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Nutrition for Eye Care B Part 1 The making of a natural ophthalmologist
An interview with Robert Abel, Jr., M.D.
By Richard A. Passwater, Ph.D.
It's uncanny how many people have been introduced to the benefits of nutritional supplements because they have developed eye problems. There will be many more as the "baby boomers" age. Dry eyes, glaucoma and cataracts start to become a problem in the 50-plus years. Later on, age-related macular degeneration looms as a real danger.
I often write about antioxidants and chromium helping to prevent cataracts. Antioxidants help protect the eye lens against the free radicals generated by sunlight. Chromium and lipoic acid help control blood sugar levels to reduce the risk of diabetic retinopathy. Now we can add to the list of vision-related nutrients the carotenoids lutein and zeaxanthin, which protect the macula and the lens.
Even though we don't like to think of it happening to us directly, our population indeed is aging. One recent poll listed the possibility of lost vision as the number-two fear of senior citizens, second only to the fear of cancer. Fortunately, an eminent ophthalmologist, Dr. Robert Abel, Jr., has written a book that will be of great help-not only in protecting our eyes, but in improving total health as well. His book, The Eye Care Revolution, has been published by Kensington Books.
Dr. Abel, a graduate of Wesleyan University and Jefferson Medical College, performed his ophthalmology residency at the Mount Sinai Medical Center in New York, NY, and a cornea transplant fellowship at the University of Florida. Dr. Abel cofounded the alternative medicine curriculum at Thomas Jefferson University, where he is a clinical professor of ophthalmology. A board-certified ophthalmologist, he is on the staff of the Christiana Care Health System and St. Francis Hospital. He has helped found eye banks, including the Medical Eye Bank of Delaware where he has been medical director since 1981. He teaches locally and internationally on numerous subjects, including cornea, cataract and nutrition, and now includes various techniques from Ayurvedic, Chinese and nutritional eye therapy disciplines in his curriculum. He instructs the Cornea Microsurgery Workshops at the Academy of Ophthalmology meetings annually and has been on the Academy's Committee of International Ophthalmology. Dr. Abel has conducted research on corneal transplants, corneal pathology, contact lenses and drugs as they relate to the eye. Further, he is an advisory board member of the Lutein Information Bureau, holds two patents on artificial corneas and has received the senior honor award from the American Academy of Ophthalmology. Dr. Abel practices ophthalmology and lives in my old home town of Wilmington, DE.
Passwater: Why did you want to become an ophthalmologist?
Abel: When I was 11, I was hit in the eye with a dirtball. This experience enabled me to observe, from the patient's viewpoint, how important eyes are and how important the need for reconstructing them is.
Over the years, I had many opportunities to observe professional eye care in action. A well-known family friend was the head of Wills Eye Hospital, and this presented me with numerous chances to learn about how the eyes function and what happens when things go wrong.
Another contributing factor to my choice of a specialty occurred when I was in medical school. I got the opportunity on a medical rotation to do ophthalmology at the same time as internal medicine. This provided a good comparison, and I found ophthalmology to be more interesting. Even subtle things seemed to sway me towards ophthalmology. The ophthalmologists seemed more interested in their work and encouraged us to take part in everything, whereas the medical residents never let us present to the chief.
Ophthalmology became fascinating to me. When I look inside the eye, I see something interesting all the time. An ophthalmologist can go anywhere in the world and, in 20 minutes, make a diagnosis with a few simple instruments. It seems a lot more self-contained than many of the other specialties.
The only reason I didn't come to ophthalmology sooner was that, somehow, early on I had gotten it into my head that an ophthalmologist wasn't a "complete" doctor. When I entered medical school, that was the only thing that held me back from ophthalmology. But I soon learned that ophthalmologists can visualize the whole person.
Passwater: There is a saying that the eyes are the windows to the soul. Can they likewise be the windows through which you can see the health of the internal body? What can you see by looking backwards through the window of the eye?
Abel: The eyes don't get sick by themselves. The whole body is involved. Likewise, they don't heal without the body healing. The eyes are the headlights of the body. Their surveillance is not only of the world around us, but also the world inside us. You can look into the eyes and see anemia, you can see liver trouble, you can see the effects of high blood pressure, thyroid, diabetes, etc. In a sense, therefore, examining the eye is a little like looking through a window of the body; with other body parts, you don't gain the same kinds of insight.
Passwater: Can you sometimes see things happening when you look in the eyes even before other clinical symptoms become apparent?
