Please note: transcript not 100% accurate.
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Do you feel nutrition is the cause of all our health problems? Tell me your honest opinion. As an eye doctor, as a healthcare provider, do you feel nutrition is, at least in your first two top things, as the culprit? Absolutely.
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This is Dr. Meenal and welcome to Uncover Your Eyes, where we uncover reality. As a mom and eye doctor, I wanna know it all. Let’s shift our focus to using lifestyle and nutrition to mitigate the course of disease. That’s what today’s guest truly believes should be the number one focus for all healthcare professionals. In the US alone,
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there are 678,000 deaths each year due to unhealthy diets causing diseases like cancer, heart disease, and diabetes. Dr. Julie Poteet is an optometrist with a master’s of science in human nutrition and functional medicine and a certified nutrition specialist. She has written and lectured extensively on the microbiome and immune system dysfunction.
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nutrition and healthy aging of the eyes and the use of nutrition to mitigate the course of ocular disease. Welcome Dr. Poteet. Thank you, Dr. Poteet, for being on today. Thank you for having me. I have, you know, seen a lot of things that you’ve, your lectures, your articles, and I know that you live by this mantra or you practice by this mantra of, you know, repair the roof before it starts raining.
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So in the perspective of nutrition, can you explain that to us? Sure. So I have to give credit where credit is due. That quote came from my mentor who is one of the fathers of ocular nutrition, Dr. Stuart Richer. He actually passed away last year, but he was talking about prevention and wellness in ocular health years before anybody else was.
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A saying he often said in his lectures is, we must repair the roof before it starts raining. For example, with macular degeneration, signs of macular degeneration in the back of the eye, drusen. When we see drusen, that represents sustained inflammation that’s been going on a long time before the actual drusen develops. So again, if we can practice prevention, we’re going to be in a lot better place. And I know, I mean, you’re an eye doctor.
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So where did this passion for nutrition kind of arise? When I finished optometry school, I did a VA, inocular disease slash primary care residency at the VA medical system in Boston. And I became intrigued that some of my veterans, and I, back then I even had World War II veterans, which was, kind of cool. It was very cool actually.
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But I became interested in why so many of these gentlemen aged so differently. You had, you know, 16, 17, 18, 19-year-old young men in the prime of their lives who, when starting out, were all this very healthy. And then I saw them in their later years, and I was just amazed at how some…
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people can age so well and then some age so poorly. So that piqued my interest. But the reason I went back to school and got more training in nutrition and functional medicine was for the same reason a lot of the other practitioners I’ve met along my journey became involved with functional medicine. And that is a personal story. My young son, my toddler,
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developed some severe medical issues for which conventional medicine did not fully address. And that was my, or my true journey into prevention and wellness, nutrition, the gut microbiome began. My son at the time, and this was over 20 years ago, had chronic severe gut inflammation as a baby, as a toddler. His pediatric GI specialist at Harvard, I lived in Boston at the time.
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And this was over 20 years ago before the gut microbiome was not, was something we, nobody talked about. Um, but he said, you know, Julie, there is something to this gut brain connection, there’s no really research supporting it yet, but there’s something about the gut and the brain. My kids, I see with chronic gut issues often go on to develop neurodevelopmental disorders, and that is what happened to my son. It’s been a journey, but healing his gut.
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was largely the reason why we were able to heal his brain. And again, it’s been a journey, but it’s why I’m so passionate about the power of nutrition and functional medicine to change lives. So. Thank you for sharing that story with our audience. I know that was hard for you. So thank you for sharing that. How did this connection, do you know how this connection between the gut and brain, like I would have never thought of it.
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And it’s kind of new to me. How did it arise? How did people start thinking there is that connection? Were people starting to correlate foods they eat to certain disorders or how is it working? Well, I’m going to read a quote, if you’re okay. I love quotes. Yeah. From one of the fathers of functional medicine, Dr. Leo Galland is an immunologist. He’s a brilliant physician writer that I’ve been following for quite some time.
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But he published an article in the Journal of Medicinal Foods in 2014 called the Gut Microbiome in Brain. The gut microbiome orchestrates human metabolism, immunity, and gene expression. And I think his quote here succinctly summarizes the role of our gut microbiomes. And this was, again, it’s a new science. This is all an evolving, rapidly involving science.
