Recently I interviewed Dr. Rani Banik, and we talked about how to approach nutrition in a way that supports eye health, the key nutrients to be aware of, why you might need an eye health supplement, natural solutions to improve eye health, the significance of gut health, eye health resources you can access. If you would prefer to listen the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am super excited to chat with today’s guest who is a return guest because we are going to be talking about how to optimize eye health. I have Dr. Rani Banik, who just released a new book called Beyond Carrots. It’s an excellent book; I have read it.
I did interview her in a previous episode, but for those who didn’t listen to that, I am going to go through her bio again. Dr. Rani Banik is America’s integrative eye doctor. She is a Board-certified ophthalmologist and fellowship trained neuroophthalmologist with additional training in integrative and functional medicine. Dr. Rani focuses on the root cause of eye diseases and uses integrative strategies for conditions such as dry eye, thyroid eye disease, macular degeneration, cataracts, glaucoma, and other autoimmune diseases of the visual spectrum. She also has a special interest in migraine with visual symptoms, multiple sclerosis, and eye stroke. Her treatments are based on nutrition, botanicals, lifestyle modification, essential oils, and supplements. Thank you for joining us again, Dr. Rani.
Dr. Rani Banik:
Thanks so much for having me back. It’s really a pleasure to be here.
It’s great to chat with you again. Really excited about the release of your book. Why did you feel the need to write your new book? This has been in the making for a few years, right?
Last year, off the record, we spoke about it. Why did you feel you had to get this book out into the world?
A few reasons. I work directly with patients. I have a brick-and-mortar private practice in New York. In that practice, I can only reach a certain number of people. I really wanted to get this information out to a broader audience, not just the people who are coming in with known eye issues, but people who may be worried about their eyes, and they really don’t know where to turn for guidance. Perhaps they are parents worried about their children’s eye health. Perhaps they’re children of older parents who are now experiencing issues, like macular degeneration or glaucoma or cataracts. They’re looking for more natural solutions. The first reason is because I wanted to reach a bigger audience.
The second reason is because a lot of my colleagues in the eye care space don’t know about nutrition. For example, going through medical school, I only had about four hours of official nutrition training. In those four hours, I remember learning about carbohydrates and proteins and fats and macronutrients, basically Vitamin C and scurvy. If you don’t have enough Vitamin C, you can develop scurvy. That was the extent of my nutrition education.
I was never taught nutrition anytime during my internship, residency, fellowship, or afterwards. It was only when I trained in functional medicine that I really began to understand the impact of nutrition. I wanted to get this information out to my colleagues, both ophthalmologists and optometrists, so that they can learn, but also, they can share this information and counsel their patients about nutrition as well.
As you know, a lot of people listening to this have Graves’, and a number of them have thyroid eye disease. The good news about this book is it’s not just targeted toward any specific eye condition. Anyone can benefit from this book. Is it safe not to say those only looking to prevent conditions like cataracts, but even those who currently have eye conditions can benefit from reading this book?
Absolutely. Doesn’t matter where you are on the spectrum of your eye health. What you can learn from this book will benefit you, whether it’s now or in the future. Some things can also be reversed in terms of eye issues using the power of nutrition. It is really applicable to anyone in their eye health journey, and also for the entire age range, from children to older adults. That’s really how I wrote it, was to be very broad and give people the foundations for what they need to include in their diet, and how to think about nutrition for eye health.
In your book, you mention the three categories of eye nutrients. Can you talk about those three categories?
I’ll preface this by saying the eye is very complex. Even though it’s a small organ, it’s about the size of a golf ball, it has over 40 different parts. Each of those different parts have certain nutritional requirements. When I categorized the three classes of nutrients, I thought about “What can go wrong in terms of the metabolism of those different eye health parts, and how can we support that?”
The three categories are mitochondrial nutrients, nutrients to support energy production and mitochondrial health because the eye is very metabolically active. Even though it’s so small, it consumes a tremendous amount of energy.
The second category is antioxidant nutrients. So many types of eye disease are linked to oxidative stress, whether it be cataracts, glaucoma, macular degeneration. All three of these eye conditions are linked to oxidative stress.
