Season 3, Episode 1: An Integrative Approach to Ocular Health and Nutrition with Dr. Rani Banik

Evelyne Lambrecht: I’m very excited for this conversation. Dr. Rani Banik is a board-certified neuro-ophthalmologist. She completed her MD at Brown University, Residency at UC Irvine and Fellowship at Wilmer Eye Institute. She runs a private practice based in New York City and is associate professor of ophthalmology at Mount Sinai. Dr. Banik is also certified in integrative and functional medicine.

She focuses on the root cause of eye diseases and uses strategies based on nutrition, botanicals, lifestyle modification as supplements for vision issues such as macular degeneration, dry eye, cataract, glaucoma, as well as migraines. She’s the author of two bestselling books, Beyond Carrots, Best Foods for Eye Health A to Z, and Dr. Rani’s Plant-Based Visionary Kitchen. Amazing. I’ve read your book and I found it very inspiring.

Eye health is something that we don’t always think about, especially if there aren’t any issues, but we know that when there are issues, it just affects everything. Right? So, you’re an ophthalmologist, a neuro-ophthalmologist, and then became a patient of functional medicine yourself. Can you tell us more about that?

Dr. Rani Banik: Yeah, absolutely. So, I went through the traditional route. I went to medical school in US. I did internship, residency, fellowship, and I was actually working full-time in academics for the first part of my career. And I thought that was what I was going to do until I retired.

But what happened was I developed a medical issue myself that really became quite challenging and that’s how I discovered functional medicine. So, I had developed migraine headaches and I developed them initially back in my mid-20s, early 30s. But it wasn’t so bad. I would get maybe one episode every two years. It was very manageable.

I knew what it was. It would come and go. But then, I was going through a very stressful period in my life, in my early 40s, and everything was happening at once, both at home and at work. And it was so stressful. And I developed migraines very regularly.

And then, it became every day. So, if you’ve ever had a migraine, you know how debilitating it can be. But imagine waking up with it every morning, going to bed with it every night, and just non-stop day after day. And then, those days turned into weeks and then into months and into years. So, I had migraine for several years and I tried everything.

I tried all the traditional medical therapies, nothing was working. I went to some of the top doctors here in New York City, headache doctors, and they just kept giving me prescription after prescription and nothing helped or gave me side effects. And finally, I said, “You know what? I need to take this into my own hands.” And I started to research and I realized, “Oh, my goodness, there’s so much written about supplements, for example, how come none of my doctors ever told me about that?

Take some supplements.” And then, I think the most eye-opening moment was when I was talking to a colleague and he’d actually been trained in functional medicine. And he said, “Rani, why don’t you try an elimination diet?” And I said, “What do you mean? What’s that?

What’s an elimination diet?” And I think nowadays it’s probably become more commonplace and most people do know what an elimination diet is, but back then I had no clue. And so, he explained it to me, you remove certain foods that may be pro-inflammatory, that may be triggering your symptoms. And so, I was really fascinated. I was like, “Wow, how come none of my doctors ever talked to me about my diet?”

And meanwhile, I cringe to think this. I was eating so poorly, Evelyne, it was just horrible. Every day I was eating pizza, ice cream and diet cherry coke. That was my diet for like day in, day out. It’s really bad.

And I never once thought, “Oh, my goodness, maybe what I’m eating is contributing to my persistent headaches.” And then, I did decide to do an elimination diet. I also went to my first functional medicine training and I was really blown away. I was like, “Wow, I was never taught any of this in medical school. Why?

Why are we never taught about nutrition? Why are we never taught about all these lifestyle strategies?” So, I loved it and it ended up that it drew me in so much. And it helped me so much in my own health journey that I ended up getting certified in functional medicine. So, I now use all of these principles with my patients also because I am a testament to how effective they can be.

But also, I’ve seen it in my patients. I’ve seen them turn around their problems with the power of nutrition and lifestyle and supplements. So, that’s a long answer to your question, but I think it definitely is something that many people can relate to who have discovered functional medicine.

Evelyne Lambrecht: Absolutely. Yeah. I think that’s the story of a lot of practitioners who practiced in conventional medicine and then found functional medicine the same way.

It was some issue that they had themselves. What were some of the changes that you saw in your patients once you started implementing functional medicine into your ophthalmology practice? And do any of your colleagues also practice this way in ophthalmology?

Dr. Rani Banik: Not to my knowledge. I think the last I checked, I’m like one of maybe two board certified ophthalmologists around the country who are also duly trained in functional medicine. There may be others that I don’t know about, but most ophthalmologists, again, they still haven’t even really heard about functional medicine. They may have heard about integrative medicine or holistic approaches, but the term functional medicine is, I think it’s gaining relevance amongst patients and then hopefully the medical community will also better appreciate it and understand its benefits. But to answer your first question, what changes did I see?

So, I first used the strategies for my migraine patients and being a neuro-ophthalmologist, I actually have a lot of migraine patients. So, I’m both a patient, but I’m also a doctor who specializes in migraine. So, I saw people turn around their symptoms, people with chronic migraine, who had migraine for like 50 years. I had this one patient… I’ll share her story with you. She was in her 70s and she came to me because her niece was also my patient and she said, “I’ve had migraine.

I can’t leave the house. I’m so debilitated. I have no life basically. I have to be in the dark all the time. I’ve tried everything, nothing’s working.”

And so, I said, “Okay, let’s try this.” I put her on a regimen of supplements. I really talked to her about her lifestyle, her stressors, how she was managing the stress, her sleep. And then, we put a plan together for her and nutrition also was a cornerstone of her treatment. And I said, “I’m not really sure if this is going to work for you, but try this.

It worked for me. Try this regimen, do it for six weeks and then come back and see me.” And she came back and she was like a new person. When she first came and she was wearing dark, dark sunglasses because she couldn’t tolerate bright lights. She was vibrant.

