataracts and glaucoma, can be prevented. And if they're already manifesting, in some cases, they can be curbed, if they're seen too early enough. And most intriguingly, it needn't be by way of drugs or surgical intervention. Simply eye nutrients, optimized diet and lifestyle, can resoundingly sustain eye health. And this forms a key dimension to eye doctor Rani Banik's practice. She combines her extensive neuro-ophthalmological knowledge of the eye and brain with holistic medicine, including nutrition, to prevent and treat eye disease, from its manifesting symptoms to its root cause. Welcome to Vital Signs, where we learn how to get healthy from all angles, from the biochemical and nutritional to the things we do that nourish our minds and our souls. I'm Brendan Fallon. Dr. Banik, it's fantastic to have you back on Vital Signs. Thank you so much for inviting me. On this topic of macular degeneration and looking at eye aging, eye damage in general, I know that the sun's UV rays can be a factor in eye damage. Is that specifically implicated in macular degeneration? And in terms of protecting the eyes from this kind of damage, are sunglasses really effective? What kind should people be using? That's a great question and so important, because we all love to be outdoors, but we need to be cautious when we are, especially on bright summer days or if we're out on the water with a lot of glare or out in the snow. The sun emits various wavelengths of light and UV rays are the most common. So there's three types of UV rays. There's UVA, UVB, UVC. Now UVC mostly gets filtered out by our atmosphere, so we don't have to worry about UVC. But both UVA and UVB rays can penetrate through the atmosphere and they can actually penetrate through the eyes. And so UVB, a lot of it gets filtered out by the cornea and the lens. Some of it, only some of it gets to the retina, but UVA does get into the retina. And these rays are very powerful. They're short wavelength rays and they can cause a lot of oxidative damage and oxidative stress. And so I describe this to my patients as kind of like biological rusting. If the eye is exposed to too many elements, too many factors, for example, photo-oxidative stress from these UV rays, then there can be some biological rusting happening. And then that can lead to a cascade of events that can lead to certain ocular issues. So we know that too much UV exposure is associated with burns on the surface of the eye. It can be associated with growths on the surface of the eye, whether they're benign or malignant. UV exposure can be associated with cataracts. And in terms of macular degeneration, what your grandmother unfortunately suffered from, the jury is really out on that. Initially, it was thought that, yes, too much UV exposure is directly linked to macular degeneration, but subsequent large population studies have not necessarily played that out. So I think it's still inconclusive, but it's important to still protect the rest of the eye from UV rays. So we should still be cognizant of that. And I always recommend to my patients to wear, especially on bright, sunny days, between the hours of 10 a.m. to 2 p.m., to wear 100% UV-blocking sunglasses. And that basically means it's blocking out 100% of UVA and UVB rays. So you have to look for a sticker on the sunglasses that says that. The other alternative the sticker may say is UV400, and that's equivalent. It basically means that those lenses can filter out rays that are 400 nanometers or less, so basically UV rays. The other tip I wanted to provide the audience here is that it doesn't matter how expensive the sunglasses are. You can buy a $10 pair of sunglasses, or you can buy a $300 pair of sunglasses. As long as it has the sticker that says 100% UV-blocking, it's doing the job. So the price doesn't really play a factor here. It's the nature of the tint in the sunglasses. The other things that many people worry about is the effect of, again, with using excessive screen use, that blue light could be posing a damage to their eyes. Is this something that people should be concerned about? Can this lead to macular degeneration? Well, the good news is no, at least not as far as we know. And the truth is if blue light from our screens really did lead to macular degeneration, we would be having an explosion of macular degeneration. It would be a pandemic-level explosion of macular degeneration because of all the time that we all spend on our screens. So retinal cells have natural protective properties against blue light and also UV light. So the good news is there are pigments in these cells that help to absorb and neutralize these potentially harmful wavelengths of light. Now, these pigments, they have fancy names. They're called lutein and zeaxanthin and mesozeaxanthin. They're really long. They're hard to remember. But I like to call them, in my mind, they're like vitamins for the eyes. So vitamins L, vitamins Z, and vitamins M. Even though officially they're not vitamins, I call them eye vitamins. But these pigments, we can get them from foods and we can get them from nutrients. Our bodies can't make the pigments, so we need to get them externally. When we eat these pigments, when we ingest foods that are high in these pigments, they get selectively deposited into the retina in the back of the eye and then help to protect us against blue light and UV light. So it's amazing how we've evolved in this way. Our eyes have evolved in this way to have natural shields, almost like internal sunglasses and internal blue blockers in our eyes to protect against our lifestyles. The fact that they're called pigments, is they have a specific color? They do, yes. I should expand on that. They're not just pigments. These are nutrients called carotenoids and