Abel: Correct. Sometimes you can see changes in the back of the eye before people even know they are diabetic. Their vision can fluctuate. Some thyroid patients may develop bulging of the eyes before any other signs are detected. You can see degeneration in the retina before the patient knows it. This degeneration can be caused by poor- nutrient absorption or poor- bowel function, both of which easily may be corrected. You can see glaucoma at a very early stage and recognize that there is stress elsewhere in the body. So the overall answer is yes.
You may be the first one to make the diagnosis and, even more important, you may be the first one to connect different organ systems. You may connect the fact that pressure is up in the eyes because of the patient's use of an asthma inhaler, or perhaps you will tie inflammation in the eyes to Crohn's disease. Some doctors tend to fragment parts of the body and look at people in pieces and treat them in pieces. But they really can't be treat in pieces.
Passwater: An early diagnosis is helpful only if it will lead to all improved clinical outcome. Carl what you see in the eye result in an earlier diagnosis that can make a meaningful difference.
Abel: Early diagnosis leads to more treatment options and the possibility of reversal. For example. consider cataracts. A cataract is a cloudy area in the lens of the eye that blocks some of the incoming light, thus making vision blurred and distorted. Cataracts are one of the leading causes ell blindness in older Americans. Surgery to remove the diseased lens currently is the only medical treatment for cataracts, and nearly two million cataract surgeries are performed in the U.S. each year.
Most ophthalmologists who see a cataract early on will tell the patient, "You're not ready for surgery yet; I'll see you in six months." And that is the extent of the conversation. Why not, instead, tell these people to drink six glasses of water every day, increase their sulfur-containing compounds, glutathione, vitamin C, bioflavonoids, lutein and a multivitamin to actually reverse the growth of the cataract and keep it at bay for long periods of time. This is the time to build up your antioxidant bank account. Isn't this better than simply telling patients that nothing can be done about cataracts and that they are a natural effect of the aging process?
Early detection of diabetic retinopathy may avoid the need for lasers and almost certainly avoid the possibility of blindness. Early detection can enable corrective steps to be taken before people lose their vision. Even Western medicine options in eye care are important: the key is that they are options, and the earlier you can make a diagnosis, the more options you have available.
Passwater: I have known people whose cataracts stabilized and even reversed after they adopted a good nutritional supplement program. Even their ophthalmologists confirmed it. However, these were not clinical studies, and I have no way of verifying these reports. You mentioned that cataracts at early stages can be reversed. Is that correct?
Abel: Yes, it is correct.
Passwater: Is it widely known?
Abel: No. In fact, most ophthalmologists probably would pooh-pooh it because they never have tried to do it. Yet every eye specialist has some cataract patients who return year in and year out with no change in the severity of the problem. There even was one drug study in which, over the course of six months, exams showed all apparent lessening of cataracts. Nevertheless, few, if any, ever paid attention to why a patient's cataracts seemed to diminish.
By the way, the study I cited didn't prove that the Cataract reversal was due to taking the drug. Maybe it was an artifact arising from our cataract grading system. Or maybe the subjects began putting on their sunglasses to stop the process. And maybe they improved their nutrition. But it is documented in the medical literature that cataracts can be reversed.
One caveat, however: a posterior subcapsular cataract that you see with trauma, steroids, or diabetes is not readily reversible.
Passwater: Let's go back to when you were in medical school. Al that time, was there much discussion about the role of nutrition in treating the various eye diseases?
Abel: When I was in medical school, we had very little discussion of nutrition-except for basic biochemistry and some "accidental" nutrition. In ophthalmology, we did learn about vitamin A and the violet purple that helps with night vision, but we learned it only piecemeal.
My son completed medical school recently, and he received essentially the same three hours of nutrition in his medical training that I had. One difference, however, is that today there are numerous articles showing that lutein is a major protector of the macula, that docosahexaenoic acid (DHA), the essential omega-3 fatty acid that is present in the retina, brain and adrenal glands, is important to eye health, and that vitamins A, C, E, and even 1utein to some degree, decreased the incidence of cataracts in long-term prospective studies.
These articles, which appear with more than minimal frequency, are helping to spark increased dialogue about the value of nutrients. This is something we did not see very often during my years in training. I believe, by the way, that one of my roles should be to help train other ophthalmologists and optometrists in the use of nutritional approaches to treating eye disease.
Passwater: That certainly is an important role. But I'm curious: if you weren't taught about this in Medical school, what aroused your interest and opened your mind to the role of nutrition in eye health?