She was talking to me. She had no sunglasses. And she said, “Dr. Banik, you literally gave me back my life. Now, I can go out, I can enjoy time with my friends. I can go to a restaurant.

I can go shopping.” She’s like, “Thank you so much for introducing me to some of these principles because I never would’ve known and none of my other doctors mentioned them to me.” So, after I saw benefits from my migraine patients, I was like, “Well, maybe this can be applied to eye health also, let me give it a try.” So, I started implementing some of these strategies for my patients with chronic eye issues. Like for example, macular degeneration is probably one of the biggest areas in which I’ve seen benefits.

People with macular degeneration, they tend to be older. They have this relentless progression of disease where they lose their central vision, they can become legally blind. And right now, for the early stages of disease, there really is no treatment that’s effective. No medication or surgery or other procedure has been shown to be effective. So, I said, “Let’s talk about diet and lifestyle and supplements.”

And so, I put patients on these regimens and I’ve been able to help people maintain their central vision, maintain 20-20 vision even despite having early signs of macular degeneration, even despite having a strong family history of macular degeneration where both parents are blind from the disease. So, in my experience, it really works. And my goal now is to get this information out there to not just patients, but also my colleagues, because I think by educating them, then they can use these strategies for their patients as well.

Evelyne Lambrecht: Absolutely. Thank you. And so, obviously a big thing that you do in your practice is eye exams, right? Eyes are the window into the soul, but they’re also window into the body. So, with these different eye conditions, what are some of the things that you’re able to see from an eye exam that relates to overall body health?

Dr. Rani Banik: Yeah, that’s a great question, Evelyne. So, the way I think of it, the eye is like a canary in the coal mine. The eye, even though we don’t really think about our eyes too much, we think they’re separate from the rest of the body. They’re very intimately connected to… basically every other organ system. So, if there’s disease going on in another organ system, it will sometimes first show up in the eyes.

And I’ll give you a couple of examples. For example, diabetes. We know that diabetes can wreak havoc on other organs, but in the eye, it’s one of the earliest changes that we see of diabetes are changes in the retina that we call diabetic retinopathy. There can be areas of bleeding, there can be areas of protein or fluid that’s leaking out. I like to call it like a leaky eye syndrome.

Many people have heard of the term leaky gut or leaky brain, but this is a type of leaky eye syndrome that causes diabetic retinopathy. So, we can pick up diabetes, we can pick up high blood pressure, we can pick up heart issues like for example, clots in the heart. We can pick them up from an eye exam because sometimes they can travel, they can migrate into the back of the eye. We can pick up a lot of neurologic conditions also because the eye is a direct extension of the brain. So, for example, sometimes I’m the first doctor to pick up something like multiple sclerosis in a patient, or even there are some early signs of Parkinson’s disease that can be picked up on an eye exam.

So, I would say there are probably at least 200 different medical conditions that can be picked up on an eye exam. It’s really incredible to think that we have this window into our health and many people don’t realize it.

Evelyne Lambrecht: Wow, that’s really, really amazing. We should all go get our eyes checked.

Dr. Rani Banik: Yes, yes, yes. Actually, it’s recommended after the age of 40, everyone should go every one to two years to get your eyes checked because a lot of these conditions, initially, they have no symptoms, and the only way you would know is to get the eye exam, but also get a dilated eye exam. So, be sure to ask for that for a dilated eye exam.

Evelyne Lambrecht: Why is that?

Dr. Rani Banik: So, the dilation, it’s when the doctor puts drops into your eyes to make your pupils really big. And a lot of people say, “Oh, can I please just skip that? I don’t want to get it done. It’s annoying. My vision’s blurry.”

But that’s really how we can get a full view of what’s going on in the retina and the optic nerve. And that gives us really so much more information than a regular eye exam without the dilating drops would give us.

Evelyne Lambrecht: Got you. I’m curious too, when it comes to blood pressure, what is it that you look for in an eye exam?

Dr. Rani Banik: So, in the retina in the back of the eye… I actually pull out my eye model here to show you because I love using visuals. So, when we look at the eye, we usually just see the very front part of the eye, the white part. You can see the cornea, which is the curved clear part in the front. But if you open up the eye, and I’m going to open this up here and show you what’s inside, there is a lot going on. There are a lot of different structures inside the eye, but particularly here, this orange here is representing the retina.

And normally the retina is clear, but we’re seeing it as orange because there’s blood vessels underneath. But you see all these blood vessels in the retina. And so, we can pick up changes in those blood vessels. We can pick up when there is elevated blood pressure because the caliber of those blood vessels changes, it becomes very thin, what we call attenuated. Sometimes we can see hemorrhages along the blood vessels, lipid or fats that have leaked out of the blood vessels into the retina. That can sometimes happen with high blood pressure.

So, there are a lot of changes we can see. And sometimes even the optic nerve can get swollen from high blood pressure. So, there’s certain warning signs that we look for. And if we see them, first of all, we tell our patients we do see some findings in the back of your eye, and you do need to go see your primary care doctor or maybe your cardiologist. So, we work very closely with other providers to help really coordinate the patient’s care based off of what we find on the exam.

Evelyne Lambrecht: That’s great. Thank you. If you are listening to this podcast, you can watch the video if you want to see that demo.

We have that on our website. So, in your book, you talk about 30 different nutrients that we need for eye health. It sounds like a lot, but what are the broader categories of these nutrients?

Dr. Rani Banik: It does sound like a lot. And don’t worry, you don’t have to count them out whether you’re getting all of them or not. But just if you think in large categories and you rotate through your foods, you will be able to supply your eyes with the nutrients they need. So, the three categories are antioxidants, number one. Number two, nutrients that support mitochondrial function and energy production.

And then, number three, anti-inflammatory nutrients. So, those are the big categories that we need to think about for our eyes. And a lot of people think, “Oh, eyes, nutrition carrots. Isn’t that enough? Carrots, if I just eat enough carrots, if I get enough beta-carotene in my diet, won’t that be sufficient?”

