Speaker 0 00:00:00 Welcome to the Dry Eye Coach podcast series. Click on dry eye. Your insider passed to the most exclusive dry eye topic. The series will raise awareness about the current and future state of ocular surface disease. The podcast will focus on a variety of topics.
Speaker 1 00:00:15 In today's episode, we have the one and only veto Mena OD from the Optical Academy in Clifton, New Jersey. Welcome, Vito.
Speaker 2 00:00:24 All right. Thank you so much for having me. So this is gonna be a blast. I hope.
Speaker 3 00:00:27 I think it's, it'll, it'll, we're glad to hear there. Vito,
Speaker 1 00:00:32 Tell us more about your practice modality. Where are you and how are you practicing?
Speaker 2 00:00:35 Sure. Yeah. So I practice in Optical Academy that's located in Clifton, New Jersey. I would say that's about 10 minutes from New York City or so. And so I'm the Sports Vision director, um, for that. And so I work really closely with the n a, which is the New Jersey Education Association, which is ex um, the largest education association entire country. And we also work the department, um, uh, the New York City Department of Education as well. And so all those numbers that you see that, um, children fail, those five percentages of children need glasses, those numbers are dead on accurate. So I'm constantly in the school systems. Um, I'm doing a clinical skills lab, bringing the equipment inside the building and exams. And so, uh, um, it's really the tripod effect because you're with the children. The, the teachers are the ones obviously teaching the kids. They've got the parents and then the parents have the grandparents. So it's really that tripod effect really bringing home that comprehensive eye exam, um, to everybody and, and spread the message to as many people as can.
Speaker 3 00:01:31 Hey dude, I wanna say kudos to you for all your hard work. I know you're involved with aoa, the sports vision. I know you had the public service award a couple years ago from Sal University and the YA OD of the Year, and both photographs, any conference ever, <laugh>, <inaudible>,
Speaker 2 00:01:50 <laugh>. Yeah. So that is, that is true. Yeah. So thank I, I appreciate the AOA for putting me on to the sports vision performance section. That was very nice of'em. Um, um, so I'm on their board and so, uh, I I went to Seat and Hall University and so I, I actually have a master's degree in microbiology. And so it, just thinking about the athletic components, well, what's the athletics need to worry about? Well, well, nutrition, right? And so that's why I have interest in the nutrition side and kinda of what we're gonna talk about today in today's discussion and relates to dryness and just inflammation in general.
Speaker 1 00:02:22 So giant sports vision, you mean those two things can, can go together. That's amazing.
Speaker 2 00:02:27 Yeah, for sure. You know, cause if your eyes are dry, it can mess with your contrast sensitivity and all that stuff. So remember, it's all about timing and reaction, timing, and that's what can, can differentiate a great athlete from an elite one. So that's why, you know, the eyes are very important. 80% of our visual system is done through that and it needs to be at it's highest level possible.
Speaker 3 00:02:45 So what sports did you play growing up?
Speaker 2 00:02:47 So I
Speaker 3 00:02:48 Played, BA has nothing to do with our talk, but I
Speaker 2 00:02:50 Was No, no, that's fine. Yeah. So yeah, so I played basketball and baseball. Um, I was better at baseball, but I liked basketball more. And so when I went to, uh, hall to D one school, I actually tried out for their team. I tried to walk on. And so, and long story short, they redshirted me and, and I just became like a, uh, an assistant manager as a student. And then I just, after that, I couldn't keep up with it. I guess I wasn't smart enough with science and sports. So I, I stopped after my freshman year. But, um, baseball is really where I like to hone on more.
Speaker 1 00:03:20 Anything. How about you, Walt? What'd you do?
Speaker 3 00:03:22 Uh, I played baseball and football, but, uh, I had the least amount of talented anyone in my family. So thankfully my kids are good and my brothers are really good.
Speaker 1 00:03:32 Well, I was a swimmer, so that's how I, it's
Speaker 2 00:03:35 Good aerobic exercise. That's awesome.
Speaker 1 00:03:36 There you go. That's how I put myself through college teaching those swimming lessons. Um, but giving back to <laugh>, our topic,
Speaker 3 00:03:43 Let's get back to this gut. So
Speaker 1 00:03:45 Get back to the gut. So important.