The third category of nutrients is anti-inflammatory nutrients. Many chronic types of eye diseases, there is a component of inflammation involved. Not just the autoimmune eye conditions, like thyroid eye disease or multiple sclerosis, autoimmune conditions like that, but other eye conditions also typically have some inflammatory component to them.
The three categories are mitochondria, antioxidant, and anti-inflammatory, just to repeat.
Yes. I list out all the nutrients in my books. It’s overwhelming when you first look at it because it’s not just one or two nutrients; there are over 30 nutrients we need to get in our diet to help support our eyes. In terms of those three categories, there is a lot of overlap. What you’re taking to support your mitochondrial health may also help provide antioxidant protection for your eyes. What you’re taking as an antioxidant can also sometimes overlap with the anti-inflammatory category. Yes, there are over 30 nutrients altogether, but there is a lot of overlap in terms of the benefits of these nutrients.
I’m not going to have you go over all the nutrients because they can read your book for that. Can you talk about some of the more common nutrients, starting with those that help with oxidative stress? Maybe two or three or however many you want to list.
Sure. We typically think of antioxidants as Vitamin C, Vitamin E, Vitamin A. Glutathione is the one that gets talked a lot about as well. These are all really important antioxidants for our body and also for our eyes.
Specific to the eye, there are three antioxidants that many people may not have heard of that are super important. These three are all the macular carotenoids. You may have seen them listed n a supplement, or maybe they’ve been talked about for other issues like brain health. For eye health, these three antioxidants are the most important. They have fancy names: lutein, zeaxanthin, and meso-zeaxanthin.
First of all, our body can’t make these three nutrients. We need to get them from an outside source, be it our diet or a supplement. Our body takes these antioxidants and selectively deposits them in the retina. These nutrients have a yellowish color to them. When we look in the back of the eye, we can see a yellow pigment in the retina, which are representative of these nutrients in the eye. They serve as our eye’s internal sunglasses and internal blue blockers. If you’re going to choose to focus on these antioxidant nutrients for eye health, you need to make sure that you’re getting lutein and zeaxanthin in your diet.
Meso-zeaxanthin is harder to come by from diet alone. There are some marine species that provide meso-zeaxanthin in small amounts. Most of the meso-zeaxanthin gets converted from lutein. Have enough lutein in your diet. Have enough zeaxanthin in your diet. That is the most overlooked antioxidant protection that people don’t realize.
Briefly, bringing up thyroid eye disease because oxidative stress also plays a role in that. I don’t think these nutrients are mentioned in relation to thyroid eye disease. Not to say they can’t help, but you can elaborate on that.
One of the nutrients that’s mentioned the most is selenium. Would you say selenium, which of course is a mineral, can also be beneficial for other diseases besides thyroid eye disease?
The studies haven’t been done looking specifically at selenium for those types of eye conditions. What I’ll tell you is that not only is selenium an antioxidant, but it’s actually very important for mitochondrial function. You have that overlap there. If you’re taking a good amount of selenium in your diet, having some Brazil nuts every day, or taking a supplement, that will also improve your mitochondria’s ability to produce energy. For thyroid eye disease, I recommend selenium to all my patients. There are studies to back that up in terms of the benefits there. I think it is really important.
Be careful because you can overdose on selenium. You want to be careful in terms of your dietary intake. I usually recommend no more than three or four Brazil nuts a day, maybe even just two. Be careful with your selenium intake.
I agree. You don’t want to overdo it with selenium, especially in supplement form. It’s interesting. With Brazil nuts, I haven’t heard of a Brazil nut toxicity, but I would agree that I never tell someone to eat unlimited amounts of Brazil nuts if you’re going to rely on the Brazil nuts. It also depends because every Brazil nut is different, unlike a supplement, where you know the dosage. You want to be cautious about giving too much selenium.
What are bioflavonoids? I am bringing this up because you mention them in your book. If you could talk about some of the more important ones for eye health.
Bioflavonoids come from plants. They are very potent antioxidant nutrients. The plants develop these chemical compounds to protect themselves against disease, invasive bacteria, other species. They’re a plant’s natural protective defense. If we eat plants that have bioflavonoids in them, that defense gets conferred to us also.