they are cousins to like vitamin A, beta carotene, other types of carotenoids in nature. I'm aware that you have a book out called Beyond Carrots, Best Foods for Eye Health, A to Z. We'll leave the link to that book in the description for viewers to check out. And I feel like you're taking us into that realm here, beyond carrots, beyond what you just get from eating a carrot for eye health. Exactly. Everyone thinks of eye nutrition as eating a few carrots and your eyes will be fine, you'll have 20-20, but carrots are really the tip of the iceberg when it comes to nutrition. And carrots do have a lot of great nutrients. They have a lot of beta carotene, which is important for eye health. Beta carotene gets converted into vitamin A, which is important to protect against night blindness and also dry eye. But these specific nutrients, again, these cousins to beta carotene, they're called the macular carotenoids because, again, they get selectively deposited into the macula in the back of the eye. And actually, I'll pull out my eye model here to give a short demonstration. So you can see that the eye, when we look at someone's eye, we basically just see the very front part. We see the white of the eye, we see the cornea, and then the iris, which is the colored part. But if I open this up here, you'll see that there is a lot, there are many other structures inside of the eye that make up the eye. So what we're seeing in the very front is just kind of the very surface. There's a lot happening here. And I'll just show you, point out a few important structures here. So the very surface here, the curved, clear surface, this is the cornea. It's dome shaped. And this is what gets dried out in dry eye, the cornea. Behind that is the iris, which is the colored part of the eye. Whether you have brown eyes or blue eyes or green eyes or hazel eyes, this is because of the iris pigment. Next, we have the lens, which is a curved structure that sits behind the iris and helps to change its shape to help us focus. So it's dynamic. It can help us focus at distance or intermediate distances or up close. It's constantly changing shape, the natural lens. Behind that is a gel-like structure, which I removed. But this is the gel-like structure that sits here to help keep the shape of the eye. This is the vitreous. And then in the very back of the eye, what's represented here in orange is the retina. And this is the light-sensing tissue in the back of the eye. These are the blood vessels that supply the retina. This yellow spot here, I don't know if the color's coming out on the camera, but this is where the macular carotenoids are deposited. And this is called the macula lutea. And lutea means yellow. It comes from lutein. So the reason why this spot in the back of the eye is yellow is because of this concentration of these pigments that come from our foods, the macular carotenoids that get deposited right here. So the light comes in through the front of the eye. It gets directed towards here. This spot right here in the macula is responsible for our highest resolution vision. So the macula is responsible for our 20-20 vision. What is the best way to get these nutrients? What decides that they go to the right place in the body? How do you recommend people get these nutrients for their eyes? Yeah, so I'm not exactly sure how the body knows to pick these up and deposit them right in the middle of the macula. We do know that these carotenoids are fat-soluble, so they are best absorbed with fats. So if you want to improve their absorption, first of all, the foods that are highest in these nutrients, I do list a whole range of foods in my book beyond carrots. But in terms of these macular carotenoids, the foods that are richest in them are the leafy greens. So spinach, kale, collard greens, dandelion greens, any type of green, arugula, romaine lettuce, these are all very rich in the macular carotenoids. And also foods that are yellow and orange. So think about yellow and orange, the colors. So for example, egg yolk. The beautiful orange-yellow color of egg yolk is actually from lutein and zeaxanthin in the egg yolk. Does it matter how the egg is prepared? Will that influence the nutrient value? So I actually don't know whether that's actually been researched. But again, if you have your egg maybe with a little bit of fat to help the absorption, that's probably best. Whether you cook it in some oil or some ghee or some butter, that would probably help to absorb the lutein and the zeaxanthin. Other yellow and orange foods, like for example, corn. And this is another interesting, fun fact. The scientific name for corn is zeamays. So Z-E-A-M-A-Y-S. Zeaxanthin gets its name from zeamays because corn is so high in zeaxanthin. Also, there are some fruits that are very rich in lutein and zeaxanthin. For example, some of the common summer fruits, such as peaches, nectarines, mango, bright yellow-orange foods, fruits are very rich in these ocular pigments. It seems almost too simple. You have this yellow anatomical region in your eye and you find the bright foods that will match that region. And they go there and they work as a natural protectant against UV rays. Exactly. The body's really evolved in amazing ways to protect itself. I do want to add one other food that I neglected to mention earlier. Yellow and orange bell peppers are very, very high in these nutrients. Many people think bell peppers immediately turn to green or red, but I would suggest seeking out the yellow and orange varieties. Speaking of nutrients for eye health, I'm aware that there are these AREDS studies that are quite well known. The result of these studies was to suggest specific nutrients for preventing macular degeneration. Where do you stand on those vitamins that are