Speaker 3 00:03:47 What is gut dysbiosis?
Speaker 2 00:03:50 Yeah, so, well, the important thing is like, usually when I do a lecture, I usually tell people that our gut and our brain are actually connected together. And so usually I'll start off the lecture saying that, you know how the saying goes, you are what you eat. You really are not, youre what you eat. Youre what the thing that youre eating has eaten because the things that they've eaten are going inside our bodies, right? So whether that's antibiotics or, you know, the, the pesticide, the herbicides that are inside the, and so now the biggest thing now is that the foods that we're eating now are not the same that they were in the thirties, forties and fifties growing up. Because now agriculture is now a business. And so they're giving pesticides, they're giving corn and soy to the animals, and they're trying to get them fatter.
Speaker 2 00:04:32 And so what's happening is if the antibiotics are trying to make these animals bigger and bigger and bigger, and then they slaughter them, and then we eat them, well, that's making us bigger and bigger and bigger, and we're gonna be slaughtered soon What to cancer, to inflammation and all that stuff. So all the oxygen and calories that we eat, it's energy for ourselves, right? So 90% of our entire body, 90% of all our cells are actually bacterial. 10% of them are actually human, human gene, right? So going back to that human or the gut to brain, um, connection, serotonin and melatonin, serotonin nine, uh, 90% of serotonin is actually found in our gut. 70% of melatonin is actually found in our gut. The rest is, is located in the brain. And so a lot of people think that our brain is the powerhouse center. It's really the gut that drives everything.
Speaker 2 00:05:23 'cause what happens is if our gut is not, is not, um, cooperating, it's gonna lead to inflammation and also oxidation. And so usually what I'll try to tell clients or patients is that oxidation, think of it like if you were to cut an apple in half, and when the apple starts to turn brown, that, that's oxidation that's happening in our bodies. It's like rusting inside our bodies. And so the biggest bacteria that we have in our body that's the most important is actually mitochondria. And so mitochondria, the ATP of our, that creates that energy, it's really engulfed the bacteria. So whenever you, you're eating sugar and, and all these things, it's actually poisonous to our mitochondria and it causes all of these things to occur, right? So going back to our gut, we need to eat right? And so I like to say this analogy, which is dying, right?
Speaker 2 00:06:15 We go out. So these represents our digestive system. The eyes are immune and is our nervous system. And then e is the endocrine system. The digestive one is actually the most important one because it's what delivers most of our vitamins, our minerals, our our polyphenols, our hormones, and our proteins. And so we need all those reactions happening inside our body because of, without them we won't be able to survive, right? So we're really feeding our, um, gut as much as we can because located inside our gut, we have stem cells. And what helps keep those stem cells alive and more active is vitamin D. So going outside more contributes to that. So we really gotta be protecting our bodies with, with the foods that we're eating and possibly the supplements that we're taking. So the biggest thing that I'll say is nothing, hands down beats eating healthy. Mm-hmm. <affirmative> vitamins and supplements. Think of that as an insurance policy. Yeah. Right? Well know that's
Speaker 3 00:07:12 Questions. That's one of the questions we had is, you know, what should we do or what we do to optimize our guts,
Speaker 2 00:07:17 Right? So the biggest thing is a lot of people don't even talk about sleep, really. And so sleep is the biggest component really, because what happens is, is that we need to minimize or get rid of the toxins that we get on an everyday basis from outside, from the smoke, from stress, whatever, right? So when we're sleeping, we need at least eight hours of sleep. Studies have shown that if you're getting less than eight hours of sleep, really, let's say five hours to, um, four days in a row, you actually become insulin resistant. And so what happens is our growlin and lectin levels, um, are active when we stay up longer and longer and longer when we sleep. What it does is our, our, um, cells in our brain shrink. What that allows the brain to do is, it's called something called brainwash. And so when the brainwash is being cleared out, it clears out all of the, the poisons that happen in our bodies.