Bioflavonoids, there are so many out there. They have identified at least 4,000 different ones that come from different plants. The ones I would say are most important for our eyes, the ones that have been studied and shown to benefit include quercetin. You may have heard of this, especially because it’s also great for immune health. Quercetin got talked about a lot during the pandemic as a great immune-boosting supplement. Quercetin has been shown to help the retina for conditions like macular degeneration.
Resveratrol is a potent bioflavonoid. It’s been shown to help with optic nerve issues as well as retinal issues.
Then there is Epigallocatechin Gallate, which is EGCG. This comes from green tea. EGCG is a very potent bioflavonoid. It’s been shown to be helpful for optic nerve health as well as retinal health as well.
These are all plant-derived compounds. What I tell my patients is to try to include a diversity of plants in your diet to try to get a lot of these bioflavonoids into your system. It’s not that you have to be plant-based in your style of eating but be plant-rich. Have a diversity of different colors to provide you with these bioflavonoids. Not the same leafy green every day, but cycle through the different shades of greens, different shades of purples and blacks and blues and reds and yellows and oranges. You will naturally provide your body and your eyes with all of these bioflavonoids.
Another class of bioflavonoids that are really important are the anthocyanins. They are pigmented compounds, very richly found in berries. That’s another great eye health food that I recommend to my patients: Have colorful berries in your diet, and you’ll be providing your body and eyes with these powerful antioxidants. Blackberries, blueberries, even strawberries, raspberries, goji berries, all good for your eyes.
I agree. You want to do as much as you can through diet. Very important to diversify.
Leaky eye syndrome, you talk about in your book. I’m thinking a good number of people listening to this have not heard of it. Most of us have heard of leaky gut syndrome. Having a leaky brain, the disruption of the blood/brain barrier. What is leaky eye syndrome? How can this be invented and/or healed?
Leaky eye is a term that I came up with. That’s probably why you haven’t heard of it before. I introduce it in my book. As I was doing my training in functional medicine, like you learned about leaky gut and leaky brain and leaky heart and leaky skin, I was thinking, “We have leaky eye as a disease as well, but it never gets talked about.”
What is it? It’s not a single type of eye issue. It’s a category of retinal disease in which the blood vessels become damaged, and blood and protein and fluid leaks out from blood vessels into the retina, where it’s not supposed to be. Basically, it’s because there is damage to the blood vessels and inflammation that causes leaky eyes.
The prototypical leaky eye syndrome is macular degeneration. What happens in macular degeneration is that there is oxidative stress in the retina. There are waste products that develop. Those waste products trigger inflammation that leads to the leaking of blood vessels.
You may have heard of two types of macular degeneration, dry and wet. Dry is not leaky eye. When it converts into wet, that is basically leaky eye syndrome. Blood leaks out, and people can lose a tremendous amount of vision, particularly their central vision. They can have a big blind spot right in the middle of their vision where they can’t see faces or read or drive. It’s because of leaking blood, protein and fluids.
Another example of leaky eye syndrome is diabetic retinopathy. A similar process happens in diabetes, where the very small capillaries in the retina become damaged from high glucose levels. There are advanced glycation end products. Damage is caused to the blood vessels, and they start to leak, and people can lose vision. These are some examples of leaky eye syndrome. It’s not just a single type of eye issue; it’s a category of multiple eye issues due to oxidative stress and inflammation.
If someone has wet macular degeneration, then it sounds like they almost definitely have leaky eye syndrome. That’s worse than dry?
My definition is leaky eye because it’s progressed into that state where blood is leaking where it should not be leaking. It’s leaking right under the central part of our vision, which causes vision loss and blindness. It’s an interesting concept. We’ll see how my colleagues in ophthalmology and optometry respond to it.
I did think it was important to point out because in the similar vein of leaky gut, if you have damage to the lining of structures, whether it be your gut lining or blood vessel lining, then you’re going to have other compounds that leak into areas where they’re not supposed to be, which triggers inflammation.
Are there any other nutrients that you have a burning desire to talk about when it comes to eye health?
Yeah, I would say omegas are another important class of nutrients aside from the macular carotenoids. Why are omegas so important? Our retina, the light sensing tissue in the back of our eye, the majority of our retina is made out of an omega-3 called DHA. Much of the brain is made out of DHA. The highest concentrations of DHA in the body are in the brain and the eye. In the eye, we need a constant supply of this omega-3 DHA because our retinal cells are constantly churning over. There is a high turnover, a high metabolic rate. Whenever our cells capture light, they basically lose their cell membranes and have to remake them. DHA is the critical structural component of the cell membrane.
