CLINICAL
nutrition
“Wet” the Appetite
Alleviate dry eye disease symptoms with these dietary directions.
KIMBERLY K. REED, O.D., F.A.A.O.
The most common nutrition-based recommendation optometrists make for dry eye disease (DED) patients is omega-3 fatty acids, says a recent yet-to-be published national survey. Given that scores of studies support the benefit of anti-inflammatory omega-3s on the ocular surface, this makes sense. (See “Determining Omega-3 Intake” below.) That said, to achieve maximum symptom relief, your DED patients may need a discussion of nutrition status and lifestyle choices. Providing a clear and simple instruction sheet for these patients is a great way to continue the educational process after the patient leaves your office. Make sure the sheet contains these recommendations:
Stay hydrated.
The importance of adequate hydration cannot be overemphasized, but it’s often overlooked in our instructions to our patients.
▸ How to educate your patient: “A good bet is to drink half your body weight, in ounces, per day of water. So, for a 150lb. person, the goal is to drink at least 75 ounces of water daily — even more if you exercise.”
Eat an anti-inflammatory diet.
Taking an omega-3 supplement every day while eating a pro-inflammatory diet is like raking leaves in the middle of a windstorm. In other words, if a patient regularly ingests foods that cause inflammation, no amount of omega-3 intake is going to completely reverse the production of inflammatory mediators that may ultimately negatively affect the ocular surface.
▸ How to educate your patient: “Omega-3 fatty acids aren’t the only substances involved in the maintenance of a healthy ocular surface. You need to eat a wide variety of foods, especially brightly colored fruits and vegetables, to achieve symptom relief. For many, a Mediterranean-style diet is beneficial. This diet is comprised mostly of fruits and vegetables, whole grains and nuts, fish and poultry at least twice a week, red meat no greater than a few times a month, replacing butter with olive oil and using herbs and spices vs. salt for food flavoring.”
Determining Omega-3 Intake
In the not-too-distant past, physicians roughly gauged a patient’s omega-3 intake by how many servings of fish patients reported eating per week. However, this can be misleading as certain types of fish are actually higher in omega-6 fatty acids than omega-3, including tilapia and catfish, says recent data. In addition, even relatively less expensive sources of salmon, such as canned pink salmon, have far less omega-3 than many expect. So, eating two servings a week of this type of fish yields an average daily intake of just 200mg to 300mg EPA/DHA, says USDA data. While no general consensus on “how much omega 3 is enough” to treat or prevent dry eye disease exists, it is generally believed that to achieve a heart-healthy benefit of omega-3 fatty acids, daily intake for most people must be far higher — up to 2000mg per day.
To take the guesswork out of nutritional recommendations, simple lab tests are available both through traditional labs (vitamin D, C, B12 levels, and AA/EPA ratios) and specialty-testing services, as well as via home testing kits. An accurate profile can be used as a baseline for before- and after-supplementation.
Say to the patient: “Sometimes a regular fish oil capsule isn’t enough to address the symptoms you’re experiencing. Ideally, we should do some lab tests to see where your levels currently are, then we can decide how much more you might need, if you’re still deficient.”
For other patients, a low carbohydrate diet is most compatible. Specifically, some studies reveal that this style of diet is helpful in patients who have lipid disorders, such as high triglycerides.
▸ How to educate your patient: “Limit or replace sugar, bread and pasta with meat, poultry, fish, shellfish, salad vegetables, nuts, eggs, seeds and cheese.”
In more challenging cases, such as when patients have multiple medical problems, including heart or kidney dysfunction, find a qualified dietician or nutritionist in your area to evaluate the individual patient’s needs, ideally using laboratory testing to check for potential food sensitivities.
Drink alcohol in moderation.
Alcohol intake has been shown to cause tear hyperosmolarity, shortened TBUT and the development of ocular surface diseases because it’s a diuretic. As a result, you should educate your DED patients to drink alcohol in moderation. Moderation is defined as no greater than one drink a day for women and no more than two drinks a day for men, says the U.S. Department of Health and Human Services.
▸ How to educate your patient: “There are some potential health benefits to drinking alcohol in moderation, such as the reduced risk of heart disease and stroke. Make sure to drink an additional 8 ounces of water for every serving of an alcoholic beverage.”
(If you suspect the patient of alcohol abuse, that’s a different discussion. The National Institute on Alcohol Abuse and Alcoholism advises seven or fewer alcoholic beverages per week for women, and 14 or fewer per week for men.)
Opening patients’ eyes
Many patients still don’t realize that diet affects the ocular surface. By providing these directions, you’ll enable them to achieve maximum DED relief. OM
DR. REED IS THE DIRECTOR OF THE OCULAR NUTRITION CLINIC AT NOVA SOUTHEASTERN UNIVERSITY’S THE EYE CARE INSTITUTE IN FORT LAUDERDALE, FLA., E-MAIL HER AT KIMREED@NOVA.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.
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