Ep. 314 Optimizing Eye Health: Migraines, Hormones, and Beyond with Dr. Rudrani Banik

I am privileged to connect with Dr. Rani Banik today, America’s integrative eye doctor. Dr. Banik is a board-certified ophthalmologist and a fellowship-trained neuro-ophthalmologist with additional certifications in functional integrative medicine.

In our discussion today, we dive into the evolution of migraines, exploring whether genetics and epigenetics have a role to play in the development of neurological headaches. We delve into the role of nutrition in maintaining optimal eye health, highlighting the specific nutrients essential for our eyes throughout the various stages of our lives. Our conversation touches on how hormone replacement therapy affects eye health, particularly in people with dry eyes, and we look at the effects of sunlight and ways to modulate the impact of blue light exposure. We also get into chronobiology and share strategies for safeguarding our vision as we age. 

Dr. Rani shares a wealth of helpful information today that many women in the everyday wellness community have asked for. You are bound to be enlightened by her insights and wisdom!

“If you think you have sinus headaches, talk to your doctor and ask if you could be having a migraine, because the treatment is very different, and it is best to get the right diagnosis so that you can be treated appropriately.”

– Dr. Rudrani Banik

IN THIS EPISODE YOU WILL LEARN:

• What are migraines?
• How the hormonal changes that happen with menstruation, perimenopause, and menopause can trigger migraines  
• How migraines evolve and change with age
• Dr. Rani explains the neurological foundation of photophobia with migraines 
• How to differentiate migraine pain from debilitating headache pain
• The natural changes that occur with our eyes as we get older
• Why dry eye is a common issue in women, especially during perimenopause and menopause
• How Dr. Rani manages dry eye in her perimenopausal and postmenopausal patients
• How to prevent cataracts 
• Using UV protection and avoiding too much exposure to blue light for healthy eyes
• The role hydration plays in maintaining eye health

Bio:

Dr. Rani Banik is America’s Integrative Eye Doctor. She is a board-certified ophthalmologist and fellowship-trained neuro-ophthalmologist with additional certification in Integrative and Functional Medicine. Dr. Rani focuses on the root cause of eye diseases and uses integrative strategies for conditions that affect the visual system. Her treatments are based on nutrition, botanicals, lifestyle modification, essential oils, and supplements.

Dr. Rani runs a private practice based in New York City and is also an Associate Professor at Mount Sinai in NYC, where she serves as an educator and researcher. As Principal Investigator of several clinical trials in diseases of the optic nerve, Dr. Rani uses cutting-edge approaches such as nanotechnology and gene therapy. 

Dr. Rani is frequently featured as an expert in the media and has been interviewed on Good Morning America, CBS, NBC, ABC, The New York Times, The Washington Post, and Fox, amongst many others. Dr. Rani has been voted Castle Connolly’s Top Doctor and New York Magazine’s Best Doctor in Ophthalmology every year since 2017.

Dr. Rani’s first book, Beyond Carrots – Best Foods For Eye Health A to Z, has won high praise from medical professionals in both the fields of ophthalmology and integrative medicine. Beyond Carrots focuses on the 30+ nutrients and 40 foods that best provide complete nutrition for your eyes. Dr. Rani has a companion cookbook as well, The Beyond Carrots Cookbook, which includes over 160 delicious and nutritious recipes that will be a feast for your eyes! Both are available via Amazon and Kindle in print and eBook.

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Transcript

Cynthia Thurlow [00:00:01] Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. 

[00:00:28] Today I had the honor of connecting with Dr. Rani Banik. She’s America’s Integrative eye doctor. She’s a board-certified ophthalmologist and fellowship-trained neuro-ophthalmologist with additional certifications in functional integrative medicine. Today, we dove deep into the evolution of migraines, discussing ways that genetics as well as epigenetics play a role in whether or not we develop this neurologic headache, the role of nutrition and eye health, and specifically what nutrients are key to healthy eyes throughout our lifetime, how HRT can play a role in eye health, especially with dry eyes, the role of sunlight in chronobiology, the impact of blue light therapy, and what are the best ways to protect our vision with age. I know you will enjoy this conversation as much as I did recording it.

[00:01:19] Well, Dr. Rani, I’ve been really looking forward to this conversation, largely because you have such a broad area of expertise in ophthalmology, neuro-ophthalmology. And I just think you have so much helpful information that I know women of the Everyday Wellness Community are really looking for. I got a lot of really great kind of broad questions. So, welcome, it’s so nice to have you joining me this morning. 

Dr. Rudrani Banik: [00:01:43] Well, thank you so much, Cynthia. It’s really a pleasure to be here. I’m very very excited to chat with you today. 

Cynthia Thurlow [00:01:48] Yeah. And I thought kind of a less common topic that we have explored on the podcast is talking about migraines. It’s certainly something that there’s a familial aspect of it. My father suffered from migraines, I have suffered intermittently with migraines throughout my lifetime, my oldest son, and so I would love to kind of explore like what exactly do migraines represent? How can they present? because as you mentioned before we started recording, they can present differently for everyone. Not everyone has migraine with an aura, which is what I always started with, that’s how I knew I had a migraine coming, and then that was usually precipitated with, “Oh, crap, now I need to go figure out, do I need more hydration? Do I need to grab my medication?” And so, let’s talk about how migraines evolve and how they change, especially with age, because I was always told, “Oh, when you get older, they’ll go away,” that hasn’t really been the case. And so, I think, in many ways, people are curious about the evolution of migraines, different types of symptoms, how do we address them proactively? 