Have enough omega-3s in your diet, preferably a combination of DHA and EPA. If you’re vegan or vegetarian, you can do ALA, which is a precursor. Unfortunately, much of it does not get converted. You can take a supplement.
There is an omega-6 that’s also been shown to be beneficial for eye health. We typically think of omega-6s as the not good omegas, the proinflammatory omegas. There is a type of omega-6 called GLA, gamma-linolenic acid, which has been shown to be anti-inflammatory and can help conditions like dry eyes.
Relating it back to thyroid, if you do have thyroid eye disease, one of the most common symptoms is dry eye. Think about increasing your intake of omega-3s and perhaps take an omega-6 as a supplement for GLA to help with your dry eye.
If someone is going to take it in supplement form, like borage oil or evening primrose oil for example.
Exactly. It’s hard to get it from diet. I don’t think that many foods have a lot of GLA. Maybe small amounts in some nuts. If you’re suffering from dry eye, I would suggest taking a supplement.
Now, there are great combination supplements that you can take, where it’s a combination of omega-3 and 6, and sometimes even 7 and 9 can also be beneficial. Always check with your doctor first before you decide to take a supplement.
Getting back to omega-3s, if someone is eating fish once a week, do you think—everybody of course is different, —but in that case, would you say that should be sufficient for enough EPA and DHA? Or is it not sufficient, and you should take a supplement? Do you recommend a fatty acid profile to see if they’re deficient?
I’ll reference the Women’s Health Initiative, which looked at thousands of women and their incidence of dry eye. What the study found was that the women who had regular fish intake of 2-3 times a week had much lower frequency of their dry eye symptoms. 2-3 times a week is the overall recommendation that we make for conditions like dry eye as well as macular degeneration.
Similar to dry eye, other studies have shown that people who have higher fish intake per week have less prevalence of macular degeneration as well. You can benefit multiple things in terms of your eye health.
I would be cautious: if you’re eating fish a couple times a week, make sure that it’s wild caught, and it has a low mercury profile. You have to be cautious with that because you don’t want to have high mercury fish and have mercury toxicity.
Let’s say you don’t know if you’re getting enough omegas. What should you do? Should you supplement? You can do an omega quant test. It’s basically a dried spot blood test that will tell you what your omega profile is. You can adjust your dietary intake or supplement intake based off of that omega quant test. It’s very easy to do.
I’m familiar with that test and have done it myself. I find it to be helpful.
Going back to the omega-6, not all omega-6s are harmful. We need omega-6 in our body. It’s the ratio that you’re looking for. If you have a really high intake of 6 and very little 3, that’s going to push your body into a proinflammatory state. If you have a higher level of 3 more equal to the 6, that will be a better balance for your body. Try to strive for that balance. You don’t want to completely eliminate omega-6, so try to get that balance.
Getting back to thyroid eye disease, we spoke about selenium. Are there any other nutrients you find to be beneficial? Omegas can benefit overall eye health, but anything else?
There are a couple of other nutrients to think about and maybe test for and see if you’re deficient and supplement if you need to. Vitamin D is the one that I have noticed most in my thyroid patients, both hyperthyroid and hypothyroid. I’ve found that Vitamin D levels tend to be very low, and I always test for it because I would like to know where my patients are, to see if I do need to prescribe them a supplement, which one I should prescribe.
The normal range that is reported in labs will be somewhere between 30-50. I would say that if you’re on the low end, you want to boost your Vitamin D level. Vitamin D is not just a vitamin; it functions like a hormone. It’s important for so many processes in the body, including thyroid health. It’s also anti-inflammatory. You want to boost those levels. Try to get them into the 50-70 range. I wouldn’t go above 70 because it may cause other issues. 50-70 is what I tend to target my patients for.
You want to eat foods that are fortified with Vitamin D. Perhaps take a Vitamin D supplement. In my book, I talk about all the different sources of some of these nutrients. Something a lot of people don’t realize is that mushrooms are a great source of Vitamin D. If you enjoy mushrooms, they have other health benefits as well, like anti-cancer properties. You can also help boost your Vitamin D through them.