Abel: Let me work backwards. In 1991, I started Tai Chi Chuan,, which is a Chinese martial art that looks more like ballet. It improves balance, moves energy throughout the system (called chi) and requires a kind of holistic approach to nature. When you are starting out in this discipline and B at least initially B are the worst one in the class, you adopt a certain openness. It doesn't matter that you are a doctor, you are a novice in this setting, and you need help. So you become much more receptive to new concepts, idea and ways of learning.
Several years earlier, I began to realize that doing 500 or 800 cataract surgeries a year was ,grossly inefficient. We weren't getting to the root of the problem. We were operating on a symptom. Not only that, we were costing Medicare a great deal of money.
Cataract surgery is the number one cost to Medicare.
I realized I had to look deeper. I asked myself, "Why do some people live longer and age well-- great memory, no eye disease and so on-while others start to go downhill earlier, suffering from deafness, memory loss, cataracts and a host of other ailments?"
I went back to school on this. I took a couple of courses in nutrition at the University of Delaware. Unfortunately, these weren't related closely enough to clinical nutrition. They were taught by dietitians.
I did, however, get reacquainted with the biochemistry. Now, when I hear people talk about NADH, or citric acid cycle, or alpha-lipoic acid, or coenzyme Q-10, I know exactly where they fit in, how they may work and what organs they are most appropriate for. Over the years, I became more open and started to read more. I even read books on veterinary ophthalmology and found out there is more to the field than meets the eye (pardon the pun). There is a lot of information to absorb, and I will be a perpetual student.
Passwater: Through the years, we have had to learn much about human nutrition from animal science and veterinary medicine. Animal nutrition is important the value is measured easily: how much meat is on the hoof; flow much wool can a sheep produce; how fast does a horse run; how much milk does a cow give? These are measurable values, and people are quick to pick up on any improvements obtained through nutrition.
Meanwhile, with regard to human nutrition, all anyone looked for in the past was whether an individual was growing normally and whether he or she was avoiding the most recognized deficiency diseases. The nutrition establishment saw no advantage to going beyond these basic requirements.
Abel: This was apparent in the old Recommended Dietary Allowances (RDAs). They were directed at minimum amounts for most people to avoid deficiency states and to avoid the need to fortify foods. Omega-3 fatty acids have yet to be considered essential by the American Rod Council.
Passwater: You've said that one of your goals is to educate your peers. You already do that by lecturing at professional meetings. And your peers probably won't read a popular book that can be understood by lay people. Given these assumptions, why did you take the time to write this book?
Abel: I spend a lot of time with each of my patients. In the management of their health care, I think of myself as their partner and them as my partners. Meanwhile, when I am on call for other doctors, I realize how few of these physicians really get into the true context of an eye problem. There almost always is a connection to other systems. Illness in the eye usually is part of a larger disharmony, and I felt that 1 had to convey this message-that the eye is only part of the body and you have to treat the whole, not the part. 1 didn't know how to go Ibis concept across to a lot of people without writing a book. The book, then, is an effort to share with each reader the kind of information I regularly give to my patients.
I also felt I had to tell people that eye problems are symptoms, not causes. I wanted them to understand that cutting something out wouldn't remove the cause. I remind patients all the time that when Pythagoras created the caduceus, which is the symbol that represents the medical profession, he emphasized that science and intuition are entwined. The caduceus symbol consists of the winged staff of Mercury, with two oppositely entwined serpents spiraling up the staff with one snake representing science or rationality and the other snake representing art or intuition. Practicing medicine still is an art.
Passwater: What would you consider to be one of the greatest deficiencies in the way that medicine is practiced in this country?
Abel: That is a very good question, and what I think of immediately is the placebo effect. On the whole, the placebo effect will cure or heal people 30% of the time, and yet in all our rigorous scientific studies we try to eliminate it.
Passwater: People tend to think of the placebo effect as being the same as no effect. Actually it is a very positive effect produced by the mind rather than by the compound being tested.
Abel: Yes, we have to get people to involve their minds in their health. We must teach them to draw upon their mental powers to stimulate their immune systems-their whole bodies. The mind is a powerful tool, both in causing, disease and in overcoming disease, and it should be enlisted on the side of healing. The body is tightly interwoven with its nerve connections and the flow of chi energy, which is described by the Chinese as the "vital life force." When blockages occur, we gel trigger points, lack of function, loss of ability and loss of creativity. We must give people hope, give them an opportunity to let their minds work toward helping them triumph over illness. We know the mind can cause stress problems; why not, instead, encourage it to work positively
Here's another point that 1 wanted the book to convey: people should seek interactive care B and they don't have to take guff from their doctors
I recently had lunch with a friend who had had a portion of her bowel removed. Hearing how her doctor talked to her, and talked about other doctors, made me feel as if we were still in the Middle Ages as far as doctor-patient relationships go. Let's quickly change this dynamic. Ultimately, the direction of any business is going to he driven by the client, and this should be true in medicine, as it is elsewhere. Eventually, people demand the product that they want. The medicine that they should want is more interactive. Patients should be in charge of their bodies and responsible for what they do. They know more about their bodies than any one else ever will.