Dr. Rudrani Banik: [00:02:51] Yes, absolutely. Well, first of all, migraine is one of my favorite topics, partly because I’m a migraine sufferer as well. And also, being a neuro-ophthalmologist, I see a tremendous amount of migraine in my practice. I would say at least 50% of people who are coming to see me have some shape or form of migraine and that’s why they seek me out, so it’s very common. 

[00:03:14] And I think the first thing to address is, what is it exactly? So, it’s not just a headache. I think that’s a lot of people just equate, “Oh, migraine, it’s a bad headache.” It’s well beyond a headache, because it actually is a neurologic condition. And in this neurologic condition, there are changes in blood vessel, blood flow to the brain, there are electrical changes that happen, and other organ systems get involved also, so it’s not just your brain that can be involved with pain, but also your eyes. You can get visual symptoms. Sometimes people have GI symptoms, especially children. We were talking earlier about your migraines when you were younger may have been different than what they are now. And oftentimes children will start out having gastrointestinal migraine, where they have nausea, vomiting, bloating, diarrhea, loose stools. So, there are many manifestations of migraines, sometimes there are sympathetic types of side effects, like people may feel flushed, they may feel like their heart’s racing, they have palpitations, this is all migraine, so it’s not just a headache, and there are actually over 40 symptoms that can come along with migraine. 

[00:04:14] Now, why it happens, we don’t know. There certainly is a familial component, about 50% of people will have a relative with migraine. And actually, if you’re a parent with migraine, there’s a 50% chance that your child will have migraine. If both parents have migraine, then there’s a 75% chance that the child will have migraine, so it has a high penetrance. And so, what I’ll say about the hereditary part of it is that there are many genes associated with migraines. It’s not just a single gene, a single SNP that is associated with migraine. There is over 50 identified genetic risks. Just because you may have a genetic risk for migraine does not mean that you will have migraine, so it’s not inevitable that it will happen to you. And there are so many other factors, those epigenetic factors, those lifestyle factors that come into play whether someone manifests symptoms or not. So, again, if you’re listening to this and you’re thinking, “Oh, my God, I have migraine, my child’s going to have migraine,” not necessarily, but there are so many things people can do to ward them off or to prevent them or decrease their frequency and severity, and we can talk about what some of those things are. 

[00:05:19] And the last thing I want to address is your point about migraines evolving over the course of one’s life, because I think, especially as a woman with migraine, my migraine has certainly changed character over the years, so we can go into that a little bit if you’d like. 

Cynthia Thurlow [00:05:34] No, I would love to, because I know for me, I kind of assumed all my neurologist friends were like “Oh, you won’t get any migraines when you’re in perimenopause, they’re going to go away.” And then I had ophthalmology friends that said, “Oh, no, you’ll actually probably get an increase in migraine symptoms as you transition into perimenopause, and then they’ll probably go away.” Well, I’m now officially in menopause and I can tell you they did not increase in frequency for me, but what did happen was they’re much more magnified. I think that the one thing I’ve learned, my two big triggers are stress. I mean, no one lives a stress-free lifestyle, and dehydration. And those two things, if they’re put together and I’m not taking care, it’s usually a check in, it’s my body’s way of saying, “Hey, you think you’re taking good care of yourself and you’re not.” But what has been your clinical experience and/or what is in the research that suggests the transition of middle age in women, do you see increases in symptoms, exacerbations? What is the typical pattern? And again, there’s a lot of bio individuality that plays into this, but what has been the typical pattern that you have seen clinically? 

Dr. Rudrani Banik: [00:06:39] Yeah, absolutely. So, we’ll talk about women specifically because we are unique in our hormonal changes that happen during life. So, usually migraines begin earlier in life, whether it’s late teenage years or young adulthood, that’s usually when most women will experience their first migraine, and it may be with or without aura. Aura is basically a symptom, it could be a visual symptom, like flashing lights, sometimes there’s another symptom, for example, trouble speaking, trying to get the words out, but you don’t really know how to say or slurred speech, sometimes people will even have numbness or tingling of part of their body, which can be quite frightening, so that obviously needs to get worked up, but that’s the type of aura that people can experience with migraine, and sometimes they just have the aura without migraine. So, typically that occurs during young adulthood, 20s, 30s. 

[00:07:29] And also, I just want to talk about the hormonal component. So, when women are menstruating, sometimes they will have menstrual migraine, which is basically a phenomenon happening because during our menstrual cycle, usually estrogen builds up, progesterone builds up into a really high point, and then right before menses begins, it suddenly drops. And it’s that sudden change in the hormone level that triggers migraine. And so along the same line, whenever there are hormonal changes that is when people may be predisposed to migraines, so during perimenopause, when there’s fluctuating estrogen levels, progesterone levels, that is a big trigger for many people, so it actually may get worse during that time. And personally, I can tell you that I began with migraine in my 20s and I just had migraine maybe twice a year or so, it was very manageable. But once I get into perimenopause, that was a really difficult time for me because I had really frequent migraine with aura. And then eventually it got to be almost every day that I had a migraine, so it was really, really a vast difference in terms of my severity and frequency of symptoms. 

[00:08:37] Then into menopause, as you said, most people will tell you, most providers will tell you things get better, but they really only get better once your body gets used to the change in your hormone level. So even though you may be in menopause, a year or two into menopause, you think that, “Okay, your, my estrogen is low, my progesterone is low, I probably won’t get as many migraines,” but your body still has to readjust, the same as we get hot flashes too, and you would think that, “Okay, I’m in menopause now, my hot flashes are going to go away or I’m five or ten years into menopause, my hot flashes are going to go away,” and they don’t, and it’s probably because your body is not yet used to that low estrogen level. 