Another nutrient I would say is really important is iron. You want to get your iron levels checked. If your iron levels are low, consider eating more foods rich in iron but also perhaps taking a supplement. We do need iron in the process of thyroid hormone formation and overall thyroid health.
Kind of like selenium. You don’t want to be too low or too high. You don’t want iron overload. I recommend testing or doing an iron panel. Some medical doctors rely on just a CBC, complete blood count. Others will just look at ferritin. I do recommend looking at serum iron, ferritin, iron saturation, total iron binding capacity.
Absolutely. Get the full panel. If you are low and decide to increase your intake of foods that are iron-rich or take a supplement, maybe get it rechecked in six months. That will guide you. Should you continue with what you’re doing? Should you adjust? Definitely don’t do it once. Do it again.
You really have to advocate. I have come across the same issue, where a lot of doctors, even if it’s for thyroid, will check a TSH and say, “Oh, everything’s fine.” You need to go beyond that. To pick up a lot of these conditions, even if they’re subclinical, you need to do the full thyroid panel, including the auto antibodies. If your doctor is a little bit hesitant or resistant to order it, really advocate for yourself. Try to get these labs done.
Definitely agree with you on that.
Eye health supplements. There are a lot of them out there these days. I know you’re encouraging people to try to get the nutrients you can through food and not rely on supplementation. When should people consider taking a supplement for eye health? Or should they? Maybe you don’t think they should. Maybe they should just rely on food or take individual nutrients like resveratrol or some of the other ones you mentioned.
If we lived in a perfect world, I wish I could say you don’t have to take an eye health supplement. Unfortunately, we don’t live in a perfect world. Studies have shown that even people on the healthiest of diets are simply not getting enough of these really important eye health nutrients.
I was talking about macular carotenoids like lutein. It’s estimated that we need about 6.5mg of lutein a day. Unfortunately, most adults probably only get 1-2mg a day. Many of us are deficient in these key nutrients. Our macular carotenoid levels decrease as we get older, so it’s even more important to supplement when you get into mid-adulthood and later adulthood to prevent conditions like macular degeneration. I strongly believe it is important to supplement, even if you think you’re eating enough.
The other reason to supplement, and you may be aware of this, Dr. Eric, is our soil is not as nutrient-rich as it used to be. There are studies comparing soil samples from the 1930s or 1940s to more recent years, like 1990s/2000s. Our nutrient levels have significantly been depleted because of agricultural practices, tilling, fertilizer use. Let’s take magnesium or Vitamin C levels. Back in the 1930s/’40s/’50s, the levels used to be much higher than what those levels are in today’s soil. This means that our food is also depleted in these micronutrients. That’s another reason why I think we should supplement.
I’m glad you brought this up because I’m doing a webinar on eye health supplements later today, breaking down the science behind supplementation and what to look for in your ingredients for an eye health supplement. There are so many brands on the market. If anyone is interested, you can watch the video on YouTube at a later date.
In terms of getting a complete supplement, I actually recommend taking a multivitamin that has all the regular components of a multivitamin, like B vitamins, C, E, D; minerals like magnesium, selenium, iron, manganese, etc. Also, look at the label and make sure that in your multi, there is the bioflavonoids. Not all multis will have them. Look for them. Then you know you’re getting quercetin, resveratrol, and other potent antioxidant nutrients through your multi.
Then consider taking a separate eye health supplement that has macular carotenoids.
There is another carotenoid that we didn’t talk about, astaxanthin. That is gaining a lot of recognition recently because astaxanthin is considered the king of all antioxidants. It comes from this red algae. Astaxanthin is red as well. It has been shown to help promote skin health, brain health, and also eye health. In your eye health nutrient, if you are taking one, look for the macular carotenoids like lutein, zeaxanthin, and meso-zeaxanthin, but also look for astaxanthin.
There are some other things you can look for as well. For example, there is a form of Vitamin E. Most Vitamin E is tocopherol, but there is a specific form called tocotrienol, which is considered to be more potent in terms of its antioxidant capability. If you are getting an eye health supplement, find one that has that tocotrienol formulation that is really potent and anti-inflammatory.