Speaker 2 00:08:04 Um, LPs, which is lipo polysaccharides in layman's terms, there's little pieces of crap. They're like fragments of cell wall bacteria. And so that's gotta be removed. Also, it minimizes amyloid buildup in your brain, and that's what can cause cognitive decline like dementia, Alzheimer's, all these different things. So number one is sleep. Number two is something what's called hermetic stressors. Hermetic stressors are things like exercise, yoga, meditation. Another thing is also calorie restriction or fasting. The reason why those are very important, and those are called hermetic stressors, is because they, um, have what's called autophagy, which means that your cells recycling program. So what that means is that our cells in our body, we have good cells and bad cells. What's pretty much happening is there's a war happening in inside our gut. When you have auto happening, what's gonna happen is your, your weak cells are gonna die off and the stronger ones are gonna remain there.
Speaker 2 00:09:02 And so those strong ones survive. It creates that more protection of a better barrier, right? The other big thing is we need to avoid lectins. So lectins, what those are, those are sticky proteins that are found on, um, all plants. So for example, what lectin is, if you were to grab a tomato from the supermarket, you feel like that sticky substance on a tomato, that's what's lectin. And so the reason why plants have lectins is because lectins poisoned something that to eat it. So plants need defense mechanism for themselves to avoid being eaten by predators. Our protective measures in our bodies are skin mucus and also our stomach acid. All those strings are, are very crucial, um, to, to create more mucus in our body to, to protect our gut. Um, obviously we all know about eating, um, two to three servings of vegetables a day.
Speaker 2 00:09:58 Um, two to three servings of fish per week. Um, nut consumptions actually very, very, very crucial because it increases our, our brain derived neurotrophic factor, which helps our brain, um, grow vitamin D and is also crucial, uh, pre and postbiotics, which get in a little bit. The biggest one that I talk about is high quality fish oils and also polyphenols. So I know it's a lot, but the biggest one that we could all do is sleep better, exercise a little bit more, not just me walking around exercising, just, you know, walking around your block or going on your bike for 10, 20 minutes a day or something like that.
Speaker 1 00:10:31 What about, what about probiotics? Because I do have some, some dry patients and a lot of them tend to a lot. Now, a good portion of them actually have chronic gut issues. So irritable bowel syndrome, they have, um, acid reflux issues and a lot of them have asked, probiotics are helpful. What, what's your take on that?
Speaker 2 00:10:49 Yeah, so for sure. So, um, I forgot to mention, so, um, going back to Hippocrates, um, back in 400 bc he said all diseases stemmed from the gut, right? Back in 19 eight, we have someone called Eli Metchnikoff. He was a Russian, um, scientist, and he got the, um, Nobel Prize. And he had said that all, I mean, death begins in the colon. So it goes back to the bacteria that we're having. So Eli Metchnikoff was the first person to actually describe what a post by, I'm sorry, a prebiotic or a probiotic was. So first we gotta just, just give that definition of what a probiotic is. So probiotics are the actual bugs themselves, the actual strains of bacteria. So if you thinking about it like watering a plant, those are the seeds that you would plant. That's what a, that's what a probiotic is.
Speaker 2 00:11:36 A prebiotic is pretty much, um, they're plant fibers and they act like food to help bacteria grow. And so that is, think of it like water and fertilizer for your seeds. That's what the prebiotic is. And then postbiotics is, um, a chemical reaction that's given off once you ingest those things to eliminate more bad bacteria from getting into your body. So to your answer about postbiotics probiotics is, it's crucial because when our gut is not aligned properly, have more bad bacteria, bacteria gets rid of our BA bacteria. These are the three biggest culprits. Number one are NSAIDs, people are popping NSAIDs left and right. They're actually the number one biggest inflammation thing that we have. But we take it all the time to minimize anti-inflammatory reactions. Number two is antibiotics. We're always prescribing antibiotics left and right. It's the number one over-prescribed medicine in just medicine, right?