[00:09:14] We actually have estrogen receptors in our brain, the part of the brain which is the midbrain and the pons where we think that migraine originates from. And so, there are estrogen alpha and beta receptors there, so that’s one theory as to why migraines are so closely tied to hormonal changes and fluctuations. The other thing I’ll mention about evolution of migraine during one’s life is that it may begin as episodic, it may become more chronic, and then the headache may actually go away, and this is something that a lot of people kind of have a hard time understanding, like, “It’s migraine, why aren’t I getting a headache anymore?” Sometimes other symptoms may predominate. So, for example, especially women and there has been a couple of papers published about this.

[00:10:02] Women who are postmenopausal, they may no longer get the headache, they may no longer have the aura, but they will have a unique form of migraine called vestibular migraine. And I don’t know, Cynthia, if you’ve ever experienced this, but I have, it is not fun. It’s basically like vertigo, where you get, like the room is spinning around you, you feel really unsteady, and you are just totally discombobulated because everything is in motion and it can last a few hours to a few days. So again, that’s a type of migraine without the headache, but it’s called vestibular migraine and many women will evolve into that where they don’t get the typical headache, nausea, vomiting, light sensitivity, they’ll develop something else instead, so it’s really a very complex type of condition and everyone, as you said, bio individuality, no two people with migraine are the same and so you basically need to address it on an individual basis as well.

Cynthia Thurlow: [00:10:59] Yeah, it’s interesting. I have not experienced the vestibular symptoms, but I am noticing girlfriends that are at the stage of life, I’m 52, that are starting to experience vertigo episodes, and I’m starting to read about this association with vertigo and in a low estradiol state, so low estrogen state. And maybe you should talk to your doctor about checking your hormones or maybe it’s time to talk about not being on that oral contraceptive, because you probably don’t need it. You may, in fact, be in menopause or nearly there, might be time to have conversations about other things. You mentioned the sensitivity to light, so this photophobia which is part of my migraine constellation. And what is going on physiologically that’s driving that sensitivity to light? Because I find this really interesting, like, as I was preparing for our conversation, I was like, “Oh, this is so interesting,” what is going on neurologically from a neuro-ophthalmology perspective, what is actually driving that sensitivity to light?

Dr. Rudrani Banik: [00:11:58] Okay, so I’m going to nerd out a little bit here with my response. So, there are different types of cells in the back of the eye that capture different wavelengths of light. And one type of cell is called, now this is a tongue twister also, intrinsically photosensitive retinal ganglion cell, so ipRGC. And it’s actually phenomenal that this type of cell was only discovered a couple of years ago, within the past decade. We didn’t even know that we had these cells. But these cells are sensitive to very specific wavelengths of light, predominantly blue wavelengths of light, so within the 400 to 480 range is where these cells are tuned in. When they get stimulated by those wavelengths of light, those cells actually project to the same part of the brain where I was talking about before, within the midbrain pons area, where there is the trigeminal nucleus caudalis, and that trigeminal nucleus caudalis is responsible for migraine. It’s really like the relay center for where everything happens with migraine. The incoming stimuli and then the pain, the outgoing pain, efference are all managed by this trigeminal nucleus.

[00:13:09] So those cells, those retinal ganglion cells are projecting right to that pain center. And so that’s oftentimes why we have sensitivity to bright lights, but also flashing lights. That’s also a very common symptom in people with migraine, is that any kind of strobe effect, like for example, if you’re in a grocery store and you see those overhead fluorescents and one of them is kind of flickering and it’s really making you uncomfortable or making you nauseous or queasy, that’s because those cells are getting triggered. The same thing happens with screens. So, we don’t perceive this, but our screens are constantly flickering. And they’re flickering, they’re made that way. They go on, off, on, off, on, off at a very high rate to save battery life. But when they’re doing that, our eyes may not see it, but our brain can pick it up that it’s constantly flickering and that can be a trigger for some people as well when just simply being on a screen for a prolonged period of time, as many of us are, unfortunately, that can be a trigger for people’s migraine and light sensitivity. So, it’s really interesting how intimately the visual system is connected to the brain’s pathways for pain, specifically for migraine pain. It really [crosstalk] almost, yeah.

Cynthia Thurlow [00:14:21] Yeah. No, it was so interesting because as I was preparing for this, I was noticing–. Thankfully, I don’t get migraines with any frequency, but when I do now, I will sometimes get pain kind of referred around my nose and I kept thinking, like, what could be driving that or pain across a cheek? And so, it makes sense this trigeminal nerve kind of distribution can definitely play a role in their referred brain. And I was like, oh, that makes sense. 

Dr. Rudrani Banik: [00:14:46] And actually you know speaking of the trigeminal system, so we have three branches of the trigeminal, branch one that goes to the forehead and the eye socket, branch two that goes to the cheek and the upper jaw, and then the third branch that goes to the lower jaw. So, the trigeminal system also goes to your sinuses. And a lot of people will have, “sinus headaches,” or they think that they’re having sinus headache when it’s in fact, migraine. 

[00:15:12] So, if you look at the classification of the different types of headache syndromes, there is no such thing as a sinus headache, it’s really migraine. So, it’s really interesting, so if you suffer, if you think you have sinus headaches, talk to your doctor and ask, could I really be having a migraine? because the treatment is very different and it’s best that you get the right diagnosis so that you can be treated appropriately.

