Sheldon Rowan, PhD
The discussion features Sheldon Rowan, PhD of the USDA Human Nutrition Research Center on Aging, Tufts University. Dr. Rowan’s research examines the impact of dietary carbohydrate quality on age-related macular degeneration.
The discussion features Sheldon Rowan, PhD of the USDA Human Nutrition Research Center on Aging, Tufts University. Dr. Rowan’s research examines the impact of dietary carbohydrate quality on age-related macular degeneration.
How Your Diet Impacts Your Eyes
July 29, 2020
1:00 p.m. EDT
Please note: This Chat may have been edited for clarity and brevity.
MICHAEL BUCKLEY: Hello, I’m Michael Buckley with the BrightFocus Foundation. Welcome to today’s BrightFocus Chat, “How Your Diet Impacts Your Eyes.” If this is your first time at a BrightFocus Chat, thank you. Let me briefly tell you about BrightFocus and what we’ll do today. BrightFocus is funding about 200 researchers around the world. They are scientists that are trying to find better treatments and, ultimately, cures for macular degeneration, glaucoma, and Alzheimer’s. And at BrightFocus, we try to share the latest news and latest updates from these scientists with families that are impacted by these diseases. We have a number of free publications and materials at our website, BrightFocus.org. Let me tell you about today’s guest. We’re really fortunate to have Dr. Sheldon Rowan with us. Dr. Rowan holds a Ph.D. in genetics from Harvard University, and he remains in Boston, where he works in the Department of Ophthalmology at the Tufts University School of Medicine. We’ve been really fortunate to help support some of Dr. Rowan’s work through BrightFocus’ macular degeneration research program, and Dr. Rowan has led groundbreaking scientific projects on the intersection of diet and macular degeneration. I think today is a really interesting topic because for most of us, when we think of diet and what that means for our health, we think about our weight, we think about our cardiovascular health, we might think about our appearance and all that comes with what we weigh, but a lot of us don’t know that your diet actually impacts your vision health, particularly macular degeneration, and that’s why we’re so fortunate to have Dr. Rowan with us today to tell us a little bit more about how diet impacts your eyes. So, Dr. Rowan, I know you were with us about 2 years ago, so welcome back to the BrightFocus Chat.
DR. SHELDON ROWAN: Thank you. This is really fun, and I’m happy to update on anything new that’s happened and also just kind of reiterate what we already knew at the time. I think it’s a really exciting area in macular degeneration research right now.
MICHAEL BUCKLEY: How did you end up becoming a scientist?
DR. SHELDON ROWAN: I became a scientist pretty much right out of high school. I knew that that was what I wanted to do. I began doing very basic molecular studies; I thought I was going to do cancer research and cure cancer, but when I started my Ph.D., I actually really fell in love with vision research. So, I’ve been working in the eye for about 25 years now. My Ph.D. work was looking at very basic questions about how the retina forms during development, and then I worked on the lens for a while, which I was interested in questions about how the lens forms but also how diseases like cataracts form. And then when I became an independent scientist, I decided I was more interested in working in a human disease–relevant area, so I joined Tufts University, I think, about 2012, and I’ve been studying age-related macular degeneration.
MICHAEL BUCKLEY: We’ll get into a lot of details over the next half-hour or so, but just kind of start us off, Dr. Rowan, big picture—how does your diet impact your eyes?
DR. SHELDON ROWAN: Our diet is a bigger determinant in our eyes than I think anyone would have guessed at the get-go, and part of that is just because our diet is such a fundamental source of our physiological health. So, our well-being, our metabolism is eventually controlled by our diet. So, we think about … with diet, we think about micronutrients and macronutrients. The micronutrients are things like vitamins. We’ve known for a long time that the vitamins that we get from our diet can have a big impact in our risk for macular degeneration. That was kind of the basis for why the National Eye Institute started the AREDS studies, which have eventually led to our current treatments for macular degeneration, but we also understood over the last, I’d say, 10 to 15 years that those macronutrients, as well—the amounts of proteins, the amounts of carbohydrates and fats—in our diet can also have a significant impact on your risk for macular degeneration. And then, all of that kind of converge within what our diet does to our gut and microbiome, which is kind of a new frontier in understanding relationships between our environment, our diet, and our well-being.