recommended by those studies? AREDS stands for the Age-Related Eye Disease Study. There were actually two of them, two of these studies done in the United States. The AREDS studies were conducted in the 1990s and early 2000s, and they included over 4,000 individuals with various stages of macular degeneration. In the studies, the participants were given the supplement or placebo. The supplement was the first AREDS study, had vitamins A, C, and E, copper, and zinc. Those were the main ingredients. Then in AREDS 2, they swapped out the vitamin A for lutein and zeaxanthin. They also still had copper, zinc, vitamin C, and E. These were the ingredients that were studied as part of AREDS. Now, what the study found was that people who took the AREDS, if they had a very specific form of macular degeneration called intermediate-stage macular degeneration, those people benefited. Those people with intermediate macular degeneration had a 25% decreased risk of progressing to late-stage macular degeneration. There was a benefit there, but there was a limited benefit, not as high as what we would have liked to see. Both ophthalmologists and patients alike were a little bit disappointed with the numbers, that they weren't more robust. My thought on the AREDS is that it's not just those six nutrients that we need to include in our diets to protect our vision, to support our eyes and our retinal health. There's a whole variety of nutrients we need. In my book, I talk about the 30 or so nutrients that are important for eye health. It may seem overwhelming like, oh my goodness, I can't even remember three, lutein, zeaxanthin, and mesozeaxanthin. How am I going to remember all 30? You don't have to remember all 30, but if you have a varied diet, a diverse diet that is plant-rich, you don't have to be plant-based, you don't have to be vegan or vegetarian, but make plants or colorful plants a staple in your diet, and you will automatically get the majority of these 30 nutrients in your diet. Rotate through a lot of the foods that I talk about in the book. I actually share about 40 different foods that are helpful for eye health. If you rotate through these foods, you should be able to get the full complement of these 30 plus nutrients. That's my thought. Don't just take the AREDS. You have to really support your eyes through diet. Lifestyle is important as well. We know that people who smoke have more than a double chance of developing advanced stages of macular degeneration. We know that people who are exposed to air pollution have higher risk for macular degeneration. People who are overweight, who are sedentary, they have higher risks as well. If you think about all of these potential lifestyle factors together with diet, then we can best support and protect our eyes against macular degeneration. I'm going to be talking about all of these topics actually in my next book, which should be coming out in late 2024. That's going to be called Beyond Leafy Greens, 7 Integrative Strategies to Protect Against Macular Degeneration. I hope you're enjoying Vital Signs. I invite you to share this video with someone you know who may benefit from the insights on safeguarding against macular degeneration and for better eye health in general. Also, find Vital Signs online to leave a comment by going to epochtv.com. Just click on the Lifestyles tab and scroll down to Vital Signs. Another question I have, and I don't know whether this is kind of an urban legend, but I've heard this idea that you should make your plate as colorful as possible with the vegetables that you choose to eat to get the maximum nutrient benefit. Is this something that is congruent to eye health as well? Absolutely. The color in foods is indicative of all the nutrients that that food has to offer, the various different vitamins and also nutrients that we call bioflavonoids. These are nutrients that come from plants. They protect plants against disease and oxidative stress. When we ingest these colorful plants with bioflavonoids, our bodies and our eyes can benefit as well. The more color, the better. I like to tell my patients this quick tip is strive for the rule of 21. Basically, most people eat three meals a day, seven days a week, so that's 21 meals in a week. With each meal, try to include a different colored food. Various different shades, not just the same green every single day, but have various different shades of greens, various different shades of reds, and oranges, and yellows, and purples, and even blacks and blues. Try to have that whole spectrum. Eat the rainbow, basically, in your diet using the rule of 21. You can even make this a fun activity. As part of the family, you can have a little challenge. Who can eat the most colors in the week? I'll try to get to 21 colors or more during the course of the week. That way, you don't have to think about and count the nutrients, and count this, and count that. Just count the colors and you'll probably get what you need by doing that. Could you provide an example of someone, perhaps a patient, that you've seen where they are experiencing macular degeneration and what kind of results came from taking this holistic approach or perhaps combining that with conventional medicine? Absolutely. The patient who first comes to mind is a patient I've been seeing for about seven or eight years now. His name is Bob. He initially came to me because both of his parents actually had macular degeneration. Both of his parents suffered significant vision loss and were legally blind. He'd been to his eye doctor and been diagnosed with initially early-stage macular degeneration that had then progressed to intermediate-stage macular degeneration. He was at very, very high risk because genetics plus his lifestyle put him at very high