But the truth is it’s not. Yes, beta-carotene is helpful, it’s important, but it’s not the only nutrient we need.

Evelyne Lambrecht: I think it’s interesting too. Obviously, we think of mitochondrial health, well, all over our bodies, but our brains need a lot of energy. But I think sometimes even as practitioners, we don’t think about the fact that our eyes require so much energy. Right? So, how important the mitochondrial health is for eye health?

Dr. Rani Banik: Yes. And so, the brain uses a lot of our energy, our mitochondrial in our bodies. Mitochondrial needs like 25% goes to brain function, but the eye is actually perhaps even more metabolically active than the brain, especially the retina, because the retina’s constantly taking in light energy, processing that light energy into chemical signals to send to the brain. So, that constant processing, there’s always a turnover of cells in the retina, and it’s very, very energy demanding. So, mitochondria are key for your retina, but also for the optic nerve.

Evelyne Lambrecht: These general categories of nutrients, are they the same whether you’re working with somebody with a cataract or a glaucoma or macular degeneration or dry eyes? Is it the same for everybody or are there certain ones that help more for certain conditions?

Dr. Rani Banik: Yeah. So, the base nutrients are all the same because again, our eyes, a lot of people think, “Oh, the eye is small. It’s about the size of a golf ball in reality,” but they don’t realize the complexity of the eye. So, within the eye, there are actually at least 40 different structures. So, those 30 nutrients are designed to support all 40 structures. But if you have a specific eye condition, let’s say for example, dry eye, you had mentioned earlier dry eye.

So, dry eye is when the very surface of the eye, the cornea dries out, and usually there’s an insufficiency of healthy oils on the surface of the cornea. And so, we have to support our oils that come from glands in the eyelids that secrete these oils. So, omegas are very, very important for that. So, that’s one example where you may want to eat for your general eye health, but you may really want to focus on specifically the omegas and not just omega-3s. This is really important.

It’s not just the omega-3, DHA, EPA that we oftentimes hear about, but some of the other lesser-known omegas. For example, there’s an omega-6 called GLA or gamma-linolenic acid that’s also been shown to help with dry eye. So, that’s an omega you may want to include either if you can get it from your diet, but also from supplementation to support your eyes. And then, there’s also omega-7. Omega-7 is getting a lot more attention now when it comes to dry eye and omega-7 has very specific dietary sources.

And if you’re not able to get them from those dietary sources, then again you may want to take a supplement to get that. And omega-9 as well, which is oleic acid, which comes from olive oil. So, if you think about it’s not just focusing on… pun intended, focusing on one specific nutrient for one specific part of the eye. It’s more having a diversity of various nutrients to support all parts of the eye. That’s really important to understand.

Evelyne Lambrecht: Yeah. Since you mentioned dry eyes, how bad is it to use eye drops or is it fine?

Dr. Rani Banik: Yeah, it’s not bad at all. I know many people probably have heard the warnings, especially last year there were a lot of warnings because there were a lot of drops, specifically generic drops that were recalled. They were over 27 drops that were recalled by the FDA because they were contaminated. So, I know there’s been a lot of fear, “Oh, should I use eye drops? Should I not use eye drops?”

My recommendation is if you have dry eye, absolutely use drops to re-moisturize and lubricate your eyes, but make sure your drops are coming from a reputable manufacturer. You can also go to the FDA website and see which specific drops were recalled. Again, most of them were generics or retail generics.

So, some of the large retail brands, all of their drops were recalled because of issues with contamination, or some of the bottles had plastic pieces in them or even glass in them. So, it was really a scary time. So, just make sure that you’re getting your drops from a trusted manufacturer that has good quality control practices in place.

Evelyne Lambrecht: Thank you. So, let’s talk about the nutrients a little bit more in detail. So, let’s get into some of the vitamins. First of all, vitamin A is a big one. You mentioned it with carrots. Does the form of vitamin a matter, what are your thoughts on that?

Dr. Rani Banik: Yeah. So, there’s two types of vitamin A, preformed vitamin A and provitamin A. And so, if you have animal products in your diet, you’re probably getting the preformed vitamin A from your diet. But if you don’t eat animal products, then you’re getting the provitamin A, which then has to be converted into vitamin A. Also, beta-carotene is a type of carotenoid that can be converted into vitamin A as well. And there’s an enzyme called beta-carotene monooxygenase that converts that beta-carotene into vitamin A.

Some people have genetic variations like SNPs that give them different function for that beta-carotene monooxygenase enzyme. So, depending on your diet, what type of diet you prefer, but also depending on your genetic makeup, you may not be able to convert some of the other forms of vitamin A into the active form of vitamin A that’s necessary for your diet. So, this is something that I do work with my patients to help them understand and also to help them tease out, “Okay, which form of vitamin A is best for you and how can we optimize that bioavailability for you?” So, it is important to realize that not all vitamin A’s are the same. So, thank you for bringing that up.

Evelyne Lambrecht: What are some of the other important vitamins for eye health?

Dr. Rani Banik: I would say the most important class are the macular carotenoids. And many people may have heard of them before Lutein and zeaxanthin. There’s also a third one called meso-zeaxanthin. They’re carotenoids, they’re cousins to beta-carotene. They’re cousins to vitamin A, cousins to things like lycopene, et cetera but they’re very unique for eye health because these nutrients… now, this is really fascinating.

I love this, how the body is developed to protect itself. So, these carotenoids, our bodies can’t make them, but we can get them from certain foods or we can get them from supplementation. Our body takes them, deposits them into the retina in the back of the eye, into the macula. I’ll pull out my eye model again for this part. Again, there’s lots of different parts here, so I’ll just show you.