MICHAEL BUCKLEY: We will get into all of those points in detail over the coming minutes, but I appreciate you setting the stage for that. I understand that the big picture, you look at a dietary pattern. I was wondering, what is a dietary pattern, and what’s a good one and what’s a bad one?
DR. SHELDON ROWAN: The dietary pattern is what we actually eat in our diets. It turns out that people aren’t eating foods in isolation. They’re eating kinds of combinations of foods together, and the dietary pattern is that summary of all of the foods that you tend to eat on a general basis. You could … the easiest way to think about this is think about someone that’s a vegetarian; that’s kind of a dietary pattern. They’re going to be eating largely plant-based foods. You could imagine there are people that are … kind of tend to a more carnivorous diet, where they’re eating more meat-based foods. And along with that, it has a big impact on the other foods that we end up eating. Every time you eat one food, you eat less of something else. So, we could think about … in America, there are two big-scale dietary patterns. We think about the Western dietary pattern; this is our typical diet that’s not necessarily the healthiest diet for us. It’s the one that we like to eat that has the pizza and French fries and red meat and sugar-sweetened beverages. All those foods tend to be eaten by the same people together. And then you have a … the prudent diet, the one that scientists and nutritionists and dietitians have been telling us for awhile to eat, the one that’s more based on plant-based foods and fish and lean poultry, and those constitute the major dietary patterns in America.
MICHAEL BUCKLEY: How do dietary patterns impact age-related macular degeneration? Do they impact the risk or do they impact the progression—or both—of the disease?
DR. SHELDON ROWAN: That’s a great question. I think the best of our understanding is that it impacts both of them. So, our group tried to look at this separately, looking both for early macular degeneration and late macular degeneration. And so, for example, what we found was that Americans that eat this Western dietary pattern have a really increased risk for advanced macular degeneration, also earlier macular degeneration. Whereas those that eat the prudent dietary pattern had a really dramatically decreased risk for advanced macular degeneration and for earlier macular degeneration. I should mention that it’s hard … we don’t know as much about the earlier parts of the disease because we’d really have to begin those studies in healthy individuals that don’t have the disease to begin with and follow them for, potentially, decades. So, we know the most about the impact of dietary patterns on advanced macular degeneration, and that’s where we’ve seen the strongest association.
MICHAEL BUCKLEY: Specifically, on the Mediterranean diet and the prudent diet, Western diet, are there … can you cite a few specific examples of foods that are good and foods that are bad for vision health?
DR. SHELDON ROWAN: I would love to talk a little bit about the Mediterranean diet. I talked about the standard patterns that you see in the American population, but I would say the Mediterranean diet is the one that we’ve studied the most and that I’m personally the most excited about. So, what makes a Mediterranean diet a little different from the standard recommended diet is it also includes a high intake of nuts, olive oil—so, a lot of sources of monounsaturated fatty acids, whereas more traditionally prudent patterns tend to be polyunsaturated fatty acids. And then besides the olive oil and the nuts, high intakes of fish, so we’re talking about maybe serving more than once a week of fish. We need very rarely to have too much red meat in that dietary pattern and just lots of fruits, lots of vegetables, especially green leafy vegetables and legumes; those are all what I would say are the cornerstones of the Mediterranean diet pattern.
MICHAEL BUCKLEY: What’s the other side of the coin—that foods that we should do less of or grab none of?
DR. SHELDON ROWAN: Within the Western dietary pattern, I would say the worst culprit is probably foods that contain trans fats, which luckily we’ve mostly phased out of our diets, but similarly, foods that are high in unsaturated fats—fried foods—have definitely been independently linked to risks for macular degeneration. And our research has also looked at this aspect about carbohydrate quality. Looking at foods that have, for example, high glycemic index that are rapidly digested into simple sugars in our blood streams, whether you’re eating high amounts of added sugars, drinking them most of the time, or eating very simple high-carbohydrate foods, those are also associated with increased risks for macular degeneration.
MICHAEL BUCKLEY: This is very helpful. We have a few questions on those points. We’ve a caller wondering, does this either damage if you’re not following a good diet or improvement or benefits for good? Do these changes happen quickly or slowly, in terms of the impact of your diet on vision? Do you either progress or regression happen fast or slow, I guess I should phrase it that way?