Speaker 2 00:12:35 What happens is, when you are taking an NSAID or an antibiotic, what you did was you just now ingested that it went into your stomach, you just created a bomb in your stomach. So what did that do? Well, you just got rid of the bad bacteria, which was, but you actually now got rid of your good bacteria as well. So what does that mean? So think about it, when, when a female were to take an antibiotic, sometimes they can get what's called a yeast infection. Now, why does that happen? Because now there's an overgrowth of candida that's overgrowing. So what happens is you, whenever you prescribe an antibiotic to someone, you gotta let them know, number one, that number two is you gotta recommend that they start either supplementing, either a prebiotic or a probiotic, have yogurt with it, keer sauerkraut, things like that so that we, we bring good bacteria back into our system. The problem is, is that if our gut is not properly healed, all those vitamins and minerals that someone might be taking are not being absorbed properly. So that's where postbiotics prebiotics and probiotics are very, very, very crucial.
Speaker 1 00:13:37 That's excellent. So do you think that prescribing antibiotics for dry disease or meibomian gland dysfunction, um, should be a first line therapy or something that's, that's reserved for when other options don't work?
Speaker 2 00:13:51 Right. So what happens is that we're in a microwave society. We want the ba the the best fix possible, right? But remember what we taught in school, we're taught in school to find the underlying cause. Whenever we give an antibiotic, what happens? Well, we got rid of the a thing that's causing the problem, but it's not getting down to the root cause of the problem. It gets of that problem in a week or two weeks later, right? But then it comes back because why the gut is messed. So if someone wants something, um, very quickly to get rid of it, yes, without a doubt. The problem is that when we take an antibiotic in our system, it stays in our system for at least two years. That's the biggest issue. And so what happens is lectins, what they do is they pry apart the mucosal cells in our gut lining and what that, when that does, we have all of these toxins going into our system that's leading to inflammation.
Speaker 2 00:14:39 So going back to your question about antibiotics, we're gonna prescribe it regardless, no matter what happens. But we the patient, what the side effects and how do we implement this as much as possible to minimize those side effects from occurring, causing other problems? So we all know the, the, the homeopathic are warm compresses or you haves taking like a and placing on their are some of the things that I actually do. And so what I tells apple cider vinegar take two teaspoons, um, two teaspoons of organic, uh, cider vinegar, boil it with a hot cup of water and soak a cotton swab on it and put it on there. Apple cider vinegar has actually anti-inflammatory and antifungal properties in it. And it actually helps, um, like I said, some of those patients, other times it's coconut oil. Coconut oil. What you can do is just put a little swab on a cotton ball and just put a small little p um, area on your lids and that can help minimize some of the inflammation as well. Those are just some homeopathic things that, that can be done that just, um, that I've seen work.
Speaker 1 00:15:48 Coconut oil is actually can remove makeup. You just have to make sure you don't overdo it all the time or it can cause a little bit of backing up, but yeah. Yes,
Speaker 2 00:15:54 For
Speaker 1 00:15:55 Sure. Great makeup remover,
Speaker 2 00:15:57 <laugh>, without a doubt and sometimes with the makeup is what's causing a lot of these, these oily glands and all that stuff too.
Speaker 1 00:16:02 So. Agreed.
Speaker 3 00:16:04 So, so to be clear, are you prescribing antibiotics for dry disease? I mean, are you still using Oh,
Speaker 2 00:16:09 For sure.
Speaker 3 00:16:10 That went away from like a z a or doxycycline hundred milligrams. Uh, uh, once or twice a day, whatever you, you
Speaker 2 00:16:17 Choose. Yeah, I mean they, they work great, obviously that's why we prescribed them cause they didn't work, we wouldn't be using them. Right. And so, you know, usually I'll be using either Keflex, one of my go tos that, uh, that I would use, you know, for have a or things like that. But, um, I do prescribe them, but I do want the patient, Hey, if you're gonna take this medicine, you need to be on some type of probiotic or you need to be something with good bacteria of back in your system because it canal, um, harm other inside your, because again, we gotta get down to what's all these issues. Mm-hmm.