Just to summarize: You recommend pretty much everyone to eat a whole healthy diet, and to take a multivitamin with bioflavonoids and a separate eye supplement with the ingredients you just mentioned.
Yes. Also, because we spend so much time on screens, our retinas get a lot of light toxicity from them, a lot of blue light exposure. It’s even more important to supplement with these macular carotenoids.
I even tell parents of my pediatric patients to try to increase your child’s intake of some of these foods with carotenoids, but maybe consider giving them an eye health supplement that has lutein, zeaxanthin, and meso-zeaxanthin. These have been shown to reduce eye strain, digital eye strain, light sensitivity, and help with dry eye.
You have to think about it in the context of what we’re doing in today’s age. Most of us spend the majority of our day in front of the screen, so you want to be proactive and protect your eyes from any potential adverse effects of screen time. Multiple benefits there, long-term as well as short-term.
I’m glad you mentioned that. One of the questions I meant to ask you also is sunlight. How important is it getting sunlight, not just for Vitamin D, but also for eye health? Obviously, you don’t want to stare into the sun, but getting some of those outside rays.
It is important especially in the early morning. It helps set our Circadian rhythms, and our eyes are directly connected to our pineal gland, which is the modulator of our Circadian clock. It is important to get early morning sun exposure.
As you mentioned, please don’t look directly at the sun. I know some people practice sungazing, which is not the best thing to do with your eyes open. Do that with your eyes closed. Those UV rays from the sun can do a lot of damage to the retina and even cause burns in the retina, so you need to be very careful about that.
Early morning sun. I would say between 8am-10am is probably best to help set your Circadian clock. Not directly staring at the sun, that’s not a great idea.
If you’re wearing glasses like I do, do you want to take them off? Not to stare into the sun, but is it important to take off your glasses while doing sun exposure?
I would say yes. Some people have tints in their glasses that may block out- Say you have a blue-blocking tint on your glasses. You want to expose your eyes to natural sunlight as our ancestors did for hundreds of thousands of years. That’s probably the best thing to do.
As you mentioned, there are great benefits to Vitamin D production as well. As well as mood. There are plenty of studies that show that people who get regular sun exposure have better regular mood profiles and less risk for depression or seasonal depression if you are getting that morning sunshine.
Can you talk about some of your favorite therapeutic foods for eye health? I know you mention a bunch in your book.
If I had to talk about categories of foods that provide multiple nutrients, the first category would be the leafy greens category. Foods like spinach, kale, collard greens, dandelion greens. These provide high levels of lutein and zeaxanthin. They also provide Vitamin A and C and some minerals and iron. Great source of multiple nutrients.
I know some people are concerned about oxalates if they are having leafy greens. Especially if you have thyroid issues, you don’t want to have too many oxalates in your system. If you’re concerned about oxalates, if you have any symptoms possibly of high oxalate content, and your concentrations in your blood, get your urine tested. That will tell you if you truly have hyperoxaluria, which is the medical term for too many oxalates in your system. Test to make sure that’s what the issue is, and it’s not something else.
Another therapeutic category of foods would be berries, which I talked about earlier. I typically recommend to my patients to have half a cup to one cup of berries a day. Try to rotate through those berries, different colors. You can have them raw or in a smoothie. There is lots of different ways to enjoy berries.
The third category of food I would recommend are spices. We haven’t talked about this yet. Curcumin, which is the active ingredient in turmeric, the yellow spice, is very anti-inflammatory. It’s very potent. It’s been shown in numerous studies to help with autoimmune conditions, like rheumatoid arthritis. There is some very early work with thyroid that is very beneficial. Try to include spices in your diet because it will help your overall health, any inflammatory conditions, and promote your eye health.
Curcumin has been shown to help with conditions like dry eye and inflammation inside the eye, which is called uveitis, and optic nerve function. Lots of great benefits there.
Along with curcumin, you may also want to include paprika, which is a great source of lutein and zeaxanthin.
If you can, you may even want to include some saffron because it’s also been shown to promote macular health. Saffron can get expensive as a spice. If you have a little bit, sprinkle it on a smoothie or in a soup. It adds a lot of flavor as well, so it’s a great addition to your kitchen.
You mentioned oxalates briefly. Is there any concern with oxalates having harmful effects on the eye, including thyroid eye disease patients?