DR. SHELDON ROWAN: That’s a great question and something that we probably don’t know exactly. We think that these are slow changes. For the most part, age-related macular degeneration develops over the process of decades. Even when you have an intermediate stage of the disease, progression usually happens in the span of years. So, we have to think that the odds are that a dietary effect is going to be an additive thing that’s going to happen slowly over time. That’s not to say that changing of a diet can’t potentially have a quicker effect on prevention of macular degeneration progression, but we think this is probably on the slow time scale and not a rapid time scale.
MICHAEL BUCKLEY: Thank you, and earlier you mentioned vegan and vegetarian, just wondering if you can comment—a caller was wondering—vegan and vegetarian diets, do these help or hurt vision health?
DR. SHELDON ROWAN: I think they probably are going to be on the helpful side. No one’s specifically looked at exclusive vegans or exclusive vegetarians and seen whether they have a greater protection against macular degeneration. That’s an interesting question. My guess is they would because, for the most part, they’re going to be consuming the foods that we already know are associated with protection, so high amounts of fruits and vegetables. You have get your protein from somewhere, especially if you’re on a vegan diet, so you’re going to get your protein from nuts and legumes, again foods that we know already are beneficial. It’s not to say that all vegetarian diets are that healthy. You can always take an extreme diet. You can eat a purely potato chip diet and you can be vegetarian, and that’s not going to be good for you. So, I would rather … people … if they’re going to do a vegetarian or vegan diet, do it in consultation with a physician or dietitian—someone that really can make sure you’re getting all of the necessary foods and micronutrients that your body needs.
MICHAEL BUCKLEY: We have a couple more questions that came in on the line. What about lactose-free? People that increasingly are going lactose-free and also gluten-free, we’ve been hearing a lot about these diets or recommendations. Do lactose- or gluten-free have impact on vision health?
DR. SHELDON ROWAN: Lactose-free, I can almost be certain, wouldn’t have an impact one way or another. The composition of a lactose-free dairy product is virtually identical to one that has the lactose. I wouldn’t have any qualms about that. The gluten-free can be a little more difficult because if you’re really strictly adhering to a gluten-free diet, a lot of times there are foods that you’re going to have to avoid that we know are beneficial, and a lot of those are whole-grain foods that do actually contain gluten. So, I think there’s a potential for people on gluten-free diets to have food types that are either highly processed because you’re buying them in a market, and the food industry has had to increase the palpability of those foods. So, they may be stripped of some of those beneficial fibers and things that are present in the whole grains. I think you could easily make a gluten-free diet that's just as healthy as a non-gluten-free diet, but I would want to be careful about how you went about having a gluten-free diet. Making sure you’re not missing … we think that fiber's kind of magical when it comes to diets. You really have to make sure you’re getting the same amounts of fiber on a gluten-free diet as a non-gluten-free diet.
MICHAEL BUCKLEY: That’s a great point, and we talked about lactose a minute ago. We have a caller wondering about cheese, particular types of cheese that have a higher amount of fat. Does that have an impact on vision health?
DR. SHELDON ROWAN: Cheese is interesting. The studies I’ve seen that have tried to look—maybe not specifically at higher-fat cheese, but they’ve lumped this category of high-fat dairy products—have actually found that it could actually be beneficial; the people that had the lowest amounts of high-fat dairy seemed to do worse in those particular studies. I think it all depends on what you’re eating along with those cheeses. I think it is very easy to incorporate high-fat cheeses into really healthy dietary patterns. What you want to do is you want to make sure that you’re not melting it on a hamburger. You have to think about … it gets into this idea of a dietary pattern; it’s what else are you eating along with that food, and what are you eating instead of that food?
MICHAEL BUCKLEY: That’s a great point. The last question for a little bit on specific foods: we hear people talk about good chocolate and bad chocolate, and I think it’s a great point you mentioned about the low glycemic foods that are sweet but still healthy. Is there any … I’m probably asking this on behalf of millions of Americans—is there any chocolate that is good to have?
DR. SHELDON ROWAN: I think all chocolate is good. [laughter] I’ve never met a bad one. [laughter] Chocolate is good; it makes you happy. That’s good. No, but what we do know is that darker chocolates do tend to have more phytochemicals. They have like these complex plant-derived compounds, like flavanols, that may be helpful; they may not be in the amounts we actually eat them. It’s hard to really see the downside of eating a semi-dark chocolate. It’s easy to go on the other side though, and if you’re having chocolate with too much added sugar and too much unsaturated fats, you can definitely overdo it. So, with chocolate you have to do it in moderation.
