June 7, 2022 - Diabetic Retinopathy
Type 2 diabetes is rapidly increasing in the United States. Almost 10% of American adults have been diagnosed, with 25 percent being prediabetic, and the statistics are trending toward almost 33% of U.S. adults diagnosed with diabetes by 2050.
The conventional treatment has been: “let’s watch it”, as very few proactive strategies are usually offered. Since type 2 diabetes is a chronic disease that affects the body’s inability to metabolize sugar, the pancreatic hormone that regulates blood sugar is not able to manage insulin levels properly and this pattern leads to hyperglycemia and produces oxidative stress.
Complications lead to blood vessel damage in the kidneys, the nerves, and the eyes.
Today’s article focuses on how type 2 diabetes affects eye health and what you can do to protect yourself from diabetic retinopathy, which affects the blood vessels in the retina. Some of the visual symptoms include fluctuating vision, dark or empty areas in the peripheral vision, eye floaters, and inconsistent blurred vision. If you have been diagnosed with type 1 or 2 diabetes, I recommend going for a full eye exam which includes an extensive retina examination.
There are two types of diabetic retinopathy. One is called NPDR (nonproliferative diabetic retinopathy), which means new blood vessels are not growing in the retina. NPDR can weaken the cell wall of the small blood vessels in the retina, which leads to leaking fluid and blood in the retina. Sometimes when NPDR progresses, the larger blood vessels begin to dilate and become irregularly shaped, creating blocked blood vessels in the retina. Edema can build up behind the retina, including the macula and this can lead to blindness, if untreated.
The second type of diabetes is called advanced diabetic retinopathy. This severe type known as proliferative diabetic retinopathy is caused by the blood vessels being blocked, so new abnormal blood vessels start growing in its place. These new blood vessels are fragile and leak a jellylike, clear substance that fills the gel sac (vitreous) which sits in front of the retina. Eventually, scar tissue from this new blood vessel growth causes retinal detachment. The new blood vessels interfere with the normal flow of fluid in and out of the eye and this causes a pressure build up which damages the optic nerve and leads to glaucoma. Aside from glaucoma and retinal detachment, the other eye issue is a vitreous hemorrhage, which is bleeding in the gel sac.
If you have hypertension, poor control of blood sugar levels, high cholesterol, tobacco use, a diet high in refined carbohydrates, obesity, poor lifestyle, then you’re at risk for developing diabetes.
Integrative Medical Approach
Diabetic retinopathy can potentially cause blindness. It is important to get a dilated eye exam.
If you have risk factors that can cause diabetes, getting a baseline of your eye health will help you monitor improvements if you apply my methods. The conventional approach uses argon laser surgery or eye injections using drugs like Lucentis, Avestin or Eylea.` These are symptom-based approaches at best, and can have their own side effects like blurred vision, possible eye floaters, cataracts, glaucoma, scar tissue formation, and eye inflammation and redness.
Sometimes these treatments are warranted but the goal is for a person to eventually move away from these methods and start using a more complementary approach. I apply many functional medicine protocols to help prevent, treat, and manage type 2 diabetes in the eyes.
First order of business is to reduce carbohydrate intake. A high-starch, low fiber diet increases the risk of type 2 diabetes. There is now plenty of research-based proof that low-carbohydrate diets are superior to high-carbohydrate diets for type 2 diabetes.1,2
Generally, I would recommend that those with blood sugar regulation challenges limit carbohydrate intake to 10-15% of total calories. Some carbohydrates I recommend include sweet potatoes, rutabaga, beets, cassava, whole fruits, and plantains.
Another option that people are experimenting with is the ketogenic diet for treatment of type 2 diabetes. On one of my Clubhouse presentations, I discussed how the keto diet may cause temporary blurred eyesight when you first go on the keto diet. However, over a few weeks, the eyesight improves, and the value of relying on fatty acids and ketones for fuel rather than glucose shows promising benefits for type 2 diabetes.3
Another protocol is to eliminate gluten from your diet. In fact some studies show that a gluten-free diet improves the health of beta cells, the pancreatic cells responsible for making insulin and improving glucose tolerance.4
Nature offers us an abundance of foods that can help neutralize diabetes:
- Blueberries have been shown to improve glucose control.5 The chemical compound anthocyanins increases the uptake of glucose and improves the health of fat cells.
- Cacao: Eating dark chocolate from the cacao bean lowers blood sugar levels after you eat, helps to dilate the blood vessels, and is an efficient delivery system of glucose to the muscle cells.6
- Fermented foods may reduce the need for diabetes medication.7
- Dehydrated, organic almonds and walnuts help reduce inflammation and improve cellular health in diabetics.8,9
- Extra virgin olive oil regulates blood sugar levels after meals.10
Some of the most effective nutraceuticals that may prevent type 2 diabetes, help improve eye circulation and reduce retinal oxidative stress:
- Carotenoids like lutein (16mg per day) zeaxanthin (6mg per day), and astaxanthin (12mg per day) which can help reduce inflammation and oxidative stress.11
- Alpha Lipoic Acid (180-240mg per day) has been shown to decrease insulin sensitivity in individuals with type 2 diabetes.12
- Astaxanthin (12mg) has been shown to reduce cataract formation and diabetic retinopathy.13
- Omega 3 Fatty Acids 1400 mg EPA and 1,000 DHA daily, reduce stress, especially in the retina, one of the causative factors seen in diabetic retinopathy.
- Ginkgo biloba 120 mg per day helps reduce oxidative stress from toxic chemicals in the retina.
- Glutathione (500-900 mg per day) is a super antioxidant that helps reduce free radicals and inflammation in the retina.
- Vitamin D helps regulate insulin sensitivity and overall inflammation.
- Magnesium affects over 300 enzymes in the body and helps regulate blood sugar levels.14
- B12 and Folate. Diabetics who take the drug metformin can benefit from supplementing with folate and B 12 as this drug depletes levels of these vitamins. B12 and Folate are critical for preventing diabetic retinopathy.15
From a functional medicine perspective, I would recommend improving your gut absorption and your microbiome. If you take the drug metformin, this could have a negative effect on gut health.16
Last points
Good sleep, exercise, reducing stress, and eliminating environmental toxins are important ways to reduce your risk of developing type 2 diabetes and preserve your eye