I haven’t seen a major issue. Everyone can have a reaction on an individual basis. I do know that particularly patients who have autoimmune thyroid issues, there is a study that shows that when they have biopsied the thyroid, they’ve found oxalate crystals in the thyroid in individuals with inflammatory autoimmune thyroid conditions.
In terms of whether it shows up in the eye, not that I’m aware of. It can show up in the cornea in primary hyperoxaluria, which is more of a genetic issue rather than a dietary issue. You can see oxalate crystals in the cornea in that condition. It’s very rare to have a genetic condition related to oxalate toxicity. If you think that’s an acquired condition, first, just test. I always go back to that. Know for sure.
Also, there are many foods that have oxalates in them, not just leafy greens. There is a whole range of foods that have high oxalate content. If you’re really worried about whether you may be sensitive to certain foods or not, you can actually do a food sensitivity test. Not an IgE, which is the food allergy test, but a food sensitivity test, where you do a whole panel of different foods, and it measures the IgG response to those foods. That may point out to you which particular foods or food groups you may be sensitive to. Then you can maybe modify your diet based on that type of test rather than guessing. A lot of people think they know, but they’re not 100% sure. It’s always better to do the test and know for sure.
Last thing I want to ask you: Are there any updates when it comes to thyroid eye disease since you were last on the podcast?
The biggest update has to do with the medication TEPEZZA, which is teprotumumab-trbw. Many of you, if you are following thyroid eye disease in the news, they have commercials on TV now for TEPEZZA. I think it’s really changed the landscape of our treatment for patients with thyroid eye disease, particularly patients who have a lot of bulging of their eyes, proptosis; if they have a lot of swelling of their lids or double vision. This drug has really changed how we manage our patients.
Initially, the drug was only studied in patients with acute disease. Let’s say less than nine months. Active proptosis, bulging, a lot of swelling, congestion. It showed benefit. But now, there are studies that show that this drug TEPEZZA can also be used for people with more chronic disease, even up to 10 years in duration. Even after the active phase of the disease calms down, it’s really stable, people can still have benefit.
It’s something that is within our toolbox for treating thyroid eye disease. It’s not something I would rush to immediately, but it’s nice to know there is this option out there. It has been shown to work. It has some side effects, but overall, it’s relatively safe. It’s important to have that discussion with your doctor, particularly your ophthalmologist, your neuroophthalmologist, or your oculoplastic doctor about whether TEPEZZA may be right for you.
As an integrative ophthalmologist, I try to bring both aspects and offer them to patients. Yes, there is that treatment that is a biologic agent. It’s a medical therapy. It’s an infusion. I also combine it with dietary strategies, supplements, lifestyle, so I always try to provide the best of both worlds, not just say, “you’re a great candidate for TEPEZZA, so get this infusion for the next six months.” That’s not ideal. You want to bring more of a holistic approach to thyroid eye disease. Use some of these modalities together to get the best outcomes.
I know you have to run, but is there anything I should have asked you that I didn’t ask you? Anything else you wanted to mention before we wrap things up?
I know we covered a lot, and I know it was a lot to cover in a short amount of time. If anyone is interested, you can get my book on Amazon. It’s available in paperback and Kindle. It will soon be available in hardcover as well. Hopefully, in the future, audiobook as well.
Also, if you want to learn more, I did offer a webinar on my top four tips for eye nutrition. That’s also available on YouTube. You can watch it at your convenience. It’s about a 45-minute webinar.
The webinar I am doing today on eye supplements will also be posted on YouTube.
What’s your website for those who are interested in the NY area who might want to see you in person?
My website is my full name, www.RudraniBanikMD.com. I also offer a lot of information on my social media platforms. I’m on Instagram, @Dr.RaniBanik. I’m also on Facebook with a couple of groups.
Wonderful. Thank you so much, Dr. Rani. This was an amazing conversation. Definitely check out Dr. Rani’s book Beyond Carrots. Thank you for getting together here. Look forward to having you on the podcast again in the future.
It’s my pleasure. Thank you so much. Thank you for sharing all your wisdom with your listeners. It’s really amazing how your podcast has helped so many people, I’m sure. I look forward to watching you grow and expand your reach as well.