MICHAEL BUCKLEY: That’s a great point. And I know you mentioned briefly at the outset about your research that gets into the gut microbiome, and I think this is interesting because I feel like, to me, microbiome is one of those words that everybody hears; you hear it a lot in the media and conversations over the last couple years, but I’m not quite sure that a lot of us truly understand gut microbiome or you hear people talk about … ads on TV about probiotics. I was wondering if you could tell us a little bit about the gut microbiome and how that impacts AMD?
DR. SHELDON ROWAN: The gut microbiome is kind of what we refer to as, like, this whole ecosystem that’s living symbiotically with us in our body. There are microbiomes in pretty much all parts of the body, but we’ve spent a lot of time looking specifically at the one associated with the colon. A lot of times when we talk about the gut microbiome, it might include the upper intestine, the lower intestine. We usually think about the colonic intestine when we think about the microbiome, and these are all of the different kinds of bacteria. There are also nonbacteria, like fungi and viruses, and the bacteria have their own viruses; it’s a huge kind of ecosystem that lives inside us and, for the most part, very peacefully and very beneficially for us. So, a healthy gut microbiome has been associated with lower rates of chronic disease and pretty much across studies; it sometimes is a little hard to exactly define what’s a healthy versus an unhealthy microbiome, but we know that there are things that can go wrong with our gut microbiomes, especially when they become imbalanced because of, for example, an antibiotic that may be killing off a lot of the beneficial bacteria and allowing undesirable ones to expand. And those are often associated with inflammatory conditions, and inflammation is … you know, we think one of the contributors to increased risks for macular degeneration. So, there’s a condition called dysbiosis. Some of your listeners might be familiar with this term called “the leaky gut,” where when the bacteria are out of balance, our guts are not working well enough to keep the bacteria in the inside. Some of the products translocate—go from the inside to the outside—and those can activate an inflammatory and an immune reaction that can have effects throughout the body. So, as far as macular degeneration connections, I have to say that, right now, the connections are ones that we found in experimental systems, so I would say knowing for sure that there’s a connection between gut microbiome and AMD is in its early stages, but we know from animal model experiments that there’s potentially beneficial functions of the gut microbiome that directly seem to keep the eye healthy, and we also know that there’s functions of gut microbiome that can increase inflammation that could make other kinds of models of AMD worse.
MICHAEL BUCKLEY: That’s interesting. As you talk about some of lessons that you and your colleagues in this field have learned, it’s kind of a basic question, like, how do you learn many of these things? Do you use clinical trials? We get callers who want to know a little bit more about what a clinical trial is and how it works. I was wondering, some of the knowledge that we’re talking about today, does that come from clinical trials on food and diet?
DR. SHELDON ROWAN: Most of what we know about diet is coming from … they’re called observational studies. They tend to be large collections of individuals—a cohort study where we may be looking at tens of thousands or hundreds of thousands of people—and we’ve collected data about them at the beginning of the study and then followed them through a study. So, the kind of classic version of these is called “a prospective study,” where ideally, you want to start with healthy people, learn everything that we know about them at the beginning, and then see which ones eventually develop a disease like age-related macular degeneration. Those … some of those studies can take a really long time, and there are some populations and cohorts that we’ve been following up for decades. A famous one is the Framingham Heart Study that’s been going on for multiple generations of people. Then, there’s also something like a more clinical trial, like the AREDS trials, where you enroll people to do to … either take a specific treatment—it could be like a drug, it could be a combination of vitamins and minerals, in the case of AREDS—and compare them against people that took a placebo, a non-version of that active medication. And then, follow them carefully, usually in a clinical setting, to see if they develop disease or if the disease progresses. So, both of those studies have taught us about the diet. I think we’ve learned more from, like, the really big population studies. Of course, the challenge in all of that is … in epidemiology, you always talk about association. It’s very hard to prove causation. That's the benefit of these randomized clinical trials, which are harder to carry out. They’re so expensive, and they often still take years just to come up with answers.
MICHAEL BUCKLEY: We’ve all been hearing a lot about clinical trials in the pursuit for COVID-19 vaccine, and I was wondering that the clinical trials just across the board, whether it’s for vision health or elsewhere, how does one join? How does … if somebody wants to help out the scientific progress, how does somebody get involved with a clinical trial?