Cynthia Thurlow [00:15:31] Absolutely. And I think it goes without saying, because this is always the question that comes in and this is, again, a broad question, how do I differentiate migraine pain from debilitating, unusual headache pain? Now, I’m speaking from many years working as an ER nurse where we saw a lot of very unusual presentations. And what would be some of the signs for someone who are listening and they’re like, “Okay, I have a history of migraines, or maybe I’ve never had a migraine,” but what are some of the classic signs of headache that really are an indication that you need to have your symptoms evaluated sooner rather than later? 

Dr. Rudrani Banik: [00:16:09] Yeah, so migraine has very specific criteria, diagnostic criteria. And so usually it has to be multiple episodes. So not just a single episode, but multiple episodes. Each episode has to last anywhere from 4 to 72 hours. So, it may be a couple of hours or it may be a couple of days. In most cases, migraine is unilateral, so one sided, throbbing or pulsing, that’s the typical sensation that people have. Less commonly, like a pressure, but usually it’s like, kind of with your heartbeat almost, like a pulsing sensation or a stabbing sensation. Like, some of my patients come in because they feel like someone’s almost stabbing a knife into their eye socket or into their head that’s how intense it can be. 

[00:16:54] And also with migraine, compared to other types of headaches, like, for example, tension headaches, migraine has associated symptoms. And we touched upon light sensitivity or photophobia, but also phonophobia. And this is really really important to recognize because many people who have migraine, they just kind of want to go into a dark room, but also they don’t want any sound, they want it completely quiet, they’ll tell their family, turn down the TV, it’s too loud, just calm it down, it’s too, too loud. So light sensitivity, sound sensitivity, nausea, and vomiting, so those are the associated symptoms, but the typical symptoms. 

[00:17:27] But again, like I was talking about earlier, there are over 40 symptoms associated with migraine. So just because those are the criteria, your migraine may not fall into that nice box, that nice category. So be sure to talk it over with your doctor. And if you’re suspicious, you may have migraine, or let’s say you have a family member with migraine and you think you may have migraine as well, then definitely ask for a referral to a neurologist, really to sort it out and be appropriately diagnosed.

Cynthia Thurlow [00:17:53] Yeah, I think that’s so important. No one needs to suffer in silence, number one. Number two, make sure you’re getting an appropriate diagnosis. And the thing that’s been interesting to me is there’s still so much misinformation about migraines. I think many people, I would say healthcare professionals included, sometimes think migraines aren’t a big deal. I’ll be the first person to say, because I’ve had a history of migraines, I’m very sympathetic when people say, “I feel like I need to go in a closet, just crawl on in a ball in the closet, be away from light and sound and people and humans, because I just feel that badly,” so it can be very debilitating for people. And I’m always, oftentimes amazed at individuals that will say they’ll have a migraine for, like, three days. I’m like, I couldn’t function, mine’s usually short lived, but it can be very debilitating. 

[00:18:42] Now, I’d love to kind of pivot and talk in generalities about overall recommendations that you make to your patients about the role of nutrition and lifestyle and eye health. I think this is so important. I think a lot of us make the association that carotenoids and carrots are beneficial. There’re beneficial compounds and carrots, but there’s so much more than that. And I know this is a particular area of interest for listeners. They kept saying, what are the real things? What are the real foods and lifestyle piece that can be very beneficial to eyes, especially as we’re aging? I think there’s a lot of misinformation that’s out there. I think people just assume they drop off a cliff in perimenopause and menopause, and they automatically get macular degeneration and glaucoma. And so I said, let’s kind of start from a place of proactiveness, and then we’ll kind of work towards some of the more common things you see in middle-aged women. 

Dr. Rudrani Banik: [00:19:34] Yeah, absolutely. So, there are some changes that happen to our eyes naturally with age, and one of them is difficulty reading, which is called presbyopia. And it happens usually in one’s late 40s, 50s, where you just can’t see clearly and you kind of have to hold things further away from you, that’s presbyopia. And ultimately, many people end up needing reading glasses, so that’s something normal, that’s something physiologic. And yes, you can kind of push it off or there’s kind of workarounds for the reading glasses, there’re things that you can do. But from a nutrition and lifestyle perspective, that happens to almost all of us. But then there are other things where they can happen as we get older and these things are preventable using the power of food and using the power of lifestyle modification. 

[00:20:20] So, I’ll take, for example, dry eye, which is very very common in the overall population, but specifically in women, particularly as they get to perimenopause, menopause. And I would say in my patient population, if I have a woman above the age of 50 without dry eye, she’s the exception. I would say over 75% of my patients who are over 50 have dry eye, particularly women. So what’s happening here? Well, there are hormonal changes, obviously decreasing levels of estrogen, progesterone, but also testosterone. And all of that together impacts the glands in our eyes produce oils and secrete tears. And so yes, you can put a band-aid on it using eyedrops like lubricating drops, you can do warm compresses, but the goal is to really get those glands functioning well and to support them in whatever way you can, so I oftentimes use, there are studies, many studies showing that nutrition is important for dry eye management. So, you want to have adequate amounts of omegas in your diet, particularly omega-3s. So great sources are various types of fish, salmon, tuna, mackerel, but also there are plant-based sources as well, seeds, chia seeds, hemp seeds, flaxseeds. And then GLA, which is an omega-6, is also helpful. It’s also been shown to be helpful for dry eye. GLA is not readily found in foods, but you can get it from a supplement. And then there are a couple of other nutrients, like, for example, vitamin A is important for dry eye, zinc is important for dry eye, etc. 