Patients will seek out doctors who don't mind their exploration of alternative methods. This will lead to the doctors themselves learning about better ways to get things done. In a sense, one reason I wrote this book is to tell people that the eyes are connected to the whole body. There is a total harmony of art and science. People should look for interactive care, and they need to be responsible for their own healthcare.
Passwater: What, if anything, influenced you to begin thinking like this?
Abel: When I started studying Ayurvedic and Chinese medicine, that really opened my eyes. I realized that these people, who did not have the benefits of CAT scans and gross dissection, nevertheless were able to treat patients over the course of several millennia, using a variety of herbal chemicals. What is remarkable is that they obtained observable results in such a large number of people that they could start to correlate what worked and what didn't.
Furthermore, their diagnostic techniques included examination of the tongue, the testing of multiple pulses, observation of symptoms, and so on. In many instances, practitioners would
tend to give multiple different herbs as one decoction. It is very different from Western medicine, in which a patient is diagnosed with arthritis and a medication is prescribed for him or her. It doesn't matter what that patient's size or build is. Any number of variable factors is considered irrelevant. In Ayurvedic and Chinese medicine, however, practitioners recognize that different body builds mean different things. I began referring patients to a Western herbalist and Chinese practitioner in our community. Not only would they recover from optic neuritis, but, additionally, patients with multiple sclerosis, lupus, rheumatoid arthritis, and many other disorders would improve. This despite the fact that Western medicine had declared nothing could be done for them other than to dull their pain. Yet, as you are well aware, there are a number of nutrients that help arthritis, neuropathy, bowel disease, immunity, etc. In fact almost any category, whether it is nerve support, bowel support, joint support or whatever, can be improved.
Nutrients will help rebuild the whole body and go to the cause of the problem-not just treat a symptom-while demonstrating little toxicity or drug interactions.
Passwater: In Western medicine, it is taught that the scientific process requires the testing of one variable at a time. As a result, Western medicine always is looking for a single drug-a single magic bullet. Other medical traditions take an alternative tack, opting for multiple, interconnecting, interworking compounds. How did you apply these discoveries in the way you approach various eye disorders?
Abel: The Chinese believe there is no tragic bullet in the same way that there is no individual body system. The body works together; for instance, the eye is nourished by the liver. The liver is the key organ for the eye. It stores all the vitamins, etc. The Chinese believe you treat someone for 10 to 14 days and then you reevaluate, because a man never crosses the same river twice. He is different and the water is different. So you need to periodically reexamine the individual in li9ght of the changes that have occurred.
I look for clues when a patient comes in, whether he or she has eye disease pr not. I look at posture, skin coloration, energy level, flexibility and a whole lot more. Is the person smiling , frowning, enjoying life? Is this person afraid of what he or she is going to hear?
There is no denying that this is a complicated situation. Many patients are on drugs from multiple doctors, and they will stay on these drugs. I also know that you shouldn't treat high blood pressure monolithically: this is a condition that is different in the daytime from the way it is at night. Also, it is different as people age and as they gain or lose weight. If the disease behaves differently, we need to treat it differently.
I actually have become a little bit aggressive and interceded with the medical care of some patients. I try to trim down their drugs, whether they're cholesterol-lowering or blood-pressure drugs . I do not interfere with their cardiac drugs per se because that is more important and more prone to difficulty. But we know that vitamin E, magnesium, folic acid, hawthorn berry, taurine and other nutrients are helpful to heart function. Yet the doctors who operate on these people put them back into the same cage they came from without any change in their environment
or nutrition. In some ways, it is almost like curse to start learning about the value of alternative medicine and then trying to educate people who are resistant to for a variety of reasons.
Passwater: Thanks for helping to explain what an ophthalmologist can learn by looking into
can learn by looking into one's eye and what that may mean in terms of the person's over all health. Let's continue our chat next month and look at specific nutrient protocols for cataract,
glaucoma, dry eye and age-related macular degeneration. WF
© 2000 Whole Foods Magazine and Richard A. Passwater, Ph.D.
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