DR. SHELDON ROWAN: There’s a lot of good ways. I’m sure the BrightFocus Foundation is happy to connect people with age-related macular degeneration trials. That would be one place. I know a lot of the patients that we think about recruiting for our kinds of clinical trials, we usually do through the clinic. So, often, it’s the patient, they are either going in for routine care or, specifically, to follow up on a disease. We may give that patient some information about a clinical trial that we’re interested in enrolling for. Those are two common routes. There’s also a really tremendous website that the U.S. government keeps running called clinicaltrials.gov, and every registered clinical trial is in there, and they will often indicate if they’re enrolling or not. You can actually go on the website and put in your subject terms of interest and see is there a study that I’m interested in participating in and are they enrolling? And there’s probably contact information there, as well.
MICHAEL BUCKLEY: That’s great, and at BrightFocus, we put together a short brochure a couple of years ago called Clinical Trials: Your Questions Answered, and it has a lot of questions to ask your doctor and other things, and we’d be glad to send that out—free of charge—to anyone on this call. What we do is simply at the end of the call … we have a voicemail box. At the conclusion of the Chat, leave your U.S. mail address, and we’ll be sure to get that out to you. Because, yeah, I really think that because of COVID, there is a lot of heightened interest about how science is made, how quickly and how well can we learn this knowledge. And you mentioned the AREDS2, and we had a lot of questions today and on previous Chats about the AREDS2 and other nutritional supplements and vitamin supplements. I was wondering if you could tell our listeners a little bit about AREDS and the field of nutritional supplements, as well. Again, I think, like microbiomes, it’s something that people hear a lot about but maybe don’t quite understand.
DR. SHELDON ROWAN: Sure, and I haven’t said anything about probiotics yet either, so let me touch on that, too. So, I’ll start with the AREDS trial. The AREDS trial was … it was initiated by the National Eye Institute a couple of decades ago based on exactly the kinds of things that I mentioned to you, a lot of the epidemiology linking deficiencies and certain vitamins to increased risk for macular degeneration, and they said, “Let’s take the best of our scientific understanding and come together with a formulation of some vitamins and antioxidants and carotenoids, things that have all been associated with protection against macular degeneration, and let’s actually give them to a subset of patients compared to a placebo and see if that reduces progression of macular degeneration.” So, the original trial, I think it had vitamin C, vitamin E; those were the major vitamins, antioxidants, as well as zinc, copper. Originally, it was beta-carotene, and then they swapped out the beta-carotene for two other carotenoids called lutein and zeaxanthin. And it found over and over again that individuals that have this combination … and I should mention these are doses that are much higher than what you would normally be able to get in your diet or even in the regular multivitamin supplement, but when you get this combination to people, there was about a 25 percent or maybe even greater reduction in risk for AMD progression. It’s been like the absolute gold-standard treatment. The best thing that we’ve come up with … and I’m kind of proud to say that this originated from nutritional epidemiology, and so, that’s a treatment. The interesting thing about AREDS is we’re not entirely sure how it works. The initial idea was that, I think, antioxidants were probably the early idea; you just give the body enough of these and you prevent that oxygen-mediated damage, but I’m not sure if the science has been consistent on that front, and so it could be that the AREDS supplements are working in multiple parts of the body. They could even be working within the gut microbiome, so that made people think about, are there more targeted treatments that could potentially work as well as AREDS, if not better? And the idea that the gut microbiome could be connected to macular degeneration, I think it’s made people wonder, “What about a probiotic that should improve my gut microbiome?” And I hate to say this turned out that we actually don’t know what the right kinds of probiotics are to take to improve the gut microbiome. So, the way we usually try to improve our gut microbiome is by feeding the bacteria the foods that they need, things like fibers, instead of trying to actually add in. You don’t want to do some kind of mad scientific experiment on your body, where you give them too much of one kind of bacteria and all of a sudden you start outcompeting another kind of bacteria that might end up being even more important that we don’t even know about yet. So, probiotics are tricky. It’s not that there’s no promise, and I think as someone that does the experimental side, I’m really excited in using probiotics to test ideas about how different bacteria may be working together in the body and to affect the eye. But I don’t know if people should really be experimenting on themselves to that degree. We know it’s safe to eat a Mediterranean diet; that’s definitely safe. We don’t actually know how safe a lot of probiotics are.
MICHAEL BUCKLEY: We have a few more questions. People ask about supplements. Is it better to have a supplement or the actual food itself?