[00:21:49] But I’ll also talk about, we were mentioning this earlier before we started recording about hormone replacement therapy. So, there are some large studies that looked at the benefit of doing traditional hormone replacement therapy for dry eye. And those studies actually found that it was not helpful. So why it was not helpful? I can only hypothesize, maybe it’s because those hormones are not getting to where they need to be, so in my practice, what I’ve done is I’ve started putting some of my perimenopausal, postmenopausal patients on compounded eyedrops that have hormones in them. And yes, I’m a little bit– this is not mainstream by any means, but understanding things from a functional medicine perspective and integrative medicine perspective, I am thinking about the root cause and where the root cause is coming from, so yes, the body’s depleted of these hormones, but specifically for dry eye, you have to think about the eye, so why not deliver it directly to the eye? that’s my thought. So that’s what I do in my practice. And also some patients are on bioidentical hormone replacement therapy, and sometimes that helps them as well. So, it’s a multifaceted approach when it comes to nutrition, lifestyle, etc. And then there’re many lifestyle things you can do for dry eye. 

[00:23:07] Now, talking about some other things you mentioned earlier, macular degeneration. Unfortunately, it is one of the leading causes of blindness in the world. The good news is that it is preventable and it is preventable using the power of nutrition. So, there are many large-scale studies looking at different populations and what types of diets they had, and what we know is that people who have a diet rich in fresh fruits and vegetables that provide the macular carotenoids. So, there are many carotenoids out in nature, but the macular carotenoids are key in the prevention of macular degeneration. 

[00:23:43] And so, this is what I talk about, I have a book that I release called Beyond Carrots: Best Foods for Eye Health. I talk about the macular carotenoids, lutein, zeaxanthin, you may have heard of them, they’re kind of hard to pronounce, but they’re super, super important for your vision health, for prevention of macular degeneration. And not only that, there actually are also studies showing that they not only benefit your eyes, they’re also good for cognitive health. So, as we get older, our brain is aging as well, so there are actually some really, really remarkable studies showing their benefit for cognitive function and memory. 

[00:24:17] So where can you get these nutrients, lutein and zeaxanthin? There are many sources. Unfortunately, our bodies can’t make them, so we have to get them from outside, either from food or from a supplement. But in terms of foods, leafy greens are probably highest on the list, spinach, kale, any kind of greens, collard greens, Swiss chard. If you can’t have leafy greens for whatever reason, if you’re sensitive to oxalates, then there are other great sources as well. For example, corn. If you choose corn, the non-GMO corn, and then also egg yolk is a great source. You know, that beautiful yellow orange color of the egg is actually from lutein and zeaxanthin, so these are yellow pigments. And then you can get them from some fruits, like nectarines, peaches, and also zucchini is a great source, and even spices like paprika. So, there’re many many ways you can get these nutrients. And then, if you are worried about it, macular degeneration, if it runs in your family, take a supplement as well. I’m a big big advocate of taking supplementation for prevention of eye issues going forward.

Cynthia Thurlow: [00:25:19] Well, and it’s interesting how many of my patients in cardiology that were women that had macular degeneration, and they would talk to me very openly about how much it had impacted their lives. And it’s always been kind of tucked in the back of my brain to make sure I’m having these ongoing discussions with my eye provider, largely because I want to do everything I can. And I wonder if our kind of modern day standard American diets are impacting the incidence of macular degeneration, as many people are not consuming, I would imagine, a lot of fruits and vegetables, and if they are, it’s probably more potatoes and corn than eating these brightly pigmented vegetables, so that’s certainly very helpful. 

[00:26:01] And in terms of other things that I know are common to see as we’re getting older, like glaucoma and cataracts, are there things that we can do proactively? I know that glaucoma seems to be something. It must be in my age group right now, glaucoma is, there are lots of husbands who seem to be going on glaucoma drops. They’ve got intraocular pressures that are elevated. This is why it’s important to see your ophthalmologist every year and get those eye exams. But do you feel like they’re much like with macular degeneration, if you are changing your diet and adjusting your lifestyle, that you can lessen the likelihood that you will go on to develop these eye disorders? 

Dr. Rudrani Banik: [00:26:34] Yeah, so in terms of glaucoma, first of all, it’s a silent disease, most people don’t know that they have it unless it’s a very advanced stage, and the only way to know if you have an earlier stage is to go get it checked out. So please, please, please have your annual eye checkup with your eye doctor and get your pressure checked, get your nerve looked at, because it’s not only a pressure problem, the nerve, the optic nerve sustains damage in glaucoma and the only way to detect it is for someone to look in the back of the eye and see what the nerve looks like. 

[00:27:02] So, what causes glaucoma? Well, again, it’s a large kind of category of different types of eye diseases. But usually, if you think about the root cause of glaucoma, it’s oxidative stress. It’s oxidative stress to the various tissues in the eye that are responsible for the optic nerve being healthy. So how can we fight that? We have to have a diet that’s rich in antioxidants. And so, for example, again, going back to the richly colored plants, the rainbow that we should be eating, I think that’s really important. To my knowledge, there have been no large-scale studies on glaucoma and diet unlike macular degeneration. We don’t have the studies to prove it. 