So, this is the front of the eye. The light rays come in through the pupil and hit the retina in the back of the eye. And see this yellow spot here. This is called the fovea, and this is responsible for our central 20-20 vision. So, if you don’t have a healthy fovea, you won’t be able to see perfectly clearly 20-20.

And so, these carotenoids their pigments, they get deposited right here. That’s why it’s a yellow spot, because these pigments are naturally orange, yellow in color and preferentially they get deposited here. And the whole purpose of this is to protect the retina. So, these three macular carotenoids, again, lutein and zeaxanthin, meso-zeaxanthin, these serve as our natural antioxidants, our natural UV blockers, and our natural blue blockers. So, many people don’t realize that we have natural protective mechanisms against blue light built into our eyes.

And if you get enough of these carotenoids, you can protect your eyes against eye strain, you can protect your eyes against macular degeneration. They’re just such important nutrients that we absolutely have to get in our diets. And in terms of, I’ll give you some numbers. It’s estimated that we need about 6.5 to 20 milligrams of lutein a day. And most people are getting less than that, a lot less than that, only one or two milligrams a day.

So, most people are severely deficient in these eye nutrients. So, I strongly urge people to be aware of them and try to improve their intake just from their regular diet and then maybe take a supplement as well.

Evelyne Lambrecht: Yeah. I have a lot of follow up questions because you just mentioned so much. So, I remember reading in your book that in Fiji, the average person, I think it’s 25 milligrams of lutein daily.

Dr. Rani Banik: Yes.

Evelyne Lambrecht: That’s really interesting.

Dr. Rani Banik: In terms of intake, they definitely are the highest population. So, they probably don’t need to take a supplement, but for the rest of us.

Evelyne Lambrecht: Yeah. What is it specifically about UV rays and blue light that is so damaging to the eye?

Dr. Rani Banik: Yeah, that’s a great question. So, these wavelengths are on the shorter end of the spectrum and UV light we can’t see. But these are really, really ultra short wavelength rays and they can penetrate into the deeper structures of the eye into the retina and cause oxidative damage and free radical damage. So, that’s why these particular wavelengths we definitely need to protect against, and these pigments, these carotenoids can help us do that. And blue light is basically, it’s visible light, so it’s part of the rainbow of colors that our eyes can see, but it’s on the short end of the rainbow spectrum.

So, because it’s on the short end, it’s definitely shorter wavelengths. Again, they can penetrate into the retina and they are just so high in energy that they can really cause a lot of damage. And blue light exposure can, again, there are studies that have shown that too much blue light exposure, especially from screens or even from too much sunlight exposure can cause issues with the retina.

It doesn’t cause blindness. I just want to reassure people that if you’re looking at your screen all day or if you’re looking at the sun too much, it’s not going to lead you to go blind. But definitely it can cause short-term issues with our vision health.

Evelyne Lambrecht: Interesting. Okay. You just made me want to jump to something else. So, I know that it’s popular right now to want to look into the sun in the morning, get that sunlight into our eyeballs. What are your thoughts on this as an ophthalmologist?

Dr. Rani Banik: I strongly advise against it. I know that there are many people who they want to wake up early, get their vitamin D, soak up that sunshine. It’s great for your skin, it’s great to set your circadian rhythm, but directly staring at the sun is quite dangerous actually, because those UV rays, particularly UVA, UVB rays, can penetrate through various different structures in the eye, get to the retina and cause burns in the retina, thermal burns in the back of the eye. And once there’s a burn there, there is scarring, there’s permanent damage that can happen and people can develop patchy loss of their central vision. So, imagine you’re trying to look at something, you’re trying to read, and there are these patchy areas that are just missing because you have damage to the retina.

So, I know again, this is a popular trend to do sun gazing because people want to set their circadian rhythm, but the reality is simply by keeping your eyes open during the daylight hours, you are getting enough stray rays to set your circadian rhythm. And so, if you do want to do early morning sunlight exposure, I would say go outside, by all means, get that UV to your skin, but wear sun protection while you’re doing it and don’t look directly at the sun. If you do really, really, really want to look directly at the sun, do it with your eyelids closed.

So, just close your eyes and then those rays will still penetrate through your eyelids. And let your body know. Let your retinal ganglion cells know. Let your pineal gland know that yes, it’s time to wake up and it’s time to get going with the day. So, you can still get the benefits, but keep your eyelids close to protect that either your retina is really, really important.

Evelyne Lambrecht: Interesting. So, going back to the lutein and zeaxanthin that are in the eye, can you actually measure those concentrations in the eye?

Dr. Rani Banik: We can. So, we have a special camera technology to measure… you can measure the pigments in your skin as well. You can do skin carotenoid testing, but that doesn’t necessarily reflect what’s going on in the retina. So, there are several ways to measure the carotenoid concentration in the retina. Now, it’s called macular pigment optical density or MPOD.

And this test is not routinely available. So, if you go to your local optometrist or ophthalmologist, they probably don’t have the instrumentation to do this test. It’s really used as a research tool. But we do know that as people get older, their MPOD levels start to decline. And the best way to keep them high, keep the levels up is to include foods that are rich in lutein and zeaxanthin in your diet and or to take a supplement.

It’s really, really important. And as those levels decline, that’s when the risk of age-related eye disease is like for example, macular degeneration goes up. We know there’s a direct correlation to lower levels of lutein and zeaxanthin levels in the retina and higher risks for macular degeneration and loss of vision.

Evelyne Lambrecht: And when somebody starts either supplementing with lutein and zeaxanthin or eating more of those in foods, do you notice it takes days, weeks, months for it to help with vision?

Dr. Rani Banik: Yeah. So, it’s not an immediate effect because you have to replenish your stores, but I would say within anywhere from one to three months, studies have shown that plasma levels start to rise and to get to a really good level. So, we have to do it consistently. So, don’t just take, a lot of people will say, “Oh, I took the supplement for a week and it didn’t really make a difference, so I stopped.” And I said, “Well, your body takes time to replenish its stores, so keep going, do it consistently for three months, and also make sure you’re getting the nutrition from foods as well.”