Speaker 3 00:16:49 <affirmative> staying on mgd, let's doxycycline. We've all had that patient that's been on a hundred milligrams like a year or longer. Mm-hmm. Yeah. Yeah. So what are your thoughts on that? Should they take them on off, uh, from back on, I mean yes. With the probiotics. Um, what are your thoughts there? Just,
Speaker 2 00:17:08 Yeah, so if we're, the hard part is that we're not really taught on the nutrition side of things. So when we fix the actual gut lining and we restore it by either sleeping, eating, all those things, um, the vitamins, minerals, all that stuff, those issues won't actually come up. It's what's causing it is because we have inflammation, oxidation stemming from the gut. So we gotta fix that first, but then that to never occur again. So we gotta give that in the beginning, but like, okay, now let's find out what's really causing it. So usually I would recommend, um, patients see a gastroenterologist, um, to minimize what's called leaky gut. And that's what lectins do. They can cause something what's called leaky gut. And so now a lot of studies are showing just not just the gut and brain, but also the gut retina access, because that can cause, um, you know, uveitis or AMD and all these things is the foods that we're eating are causing all these things to occur.
Speaker 3 00:17:57 Mm-hmm. <affirmative>, well, we wanna stay away from the leaky gut, uh, for sure. But you know, when it comes to the antibiotics for dry eye mgd, you know, oftentimes yes, we may prescribe this, but we have to be defining the underlying cause, you know, describing a, a heat mask, uh, doing an MGD procedure, evacuating those glands, prescribing antiflammatory. So they do play a role. We just, uh, love to get your insights on that. You mentioned nutraceuticals, so we, for dry eye yes. We're doing omegas, uh, you know, what are, what are your thoughts there? Do you have a, what dosage is there?
Speaker 2 00:18:30 Yeah, I'm a big fan of high quality fish oil. So the DHAs, well, when it comes to dry eye is usually the EPA that people are gearing towards. But when it comes to, and we, that d is fat, so if our is fat, what do we with, well obviously our brain. And so we need good quality DHA to sustain ourselves because it helps minimize cognitive decline, it helps with our oily glands, all that stuff, right? And so a minimum of a thousand milligrams of dha, right? So when you go to a store and you see different types of supplements out there, you'll see a total of a thousand. But you look in the back of the bottle and it says EPA and DHA only have like five, right? And it has other types of differents. So you want a minimum of milligrams of D when it comes to high quality fish oil. That will help, um, minimize some of those things that we're experiencing when it comes to m as well.
Speaker 3 00:19:25 Yeah. One of the things that, and I we've talked about this before, is, and having that in the nutraceuticals because it does have great, uh, anti-inflammatory properties in the right ratio. And so, uh, and so that, that's something that I've been using. I know she has been using it as well with the formulation. So any final pearls you have when it comes to why thes in dry eye?
Speaker 2 00:19:52 Well, again, it comes down to really all the sugar that we're eating and the, the foods that we're eating. It's not the same as it was in the past. We gotta be more proactive than reactive, right? So you know how a lot of people are either going gluten-free or they're eating organic and it doesn't, that organic is the end all bee, all the reason why you go organic is to minimize herbicides and pesticides that in the are, right? And so that's why people are doing that, um, minimizing meat consumption because what's happening with the meat consumption is that this is what's causing most of the inflammation in our body as well. We're not consuming a lot of fish. Um, that's another issue. So nobody's gonna care about our gutter or brain more than us, right? Mm-hmm. <affirmative>. And so if we don't, if we don't take that proactive approach, you know, we're gonna be dying sooner. You know? So medicine has kept us around longer. We're the, we're the best country when it comes to, to medicine and all that stuff, but you know, we're also sicker. We more cancer, more diabetes than ever, right? And it comes down to really the things that, that we're eating. So it really comes down to, to our gut, gut because our gut is really has nine times more signaling than it goes to the brain. And so when you have oxidation inflammation, it's gonna run rampant throughout our entire bodies.
Speaker 1 00:20:58 Thank you for bringing to our attention how important it is, what that, the aspect of diet when it comes to, um, yet another aspect of our health, which is actually ocular surface dryness. Um, you're such a wealth of knowledge and we really to having you on today and Awesome. Thank you. The champion for all areas of optometry and for coming on today and discussing this one little, um, aspect of it, which is how to get our patients healthier with their bodies when it comes to dry eye.
Speaker 2 00:21:25 All right. I appreciate the time. It was a blast, like you said. And, uh, can't wait till the next one.
Speaker 1 00:21:30 Thanks for listening. Join us for our next episode soon. Here's a quick word from our sponsor.
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