[00:27:46] Yet what I did for when I was doing the research for my book is I researched all the literature in terms of the basic science. So maybe this is an in-vitro study or maybe it’s animal study, and it hasn’t quite made it to the human level yet, but there are plant compounds that can prevent oxidative damage in the optic nerve in the ciliary body which is also involved in glaucoma. So, there are things you can do from a nutritional standpoint to protect those tissues using these antioxidants and also bioflavonoids, things like quercetin, turmeric and omegas as well. So, there’re lots of different things, nutrients that you can keep in your wheelhouse that will help you manage these conditions. The other thing is berries, so berries are very powerful, they have anthocyanins that give them their beautiful colors, especially the deeply pigmented berries. So, berries have been shown or at least berry extracts have been shown to help protect the optic nerve and glaucoma. Even ginkgo biloba, which we’ve heard a lot about for memory and cognition. But even ginkgo, there’re some studies looking at ginkgo. 

[00:28:53] But what I would say is how I counsel my patients is you certainly should start adding on some of these nutritional strategies when you’re managing your condition. But ultimately, if your eye doctor tells you that your condition is progressing and they recommend drops or maybe they recommend a surgery or laser, then I would definitely take that into consideration as well because you don’t want to be at risk. I mean, you can support your own eye health to a certain level, but if it’s already progressed to a different stage, then you should definitely get that treated and prevent further vision loss going forward.

Cynthia Thurlow [00:29:29] Yeah, I think a lot of what I’m hearing is there are a lot of things that we can do proactively. I think it’s important to make sure we’re eating this brightly pigmented diet. I think what seems to be really popular right now is either really low carbohydrate diets or carnivore-ish diets, and we’re forgetting about the necessity of consuming brightly pigmented fruits and vegetables and it goes without saying we’re designed to be omnivores. This is my personal philosophy, we’re designed to be omnivores and eat from a variety of different sources and so I’m glad that you’re reaffirming that it’s important to be consuming more than just protein. We do need to consume healthy fats. It is important to be consuming fruits and vegetables.

[00:30:11] When we’re talking about changes to the lens as we’re getting older, cataracts, I think many people think, “Oh, that just happens to grandparents.” I have friends who are already developing some degree of cataracts. Are there things that we’re doing in our modern-day lifestyles that are hastening the development of cataracts or changes to our lens that impact our vision?

Dr. Rudrani Banik: [00:30:31] Yeah, so cataract is basically, it’s an oxidative stress change in the lens. So normally the lens is clear, it’s transparent, like as though you’re looking through a clear window, and over time, through oxidative stress, that lens starts to yellow, so it becomes opaque, so that lets in less light, it decreases vision, it makes things blurry, hazy, etc., so why does it happen? Well, again, the root cause is oxidative stress and what can you do about it? going back to the antioxidants. And also, there is another carotenoid that I should mention here when it comes to cataracts, and that’s astaxanthin. So astaxanthin is a cousin to the macular carotenoids, lutein, zeaxanthin. Astaxanthin is not readily found in our food sources, but it comes from algae, so it’s marine based. And so if you eat a lot of fish, you may be getting some degree of astaxanthin, probably not enough for eye health, but at least some degree. But astaxanthin is believed to be, like the king of antioxidants, I would say the queen of antioxidants. But typically, you hear the king of antioxidants. It’s more powerful than glutathione, more powerful than vitamin A, C, and E. So, if you’re concerned about cataracts, maybe eat a balanced diet with those colorful fruits and vegetables, but maybe take a supplement that has astaxanthin in it and the macular carotenoid, so take something that is going to give you full protection. 

[00:31:53] The other thing with cataracts is light toxicity, so UV light in particular is definitely associated with cataract acceleration and formation, so protect your eyes. Now, I know I get a lot of questions about this whenever I say, wear your UV protection, wear those 100% UVA, UVB blocking glasses, and people say, “Well, what about my circadian rhythm? If I block those rays, isn’t it going to throw things off? I’m not going to be able to have healthy sleep patterns.” The truth is, even with sunglasses, you’re getting in so much stray UV light from the sides, you’re getting it through your skin, your body knows what time it is. There is no way your body will not know what time it is simply by wearing sunglasses. And the downside to not wearing sunglasses is way too risky. You can develop growths on the surface of the eye that are benign or even malignant. There are eye cancers that can develop from too much UV exposure, cataracts, macular degeneration, burns. 

[00:32:53] So, for example, I know that there’s a practice called sungazing that is popular amongst many people, but it’s very very risky if you look directly at the sun, because those rays, even in the morning, when the sun’s not at its zenith, even if it’s kind of midway or just rising, those rays still get through the atmosphere, they’re still very powerful, they can cause a burn in your retina called solar retinopathy. And once you get that burn, I mean, it’s a small small burn, but that’s irreversible, and you may end up with a missing spot in your vision, so why take the risk? So, I tell my patients, if you want a sun gaze, what I would recommend doing is do it outside with your eyes closed, and those rays will still get in through your eyelids, they will still help you set your circadian rhythm, you’ll still get all those great vitamin D benefits, but you won’t be putting your retinae at risk. 

Cynthia Thurlow: [00:33:42] I love that you brought that up, because, of course, that was the direction I was hoping to get the conversation going, because this whole emphasis on chronorhythms, chronobiology, circadian rhythms, getting sunlight exposure in the morning. You know, for me, I have very light irises, and so for me, I don’t tolerate brightest part of the day. I really genuinely need some sun protection. I’m not someone that could stand outside all day long and have no sunglasses on. So, I’m grateful to know that I’m still getting some sun exposure, even with my prescription lenses, it’s certainly very reaffirming. And also to know that for the people that really do want that sun exposure, that they can just keep their eyes shut and they’re still getting exposure. It’s not as if you have to be standing outside for 20 minutes with your eyes wide open, struggling, squinting, suffering in order to get that sunlight exposure. Our bodies are very attuned to grounding and in connection with the earth. 