So, it’s important to do both, not just rely only on the supplement because yes, you can do that, but it’s really best to get some of these nutrients in the way that nature intended from natural foods. And the good news is there’s so many foods out there that can help provide us our eyes with lutein and zeaxanthin. This is what I really try to focus on in the book is there is a diversity of different foods, like for example, I’ll just list a couple of them.

Evelyne Lambrecht: Yes, that was my next question.

Dr. Rani Banik: Yeah. Leafy greens are really, I would say, in terms of macular carotenoid content, leafy greens really are at the top of the list. So, spinach, kale, collard greens, Swiss chard, romaine lettuce, those are amazing sources. But let’s say you don’t like the taste of leafy greens, you find them a little too bitter. Let’s say you have sensitivity to oxalates, which are compounds that are found in high concentrations in leafy greens.

The good news is there are many other foods that you can turn to get your lutein and zeaxanthin intake. So, egg yolk is a wonderful source. That beautiful orange, yellow color of the egg yolk is because it’s high in lutein and zeaxanthin. I know a lot of people have taken to throwing out the egg yolk and just having the egg whites, but please, please, please don’t do that. Make sure to have your egg yolk.

And then, other fruits and vegetables that are orange or yellow in color, for example, I love this orange peppers and yellow bell peppers. Many people immediately when they think about using bell peppers in their food, in their meals, they turn to green. But orange and yellow have the highest lutein and zeaxanthin content along with corn, which I know some people stay away from corn because they’re concerned about GMO corn, but you can always get non-GMO corn.

But it’s a wonderful source of lutein and zeaxanthin. And actually, the scientific name for corn is “Zea mays,” and that’s where the word zeaxanthin came from is actually it came from corn. So, those are some great sources. Even some spices are good sources of lutein and zeaxanthin like paprika. That beautiful color of paprika is because it’s high in lutein and zeaxanthin as well.

Evelyne Lambrecht: Awesome. Well, my favorite is Nasturtium flowers, but they only grow right now along the San Diego River. And I think I see them in patches all over San Diego.

I don’t know if they grow all over the country. They’re spicy, but they are good. But obviously I can’t get enough of that to sustain me.

Dr. Rani Banik: Actually, I think we were talking about this earlier, Evelyne. I actually had someone reach out to me and say she was diagnosed with early-stage macular degeneration, and she just started to have lots of edible flowers, including nasturtium and also marigold. Marigolds are a wonderful source as well. Marigold petals, particularly the deep orange ones. She was able to turn her macular degeneration around.

So, her doctor, she went back to her ophthalmologist, and he said, “Wow, whatever you’re doing, keep doing it. Because those changes that were there before have basically reversed, which is incredible.” That’s wonderful that she was able to do that. So, I love the idea of edible Flowers.

Evelyne Lambrecht: Yeah, that’s a really great story. I know supplementally, one of the biggest extracts that I see is Lutemax 2020, so I’m curious about some of the research around this ingredient. Can you tell us more about it?

Dr. Rani Banik: Yeah, so Lutemax 2020 is a blend. It’s a proprietary blend of all three of the macular carotenoids. So, it’s probably the most commonly used branded ingredient out there in most supplements that provide lutein, zeaxanthin and meso-zeaxanthin. Also, in Lutemax 2020, the ratio the way is designed so that it allows for the best absorbed bioavailability the way nature intended for these macular carotenoids to be provided to our eyes and the rest of our bodies as well. And there is the company that makes Lutemax 2020.

They actually are heavily based in science, so they run a lot of clinical trials looking at the benefits. So, there are quite a few clinical trials out there showing the benefits of Lutemax 2020 for eye health, eye strain, eye fatigue. They just did a study in kids, which is amazing in children, school-aged children using Lutemax 2020 to help with their screen fatigue, et cetera.

And there’s also studies looking at brain health, so cognitive benefits of Lutemax 2020. So, it’s my go-to ingredient. So, whenever you’re looking for an eye health supplement, always look for that particular ingredient on the label.

Evelyne Lambrecht: We know our kids need that. Screen time is rampant.

Dr. Rani Banik: Yeah. Well, actually, I’m going to ask you. How many hours do you think a typical adult in the US spends on a screen?

Evelyne Lambrecht: Well, I know how many I spend, and it’s embarrassing. I guess it depends on the kind of job you have. I don’t know. Eight, ten.

Dr. Rani Banik: Yeah, actually higher than that. It’s higher. And so, this study came up before the pandemic, and it was 10 hours, 36 minutes was the average, which is crazy to think. And that was pre-pandemic. So now, I know that number’s probably gone up quite a bit.

A lot of us are still maybe working from home. Kids are on screens all day. So, for adults it was over 10 hours. For children, it was about six hours a day on a screen, which is really, that’s a lot. Yeah, it’s a lot.

And it can definitely take a toll on our eyes. And that’s why you really need to provide your eyes with that blue light protection in the form of the macular carotenoids more than ever. Really important.

Evelyne Lambrecht: I love it too, that there is research showing it also helps with cognitive health, and I believe there are studies on skin health too. There’s a lot of crossovers between eye health and skin health nutrients.

Dr. Rani Banik: Yes. Yeah, absolutely.

Evelyne Lambrecht: Yeah. Since you mentioned blue light a couple of times, I actually would love to ask you about blue light glasses really quick. So, the ones that have a light filter, not orange glasses, is that something that people should be wearing all day if they’re on a computer or just at night before going to bed? What are your thoughts on that?

Dr. Rani Banik: Yeah, it’s one of the most common questions I get from my patients is, number one, should I buy blue blockers? And then, number two, which brands are the best to buy? So, my answer to that is if you can get enough of these carotenoids in your diet, the macular carotenoids, and if you’re maybe taking a supplement, you may not necessarily need to have those blue blocking glasses. That’s number one. Number two is if you do have a lot of eye strain and fatigue despite doing supplementation and diet, then yes, you may consider doing a blue blocker.