DR. SHELDON ROWAN: The nutrition scientist in me is going to say it’s always better to have the food than the supplements because it might be something that’s coming along that you didn’t think was the main part of it. Think about a food like an orange, and you think, “Okay, I want to eat oranges to get more vitamin C, or I could take this vitamin C supplement.” But what if the really healthy part of the orange is what gives it the orange color or the fiber that’s in the peel or the segments between the oranges. So, we know that the whole food always has the benefit. We don’t know if you can isolate that. Fruit juice doesn’t work the same way that eating the whole fruit does. So, I always go for the whole food versus a supplement.
MICHAEL BUCKLEY: That’s a great point. We have an interesting question from someone that’s wondering how to get started. Obviously, these types of changes to diet can be pretty challenging, can be pretty overwhelming. Is there a good attainable starting point to move toward a diet that’s better for vision health?
DR. SHELDON ROWAN: That’s a great question. I think a lot of people struggle with their diets. You’ve established your dietary pattern of what foods you like to eat, and then you’re like, “Oh, but maybe I want to eat a Mediterranean diet.” But all of a sudden you’re trying to eat of these new foods and maybe you’re not as familiar with them. You don’t like them as much. You’re probably not going to stick with it. I think the best approach is to start to make small substitutions with things that you don’t mind sacrificing, so for example, if you’re used to eating your sandwich with sliced white bread, you can think about changing that white bread to a whole-grain bread, and you don’t even have to go full whole grain. There are versions of white bread that look and taste pretty similar but maintain all of the fiber and protein that a whole-grain bread would have. So, you can start by making easy substitutions; switch over the ham for turkey. You can get a smoked turkey, or you can get flavored turkey that might give you that same feel, so you don’t feel like you’re actually changing your dietary pattern, even though you’re making small changes. Again, if you’re used to eating fruit juice as part of your diet, say for breakfast, have the fruit instead. You already like it, probably. Most people enjoy fruits. Vegetables can be a little trickier. I would say eat the foods that you like. If you’re trying to force yourself to eat something you don’t like just because you know it’s good for you, you’re probably not going to stick with it. And I also don’t … people shouldn’t be afraid to get help. This is what dietitians do. They’ve been training, working in hospitals with thousands of patients, to do these exact things. I think it’s always a great idea to get help from someone that really knows how to do it and can work with you personally to tailor something that’ll work. Books can be great, too, but maybe, don’t plan your new dietary change from a Facebook thread.
MICHAEL BUCKLEY: Great advice on a lot of levels there. Yeah, and I think, as you say, we had a few listeners ask today about hearing that there’s some fruit that has sugar in it and you were instinctively told to think that sugar is bad and fruit is good, so you can help us clarify what to make out of sugar and fruit?
DR. SHELDON ROWAN: It seems like a paradox where, like, eat fruits; they’re good for you. Don’t eat sugars; they’re not good. And then you look at what that fruit has, and it’s got all of this simple sugar that … it’s fructose, and you’re, like, “I know that fructose is bad for me.” The thing is, in the context of the whole fruit, the math doesn’t add up that way. All of the benefits of everything else contained in that fruit, especially the fiber or especially all of these other macro- and micronutrients that are part of it, balance out any potential negative effect of that amount of sugar. The other thing is even fruit that tastes really sweet to us, like you think about grapes, for example. Grapes are high in sugar; they have a high glycemic index. In principle, you’re, like, I should not eat grapes, but the amount of grapes people actually eat at a time, the sugar you’re getting in there is not really all that much compared to drinking a can of soda, or even a lot of foods that don’t taste sweet, a lot of processed foods just have a lot of added sugar. I don’t think … if you like a fruit or a vegetable, I don’t think you should be scared if it’s sweet. I love butternut squash and sweet potato, and they’re sweet and they’re just tremendously great.
MICHAEL BUCKLEY: That’s good advice, because you’re exactly right; it is a paradox, and you’ve helped clarify that for us.
DR. SHELDON ROWAN: It’s hard for people that are trying to do a strict ketogenic diet, where they’re told you have to have zero carbohydrates, and they’re suddenly cutting out a lot of very healthy foods that have small amounts of carbohydrates. Unless that’s what your doctor wants you to do, I don’t know if that’s worth what you lose by not eating those foods.