risk for developing vision loss from AMD. Now, in terms of his lifestyle, he was overweight. He was not exercising. He was very sedentary in his job. He also had a sad diet, like what I had mentioned earlier, a standard American diet, which is high in unhealthy omega-6 fats, usually saturated fats, also high in refined sugars and high in processed food. His diet and his lifestyle were not really supporting him in his prevention against macular degeneration. I put him on something I developed called the MAD diet, the macular degeneration diet, so M-A-D-D. I'll be talking about that in my new book as well. But the MAD diet, which is really a form of the Mediterranean diet, but a very highly specialized form of the Mediterranean diet to really get enough of those I-nutrients in and in high quantities. I slowly switched, and this was not an easy process for him because his lifestyle had been like this for years and actually decades before he came to see me. I had to very slowly switch him out of his habits, get him off of some of those foods that he was eating as a habit and get him into the MAD diet. Also, I got him exercising a little bit. He was walking. He was swimming. By the way, I didn't mention this. He was also still smoking. His doctor hadn't even mentioned anything to him about that, that he should consider quitting smoking for his macular degeneration, but he was able to do all those things. It wasn't overnight, but I would say in about six months or so, he had, first of all, his vision was stable. He had not progressed in his macular degeneration, which is all very positive, but also he had a lot of other benefits to making these dietary and lifestyle changes. He was actually able to lose about 30 pounds in six months. He was able to get off of his blood pressure medications, and he was also able to reduce. He was also taking a medication for diabetes and reduced the dose of that medication as well. He had many positive health outcomes by following a vision plan. Even though it was really designed to help him with his macular degeneration, it not only helped him with his vision, it helped him in so many other ways as well. He feels very healthy. He has a lot of energy now. He never really had much energy before to do all these things. Remarkably, his vision, even though he has intermediate stage macular degeneration, his vision remains 20-20 in both eyes, even though he has that stage of macular degeneration. He's one of my star patients who's been able to follow the recommendations and yield the benefits. A very wonderful, very hopeful treatment outcome. Just lastly, in terms of someone who is aging, is it really possible for them to regain their eye health? With something like macular degeneration, is it possible for it to be stopped? Absolutely. It depends on what stage it's at. If someone has come to me and they've already experienced vision loss from advanced stage macular degeneration, unfortunately, once that vision loss has developed, we cannot reverse it. The goal here is to diagnose it early and arrest it from progressing. That's really the goal. In many patients, I've been able to help them maintain what they have. In some patients with maybe perhaps other types of conditions, they have been able to reverse their vision loss and turn things around. But when we're talking specifically about macular degeneration, unfortunately, I don't want to give anyone any false hope that if you have an advanced stage that you can follow this diet and this lifestyle plan and you'll get back your 2020 vision. That unfortunately cannot happen once macular degeneration does. There's a lot of scarring that happens in macular degeneration. Once that scar tissue is set in, at this point, there's no way to reverse that. Maybe there will be some treatment in the near future in the next five to 10 years. But we know these lifestyle nutrition strategies are really aimed at people who are in the earlier stages. So early macular degeneration, intermediate, or perhaps you haven't even been diagnosed, but perhaps you have a family member or multiple family members who have macular degeneration. You know that you carry the risk because of your genetics. This is what this type of approach is. These types of patients are whom this type of approach works best for. Apart from the genetic factor, what other signs might clue someone into the fact that they might be developing macular degeneration? So there are some symptoms that can happen. Usually difficulty seeing in dimmer lighting, for example, driving, having issues with night driving, loss of contrast can happen. Difficulty reading in dimmer conditions can be potentially an early sign of macular degeneration. And another sign is a waviness or distortion in one's vision. So if you're trying to read something, and if you see the letters looking a little bit wavy like this, then definitely please go get it checked out by an ophthalmologist and get the exam done to make sure that you're not developing macular degeneration. Because that is one of the symptoms that is very unique to macular degeneration is this distortion in vision or waviness. Like for example, if you look at a doorframe, something that should be perfectly linear and straight, if it starts to look a little bit warped or distorted, please, please, please get that checked out. Dr. Banik, thank you so much for joining us on Vital Signs again and outlining some tasty and promising treatments and ways of countering macular degeneration and other eye damage. Well, thank you so much for having me. It's been a pleasure, Brendan. And you can subscribe to access these and other news and health insights by clicking the big red button. It's been great to be with you. I'm Brendan Fallon, and this is Vital Signs.