[00:34:39] Now, when we’re talking about the impact of blue light therapy, this is obviously with, especially the past three years, where we probably have had more connection to devices, tablets, computers, etc. Do you set up limits for your patients? Do you have guidance about how much blue light exposure is healthy versus what is detrimental? Because I would imagine you also see younger people as well. Are you seeing changes in eyes at a younger age that you are surprised to be seeing because of the cumulative net impact of blue light exposure? 

Dr. Rudrani Banik: [00:35:13] Yeah, it’s such an important topic to bring up, so thank you for addressing it. So, before the pandemic, there was a study that looked at the average amount of screen time that adults had and this number is crazy. It was over 10 hours a day before the pandemic, this was published in Scientific American, over 10 hours a day. And for children, it was estimated that children spend about 6 hours a day on screen. So, this is again pre pandemic. So, that being said, there are many potential concerns about blue light. 

[00:35:47] One thing I just want to bust this myth is that blue light will not ever cause blindness. It won’t ever cause permanent damage to your eyes. However, it can cause short-term side effects. And it’s the syndrome that we call computer vision syndrome or digital eye strain is the other way it’s termed. And so, it’s a constellation of symptoms that includes trouble focusing, blurry vision, dry eye, sometimes headache, light sensitivity, neck pain, shoulder pain, so this again, it’s an umbrella term that includes all of those symptoms. Some of them are vision related, some of them are more musculoskeletal. But yes, that exposure to screens and blue light can be linked to all of those types of symptoms. And I’ve definitely seen, especially during the pandemic and now afterwards, patients really suffering from, they’re on screens anywhere from eight to 12 hours a day for both work and personal use. Their kids are on screens for homework even though they’re not home and doing school from home anymore, they’re still doing a lot of their work on screen, so many patients come in with these symptoms.

[00:36:53] The good news is that you can really modulate these symptoms. There are so many things you can do, not just blue blockers. I know a lot of people immediately think, “Oh, I have to go get these blue blockers,” but there are many other ways that you can protect your eyes against screen time and blue light. So, I’ll just list what I would consider my top three. So, number one, use nutrition. So, the macular carotenoids, lutein and zeaxanthin are your eyes natural blue blockers and UV blockers. So, they’re placed, the body absorbs them, deposits them preferentially in the macula, and they sit there, they serve as shields for light. They neutralize the light coming in, so you can protect your eyes that way. That’s number one.

[00:37:35] Number two, you can use a screen filter and I’m not talking about the type of screen filter that you put on your screen, not like a physical screen filter. You can use an app that will internally adjust the amount of blue light from your screen. So, these apps are very smart. They know where you are geographically, so they know when the sun is rising, when the sun is setting. And they will adjust your computer monitor’s light levels to mirror the sun’s natural path through the sky, so it’ll be highest in midday, the blue light coming from your screen, and then towards the end of the day, it’ll be less and less and less to a point where before 2 hours after sunset, there’s no blue light coming from your screen. So those are some great ways to protect your eyes against screen time.

[00:38:25] And then the last way, I would say is supplementation. So, there are some really powerful studies that have been published and there’s actually two more in press that look at the use of supplementation with, again, lutein, zeaxanthin, and astaxanthin, your eyes– powerful carotenoids in terms of helping with eye strain, helping with dry eye, helping with light sensitivity and focus and attention. So, I think that those are some great ways to protect against blue light. If you wanted to get blue blockers, I am not opposed to blue blockers. I actually have a whole bunch of my bag of different pairs of glasses that I use. And what I would say is use the tint appropriate for the time of day.

[00:39:10] So, during the day, if your eyes are really sensitive, you’re really strained, use a lighter tint blue blocker, maybe a light yellow blue blocker, one that almost looks clear. And then as the day goes on, if your eyes are becoming more and more fatigued, sensitive, then use a deeper color, so you may want to switch from that light yellow to a deep amber or even the deepest red. And the way you know that the blue blocker is helping or blocking out various forms of blue light, you just put them on and you look at a screen and look at something blue on your screen. And if you’re wearing a lighter tinted blue blocker or a clear blue blocker, you will still be able to see blue using those blue blockers, so those tints only block anywhere from 10% to 30% of the blue light. The deeper tints will probably block about 98% to 99% of the blue light. And when you put those deeper tints on, if you look at your screen, you won’t see blue at all. So that’s how you know if your blue blocker is working or you can kind of gauge how much it’s working for you. So have a couple of pairs and just experiment with them. I think that’s the best thing to do. 

Cynthia Thurlow: [00:40:12] I love all those suggestions. And it’s interesting, in my mind, I’m thinking, “Okay, how much consumption of lutein and zeaxanthin,” obviously, getting your book would be a great resource. In terms of screen filters, do you have favorites? Because that will be the next question. Someone will say, what were some of her favorites? Do you have favorites or ones that you find are easiest to use, easiest to install? I mean, apps should be easy to install, right? that’s the purpose of an app, but I just thought I would check, because inevitably that will be a follow-up question I’ll get. 

Dr. Rudrani Banik: [00:40:41] Yeah. So, there are two available that a lot of people use. One is called iristech.co and one is called f.lux. I actually prefer the iristech.co, and I’ll tell you why. So, both are very sophisticated, both can adjust the blue light depending on where you are in the world, but IrisTech has an additional feature, and what it does is it takes out the flickering, and you will notice this right away. So, if you download IrisTech to your phone or tablet, your computer, the only thing you can’t download it to is a TV monitor, but any other monitor you can download it to, it’ll look different when it’s no longer flickering, so if you happen to have migraine and light sensitivity, and you’re on screens all day, like many of us are, you may want to try that out. And the other benefit of IrisTech is that there are, as of the last time I checked, there were 27 different settings. So, you can adjust, you can play around with it and figure out which one you feel most comfortable with. So, for example, they have a healthy setting, they have a sleep setting, they have a movie setting, a gaming setting. So, play around with it and see what your eyes feel best with. And then, yeah, just experiment and try it out.