MICHAEL BUCKLEY: That’s a great point. So, Dr. Rowan, just kind of concluding big picture, I know you have been working in this field for a little while. I was wondering, how do you think we’re doing in terms of scientific progress, public awareness, and behavior change? How do you feel that we’re doing in terms of better understanding and treating and, hopefully, curing AMD?
DR. SHELDON ROWAN: I think it’s an exciting time. Certainly, doing research, this is a really exciting time for me. I think one of the things that we’ve done, we’ve spent a lot of time trying to understand what the actual mechanism that’s causing AMD, and that’s really helped, I’d say, fuel the drug discovery side of things. And we’re not quite there … we’re definitely there with wet macular degeneration; we’ve made huge steps. I think that for dry macular degeneration, we’re so close. I’ve seen early results from a number of studies that look so promising, and it’s just … that’s one of those, like, time and money things. Something is going to come out from there, but from my perspective, maybe thinking a little more in a public health level, I’m excited about what we’ve understood about the diets and macular degeneration because that’s something people can start to change in their lives. They don’t have to wait to have the disease. They don’t have to do this under instruction of a clinician or as part of a clinical trial. We have the opportunities to make lifestyles changes, and I should mention my research and what I’ve been talking about have really focused on diet, but there are other lifestyle changes that can really all work together with the diet. So, for example, not smoking—that’s kind of … hopefully, for this audience, they’ve heard that message a lot. But also exercise could be something that independently lowers your risk, and I wanted to mention one study that I really like that looked at this combination of what happens with better eating. They used the American Healthy Eating Index, and then more exercise and not smoking, and each one of those on its own had a benefit, but when you combined them together, they found people that adhered to a healthy eating index, got a lot of exercise, didn’t smoke, had 71 percent lower odds of early macular degeneration. So, that’s a change people can make right now without … we know the research on it; the results are really clear. And I think prevention sounds a lot better to me than having to go to your doctor and then find out what you’re going to need to do. So, that’s a place … I don’t think drugs are going to be able to give us that same kind of effect. You don’t want to be drugging healthy populations to prevent a disease, but changing our lifestyles—something that’s in our control that we can say, like, this is a scientifically proven understanding, and you can do this now and it’s safe and it’s not just going to help you lower your risk macular degeneration, but it’s going to lower your risk for cardiovascular disease. It’s going lower your risk for diabetes. It’s going to lower your risk for heart disease, etc. That’s exciting to me. The fact that we actually know that, it sounds great in theory, but it’s another thing to have the data out there. I’m really excited about the Mediterranean diet, too. In the last few years, there have been studies from all over the world. Sometimes … especially in America, we tend to look at ourselves a little bit too much. But the Mediterranean diet studies have now happened in Australia, in different parts of Europe and North America; they’re all coming to the same conclusions, and they’re not people necessarily eating the identical Mediterranean diets. They’re eating a dietary pattern that is consistent with their population. So, for example, people closer to coastal areas are having more fish. People further from the water might be having more fruits and vegetables. All of those studies have really converged on this protective effect of the Mediterranean diet. Some of those things have also shown that fish consumption can be a huge thing, even on its own. Increasing the amounts of fish we eat seems to be kind of that one food group that doesn’t even need everything else to work together. So, taking fish plus everything else is a great way to think about preventing macular degeneration or progression if you have macular degeneration.
MICHAEL BUCKLEY: Great, thanks. This has been just a wonderful conversation we’ve had today, and I’m really confident that our listeners came away with lot of useful advice, both short-term actions, as well as understanding how two things that they may not have connected—the diet and the vision health—are very interrelated, and they’re such a … at the core of healthy aging. Dr. Rowan, on behalf of BrightFocus, I just want to thank you for being so generous with your time today, and this is … I think I can speak for all of us, this has been really helpful and appreciate all you’re doing to try to proactively save people’s sight.
DR. SHELDON ROWAN: Thank you so much. I mean, I love doing this. Public outreach is just so important. You know, doing the research into a void isn’t beneficial to anyone. So, I appreciate the opportunity to reach out to the people that support your group. It’s just tremendous. And I can’t wait in a couple of years to tell you about my research results, which I hope will be just as exciting.
MICHAEL BUCKLEY: Again, Dr. Rowan, on behalf of everyone on the call today and BrightFocus Foundation, thank you so much for all that you do and being with us today. This concludes today’s BrightFocus Chat. Thank you.
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