But the tint is really important. So, you were alluding to this earlier, is if you have a light tint, whether it looks clear or if it looks like a slight light-yellow tint, those glasses are not blocking much of the blue light. So, those glasses are probably blocking only about 10% to 30% of the blue light. And so, if you wanted to have just a little bit of something during the day, you can certainly wear them. But at nighttime, that’s probably not sufficient to protect your eyes at nighttime and protect your eyes basically from the adverse sleep effects of too much blue light, particularly later in the day.

So, if you’re working late into the night, you want to get some good blue blocking glasses. I would suggest getting a deeper, deeper tint. So, either deep orange or amber or deep, deep red. And the way you know how much blue light it’s blocking is, yes, you can ask your optician, you know how much blue light does this really block. But a simple test you can do is you can put them on and you can look at your screen and you’re looking for the color blue on your screen.

And if you can still see blue pretty well, you know that those blue blockers are probably not blocking that much of the blue light versus if you wear some of the deeper tinted blue blockers, again, red or orange or amber, when you put those on, you don’t see any blue light at all. So, you know that those blue blockers are probably blocking about 98% to a 100% of the blue light coming from your screen. So, keep that in mind. And sometimes even though I try to work on my diet and I take a supplement, I still do feel some fatigue.

So, sometimes I do wear blue blockers myself, and I have different pairs for different needs or different times of the day. So, you can have maybe two different types of blue blockers depending on what your needs are and switch them up depending on the time of day. The other thing I really love is there is an app, there’s a screen filter app that you can download to your computer, which is very sophisticated. It knows where you are geographically, so it knows what time the sun is rising and what time the sun is setting. And so, it can mirror the natural amount of blue light coming from the sun, on your screen, so it can adjust the amount of blue light coming from your screen depending on what time of day it is.

And so, it’s called Iris. You can download it to your computer, to your phone, to your tablet, basically any screen except a television you can download it to and you can try it out. And you’ll see there are different modes you can play around with and you can see what your eyes feel most comfortable with, but that’s another great way to modulate the amount of blue light coming from your screen and to help improve your sleep as well.

Evelyne Lambrecht: Thank you for that. I actually have not heard of Iris. I use f.lux, but it sounds similar.

Dr. Rani Banik: Yeah, it’s similar. I actually prefer Iris because it has a lot more functionality built into it, and at least the last I checked, there are at least 27 different modes you can try playing around with. So, they have a healthy mode, they have sleep mode, movie mode, gaming modes. There’s a lot of different permutations, combinations of the filters that you can apply on your screen. But f.lux is wonderful as well.

Evelyne Lambrecht: Great. Thank you. Okay. Let’s talk a little bit more about other types of supplements. So, we talked a lot about the carotenoids. Let’s talk about some of the antioxidants and bioflavonoids. Can you name some of them, some of the most popular ones that you recommend and maybe foods that they’re in and just some of the research in eye health on those?

Dr. Rani Banik: Yeah, absolutely. So, bioflavonoids, they’re abundant in nature, there’s over 4,000 of them that have been identified in nature, and they protect plants from disease, from infection and oxidative stress. So, when we eat them, they protect us as well. And there are studies to show that certain bioflavonoids can help protect retinal cells or retinal pigment, epithelial cells. These are cells underneath the retina that help to keep the retina healthy.

They can help protect the lens and the cornea. So, a couple that I really love are quercetin, which is also very well known for its immune benefits, but it can also benefit eye health. There are studies to show that. Resveratrol, it’s a deep pigment that comes from basically like red wine, grapes, cherries, et cetera, but that can also help protect the eye and maybe even help protect against glaucoma. Then sulforaphane, which comes from one of the wonderful sources of sulforaphane, is broccoli, broccoli sprouts or broccoli seed extract.

So, I love educating my patients about how they can incorporate some of these plant derived compounds in their diet, but also maybe look for them specifically on the labels of supplements. If they’re taking a supplement for their eye health or maybe they’re taking a multivitamin, make sure that your multi has some of these key bioflavonoids in it so that it’s not just protecting your body, supporting your body and other functions as well. But it’s also protecting your eyes in a very deep, meaningful way. I think it’s really important to try to boost your eye’s nutrient support system in every way possible.

Evelyne Lambrecht: Yeah. And then, what about some of the other supplements that you recommend? I know one of the categories in your book that you also talked about were the anti-inflammatories, and we talked about the omegas already. What are some of the others that you recommend to your patients?

Dr. Rani Banik: So, I love vitamin D as an anti-inflammatory. It’s not just a vitamin. It actually has so many functions in the body, functions like a hormone almost, it’s anti-inflammatory. So, I love getting my patient’s vitamin D levels up, boosting them with diet and also supplementation, and also curcumin, which comes from turmeric that’s commonly known as a spice turmeric. But curcumin has been shown to have many anti-inflammatory benefits for the eyes ranging from all different parts of the eye, the front of the eye, the cornea, the lens, the retina, the optic nerves.

There are many, many potential different eye structures that can benefit from having curcumin. So, those are my go-tos. But all the omegas, as we talked about earlier, DHA, EPA, GLA, those are also very helpful for vision health.

Evelyne Lambrecht: Yeah. Can you name some of the biggest bang for your buck foods that you recommend to your patients?

Dr. Rani Banik: Yeah. The biggest would be, we talked about the leafy greens already, but also berries. I love berries because they… we didn’t talk about this earlier. We were talking about bioflavonoids, but there’s another class of bioflavonoids called anthocyanins. And these produce, they’re deep pigments, so they are found in deeply pigmented berries like blackberries, blueberries, you can even find them in red berries like goji berries, raspberries, strawberries. But these pigments have also been shown to protect our eyes, particularly the retina.