Cynthia Thurlow: [00:41:51] I love that. And I’m a huge proponent. I’m very sensitive, especially as we’re heading into fall and it gets dark at 5 o’clock in the afternoon in Central Virginia. As soon as the sun goes down, if I have to teach or I’m doing a webinar I have to wear my blue blockers, it really does, there’s something about– I mean, I could be on my phone and it wouldn’t be the same impact if I’m watching TV, which I don’t do a lot of or I’m doing a webinar if I don’t wear those blue blockers, I am wired when I go to bed, there’s been so much suppression of melatonin that my body is like, “Oh, it’s not time to go to bed,” so I do think that there’s a lot of benefit and mine completely distort the blue, so I have to remind myself when I’m looking at things that it’s not going to look exactly as it would look without them. 

Dr. Rudrani Banik: [00:42:30] Try the screen filter. I think that could really be a great solution. And then you won’t have to wear the glasses. 

Cynthia Thurlow: [00:42:36] Yes, I’m excited about that. I’m definitely going to check that out. Before we wrap up today, I would love to kind of touch on the role of things like sleep and stress management and hydration and how they interplay with our vision and our eye health. Because I know with your kind of functional integrative perspective, you’re thinking very broadly at all the things that impact eye health. And I think for a lot of people, they think about the value of sleep health for a lot of things, but they may not even actually know that the quality of their sleep can also impact the way that we view the world. 

Dr. Rudrani Banik: [00:43:09] Yeah. So sleep is so important in terms of just a basic need for our eyes. We need to rest our eyes from constant stimulation from light, that’s one thing. But also, during sleep, we lubricate our eyes, you know when our eyelids are closed, they’re being nicely lubricated, so there’s another role for sleep in terms of that. And there are many actually sleep disorders linked to vision problems. And I just want touch upon this because I think it’s really important for people to realize the connection between something like sleep apnea and vision problems. So, as a neuro-ophthalmologist, I take care of patients who’ve had eye strokes, basically strokes to their optic nerve, and one of the biggest risk factors for a stroke to the optic nerve– now, it is rare, it’s not very common, but one of the biggest risk factors is obstructive sleep apnea, and so it’s important to get that screened if you suspect that you have it, or maybe your partner, you suspect your partner may have it, because if you treat the sleep apnea, you can prevent something like a stroke to the optic nerve, which is irreversible. And then there are numerous other things linked to sleep issues, for example, dry eyes, floppy eyelid, when people sleep sometimes their eyelid actually flips over and they can get a lot of irritation on the eyelid, they can wake up with swollen lids, so there are many many factors linked to healthy sleep, healthy sleep hygiene. 

[00:44:30] Now, in terms of hydration, this is such an important and really underestimated factor in terms of keeping your eyes healthy. So, our eyes depend on blood flow and circulation and the removal of toxins from our retinas, which are highly metabolically active. And the best way to do that is to have adequate hydration. So if you’re hydrating well, you’re improving blood flow through your cardiovascular system to your eyes. You’re supplying your eyes with the nutrients they need, but you’re also removing a lot of the waste products that are built up underneath the retina. And this goes back to macular degeneration, where it’s really a waste product buildup that leads to vision loss. So, if you hydrate well, you are helping your whole body, but you’re also supporting your eyes in terms of that respect.

Cynthia Thurlow: [00:45:17] Yeah, it’s really interesting. I have a family member who, unfortunately, had a retinal occlusion, had a retinal infarct, and then lost 70% of the vision in one eye, and 90% in the other, and it was just kind of a catastrophic change, and one of the things that she has been very proactive about is reminding all of us to make sure we’re taking care, not only communicating about changes in our vision, but also being very proactive and that was actually her specialist had recommended that she be more mindful. You know this is what happens. Sometimes as we get older, my patients would say to me, I don’t want to have to go to the bathroom, it’s kind of a hassle. I don’t want to drink as much and trying to help them understand that it’s not just an inconvenience, there’s really a reason to keep our bodies as optimized as possible. 

[00:46:02] Well, obviously, Dr. Rani, that I could talk to you for hours, there’s so many different avenues we could go down. I would love for you to let my listeners know how to connect with you, how to be your patient if they’re in the New York City area, how to get connected to your books and your other resources that are available. 

Dr. Rudrani Banik: [00:46:17] Well, thank you, Cynthia. It’s been a pleasure for me as well to chat with you. So, the best way to connect with me is through my website, drranibanik.com. And there you can find my books, so I have the book on Nutrition Beyond Carrots, but I also have another book coming out next year in 2024 on macular degeneration, so that one is called Beyond Leafy Greens, so that should be released soon. And I have courses as well, so if anyone’s interested in promoting their eyes, especially as we get older, the course is called Ageless Eyes, so I go through basically all the four challenges many people, specifically women, experience with their eyes as they’re getting older and how to manage them and navigate through them and come out gracefully on their other end. And then I have a supplement line through my website and then you can connect with me as well. And if you’re in the New York area, yeah, I would love to see you in my practice. I would love to help you on your eye health journey. 

Cynthia Thurlow: [00:47:11] Wonderful. Thank you so much. 

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