So, I would say again, leafy greens, berries. And then, I would say the third food group I would include are nuts. So, nuts of all kinds.

But if I had to choose one nut that I love the most, it’s pistachio for your eyes. And it’s because pistachio, not only does it have healthy fats, it has omega-threes, it has some omega-6s as well, but it also has lutein and zeaxanthin. So, that greenish color of the pistachio is actually because of it’s rich in lutein and zeaxanthin as well.

Evelyne Lambrecht: Amazing. That’s one nut I just don’t really seem to ever eat. So, we’ll have to change that.

Dr. Rani Banik: Yeah. Any kind of nut is wonderful. So, cashews, almonds, they’re also rich in vitamin E, which is also another important antioxidant for eye health, for prevention of cataracts, and also macular degeneration. Since we’re talking about vitamin E, I know a lot of people always ask, is there a particular form of vitamin E that may be beneficial? And my go-to is also always tocotrienol. There are different forms of tocopherols, tocotrienols, but I love delta tocotrienol, delta and gamma combined for eye health. There are some early studies looking mainly in animal models, but looking at cataracts and cataract prevention using tocotrienol.

So, we know that it’s a very, very potent antioxidant. And there also may be some anti-angiogenic benefits of tocotrienol as well. So, I think there may be some future studies looking into macular degeneration, perhaps even diabetic retinopathy using tocotrienol. So, I love that particular form of vitamin E.

Evelyne Lambrecht: Very interesting. With tocotrienols, we know that it helps with so many other things already. So, it’s great to hear that it’s being studied more in eye health as well. In terms of making this simple for your patients. I think in your book you said you encourage five cups of plant foods per day.

When you tell your patients that, I mean, I think that most of the guests we’ve had on the show, that’s probably what they recommend to their patients. But I’m curious how you recommended it in the context of eye health and to encourage them to do it?

Dr. Rani Banik: Yeah. I have a very simple way to get your five cups in, and actually not just throughout the day, but just all in one go. So, this is a super quick hack you can do incorporate into your daily routine is to have a green smoothie every day. And within the smoothie, the simplest thing to do is you pack in three to four cups of leafy greens. You’re getting about at least three cups right there, and put in whatever leafy green you like, then add in a cup of berries, and then you can add in some seeds.

So, chia seeds, flax seeds, hemp seeds, whichever seeds you like. They provide ALA, which is a precursor to DHA and EPA. So, you’re getting some good omega-3s there. You can add some protein powder. You can add the milk of your choice, add some ice, maybe add some flavoring to it.

And right in that one smoothie, you can easily get basically your five cups, your daily requirement right there. So, super quick, super simple, and then you’re done for the day. And you’re supporting your eyes, but also other parts of your body as well. A daily green smoothie is great for your brain health, it’s great for your skin health, it’s great for migraines, so many other health benefits of doing a daily green smoothie every day.

Evelyne Lambrecht: Yep. Smoothies for the win.

Dr. Rani Banik: Yes.

Evelyne Lambrecht: One more topic that I would love to cover is the AREDS studies, AREDS, A-R-E-D-S, age-related eye disease studies. So, what did those studies show? I think there were two sets of them. And why did they only show a 25% reduction in risk, I believe it was in… was it macular degeneration? Tell us more about those.

Dr. Rani Banik: Yeah. So, the ARED studies, these were two pivotal clinical trials in ophthalmology. They were sponsored by the National Eye Institute, which is part of the NIH. And each of the studies had over 4,000 patients in them. And what the studies we’re looking to see is whether supplementation can help prevent two eye diseases, age-related macular degeneration and cataracts.

So, what they found was that they had a very specific formulation that they were working in with. So, AREDS1 had vitamin A at a high dose, vitamin E, vitamin C, copper, and zinc. So, basically these select nutrients taken for… I forgot exactly how long it was maybe a year or so. And patients were examined to see if they were at risk for developing cataracts or macular degeneration. So, there was really no benefit that they found for cataracts, but for macular degeneration, they found that only a very specific subset of patients with AMD, which is the short form of macular degeneration, benefited only about 25% of people who had that particular type of macular degeneration benefited.

So then, the next phase of the study, AREDS2, what they did was they took out vitamin A because they were worried about it may be causing lung cancer and smokers. So, they took out vitamin A. They replaced vitamin A with lutein and zeaxanthin, and they also added in DHA and EPA in some of their arms of the study. And what they found was that switching out for lutein, zeaxanthin basically still conferred the same 25% reduced risk. So, the question is, why don’t more people benefit?

Why is it that there’s only such a limited number of people who benefit? And my thoughts, I have many thoughts about the AREDS studies about why they didn’t quite have as much to protect or they didn’t confer as much protection as what we would’ve liked because it’s not just six nutrients that we need to focus on. There are many more. So, if you’re only giving people a select number of nutrients, it’s not really supporting their whole eye health. But also, these studies were published in the mid-1990s to early 2000s.

And since then, we know that there are other nutrients that are also really, really important for retinal health, including meso-zeaxanthin, which is the third macular carotenoid that was not included in those studies. And we think that maybe meso is perhaps of the three macular carotenoids, the most important of the three. Also, astaxanthin, which is a nutrient that comes from marine algae, which is also a potent antioxidant maybe of all the antioxidants that are known to us, maybe the most potent of all the antioxidants.

And you’ve probably heard of astaxanthin when it comes to skin health or maybe brain health, but it’s also been shown to be beneficial for eye health as well. I also really strongly think that one of the reasons why the AREDS didn’t do quite so well was because it didn’t have bioflavonoids in them. So, I think that’s another key important group of nutrients that were missing in AREDS and also didn’t have tocotrienol. It had tocopherol, but it didn’t have tocotrienol. So now, they’re planning for a third AREDS, the AREDS3 study.

So, I think this is going to probably be launched within the next few years. I don’t yet know what the formulation is that they’re planning to include in that, but I’m really curious to know whether it’s going to have the meso-zeaxanthin, whether it’s going to have astaxanthin, whether it’s going to have tocotrienol, and whether it’s going to have the bioflavonoids as well.

Evelyne Lambrecht: Do you get to have any input? Can you submit something to them?

Dr. Rani Banik: Oh, no, I’m not directly involved. There’s a Dr. Emily Chu, who’s been the lead researcher in these studies, and she’s been really important in designing the study, in choosing the nutrients. But I will definitely reach out to her and let my opinions hopefully known. When I was writing the book, I really looked at a lot of the research out there, what’s been published, what’s been shown, what theoretically may benefit the eye. And so, I just find that sometimes it’s whatever is out there doesn’t necessarily make it into human studies.

But I really do hope that those nutrients that I mentioned, I do hope that they will make it into the third AREDS, because I think those are the key missing links to supporting complete eye health.

Evelyne Lambrecht: Yeah, I thought there was something interesting too. I think you wrote about this in the book, but the study also gave people really high levels of zinc, like extraordinarily high. How much was it?

Dr. Rani Banik: Yeah. 80 milligrams both studies, AREDS1 and AREDS2. And it’s really shocking to think or to hear that, “Why is it 80 milligrams?” The recommended maximum daily allowance for adults is 40 milligrams in the US. So, they were doubling the amount of zinc that they were giving. And because of that high level, they also had to give copper to make sure that copper didn’t get needed with those really, really high levels of zinc.

And the other thing I’ll tell you is that not all people can safely take that high level of zinc. There are actually two genetic variants that have been identified, and people with macular degeneration that if they take a very, very high level of zinc, it actually increases their risk of macular degeneration. So, not only, it doesn’t not just do anything, it actually makes them at higher risk for macular degeneration if they’re having that 80 milligrams of zinc a day.

So now, some of the formulations have actually cut back on the zinc level because they realize that for some people with macular degeneration, it may actually be toxic and harmful. So, it’s important to realize that and be mindful of those high levels. And in my practice, I actually do genetic testing specifically to see if my patients have those specific variants, those markers. And if they do, then I really limit the amount of zinc that they’re getting from supplementation because you don’t want to overdo it with that important nutrient.

Evelyne Lambrecht: Very, very interesting. Do you know what those SNPs are off the top of your head?

Dr. Rani Banik: Yes. Complement factor H and ARMS2.

Evelyne Lambrecht: Interesting. Going to go look at my raw data.

Dr. Rani Banik: There’s one more. I don’t remember off the top of my head, but there’s actually three genetic variants.

Evelyne Lambrecht: Cool. Thank you so much. I’d like to transition to some questions that we ask every guest on the podcast. And I think I know the answers, but what are your top three supplements that you personally take?

Dr. Rani Banik: Yeah. So, first of all, I take my eye health supplement, which includes the three macular carotenoids, astaxanthin, berry extracts, and tocotrienol. And then, I take a multi, which has everything a normal multi would have, but it has those bioflavonoids that we talked about earlier. And then, I take an omega supplement as well. So, those are my go-tos. And because I have migraine, I actually have a separate one I take as well that includes specific nutrients for migraine, including magnesium and riboflavin, and a couple of other things like feverfew.

Evelyne Lambrecht: Nice. What are your top health practices for your personal health and wellbeing? I feel like you’ve come a long way since those early days of pizza and coke.

Dr. Rani Banik: Yeah. So, I would say the biggest thing that made the difference for me, it was changing around the amount of fruits and vegetables I had in my diet. So, before I had basically none, like hardly any fresh fruits and vegetables. Now, I try to get at least five cups in a day, oftentimes more than that, seven or nine cups a day. The other thing is exercising regularly. So, I really was not doing that during that period in my life.

So, I make it really a priority now is to exercise regularly at least three times a week to get my heart rate up, to keep my heart health and support that. And then, the third thing is stress modulation. So, I know many people have stress from various different aspects of their lives, whether it’s stress at home or stress at work or stress with their health. But it is important to find ways to try to modulate and mitigate that stress and so you can better be able to deal with it. So, I think it’s really, so for me, it’s taking long walks, it’s doing some meditation, it’s doing yoga.

These are my go-to for stress relief. But everybody has to find what may work for them and help support them in a very foundational way.

Evelyne Lambrecht: What is something that you’ve changed your mind about through all of your years in practice?

Dr. Rani Banik: So, one thing that really, I’ve learned is that one, it’s not a one size fits all for everyone. It’s not that what works for one person is going to work for everyone. So, you have to find your own path and whether it’s your diet, whether it’s your supplement regimen, whether it’s your lifestyle routine, find what works best for you, because again, it could be, you could have an identical twin and it may work for you, but it may not work for them. So, it really is a very individual journey to find what works best for you, and you have to resonate with that to really support you.

Evelyne Lambrecht: Yeah. Great points. Rani, thank you so much for being here. Where can practitioners learn more about you and your practice?

Dr. Rani Banik: Thank you for having me, and I love sharing all this information. You can find out a lot more about what I do and what my philosophies are and my mission through my website, which is www.drranibanik.com. Also, if you’re on Instagram, I do post a lot of tips, eye health tips, as well as migraine tips on Instagram, and I have a YouTube channel as well where I have a lot of educational videos.

Evelyne Lambrecht: Awesome. Thank you. Thank you so much again for sharing your knowledge, and it’s so great to have you as an ophthalmologist sharing this information and implementing functional medicine. It’s very inspiring, so thank you.

Dr. Rani Banik: Well, thank you so much. Thank you.

Evelyne Lambrecht: Thank you for tuning into Conversations for Health. Check out the show notes for resources from our conversation today. Please share this podcast with your colleagues. Follow rate or leave a review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht dedicated to engaging discussions with industry experts exploring evidence-based, cutting-edge research and practical tips.