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But his quote is that the 100 trillion bacteria in the body of an adult human contain about four million distinct bacterial genes with more than 95% of them located in the large intestine. Since most of these genes encode for enzymes and structural protein that influence the functioning of mammalian cells, the gut microbiome can be viewed as an anaerobic bioreactor.
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program to synthesize molecules which direct the immune system, modify the epigenome, and regulate host metabolism. The gut microbiome rivals the liver in the number of biochemical processes in which it operates. And from an ocular health standpoint, every ocular disease we see, every disease we see in the eye, everything we treat has an immune component. And so the gut microbiome…
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largely drives chronic sustained inflammation. You know, you asked me when did this interest in this knowledge of the gut microbiome interacting with the brain? I can’t tell you exactly where it started. I just know that I’ve watched in the past 22 years the evolution of it actually becoming something that people actually accepted. For me, I mean, I don’t know a whole lot about the gut, but I’m, you know, I want to simplify things.
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what you intake nutritionally is what’s affecting our gut and therefore our brain, correct? Absolutely. Diet is the most powerful influencer of our gut microbiome. The more diverse our diet, meaning the more diversity in the foods we plant, plant foods, dictates the diversity of our gut microbiome. A diverse gut microbiome is health promoting.
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The standard American diet, it actually decreases microbiome diversity and promotes inflammation, but our gut is what drives sustained chronic inflammation. I do, you know, I would love to read you another quote. And this was from 2019, the Congress of Clinical Rheumatology. The keynote speaker, Dr. James Rosenbaum, chief of ophthalmology and chief of rheumatology.
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at Oregon Health and Science University. And he said in his keynote address, he said, I submit to you that in any disease that has an immune component, whether it’s Alzheimer’s, Parkinson’s, autism, atherosclerosis, obesity, diabetes, and any disease that you are seeing in your clinics with an immune component, and let’s face it, ocular diseases, they all have a chronic sustained inflammation. The microbiome is having some effect.
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Whether it’s a small effect or a large effect, it’s hard to say, but in these experimental rodents, it’s a huge effect. And one day we’ll have a therapy that is directed towards repairing or changing or altering that microbiome. And this was five years ago. And since this, we now, you know, more data has confirmed that it’s a really large effect. Our gut microbiome is driving chronic sustained inflammation. Listen, it’s one per the T-FOS, the Tear Film and Ocular Societies reports.
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Poor diet is the second largest contributor to dry eye disease. And that’s something every single one of us treats in clinic. And we see it’s such an epidemic. So yeah. So you mentioned something about diversity in nutrition, I feel. What does that mean? Does that mean eating different foods every day? Or what does that look like? It means eating the rainbow. It means eating. I have a…
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A saying I share with my patients, the KISS principle, keep it simple. Keep it simple, silly, or keep it super simple. When I was growing up, you know, my mom was famous for saying, you know, the saying was keep it simple, stupid, but I don’t like saying stupid anymore. But in the KISS principle, one of my first, it’s three, I believe, you know, things are easily remembered in three. So one of my first things I recommend is eating the rainbow.
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eating a diversity of different colors, different types of produce in our diet. And when I say that, the thought process by people is, oh, it’s different polyphenols, it’s lutein, zeaxanthin. But one of the main reasons, one of the deeper reasons I want people to eat a diversity, eat the rainbow, is because the diversity of our diet, different plant foods dictates the diversity of our microbiome. Most beneficial bacteria.
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are vegetarians. Most beneficial bacteria love plants. You know, first of all, the fiber, the fiber component. The average American only consumes around 15 grams of dietary fiber a day. USDA recommends 25 to 38 grams. Our ancient ancestors consumed between 100 to 150 grams of dietary fiber per day. And so we know dietary fiber increases the good bacteria in our guts.
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You know, there is a professor at MIT, Dr. Eric Alm, that found adding just 10 more grams of dietary fiber per day led to 11% more diversity in our gut microbiota. So again, you know, we aren’t just what we eat, we are what our microbes eat. Okay. So you talked about eating the rainbow. So you know, I’m assuming that’s like the fruits and vegetables, all the different colors.
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Are there any other foods that you feel as healthcare providers or even optometrists, we should focus on educating our patients good foods? Right. So I actually think that eye care providers are profoundly spoiled. We have the ability to image the microvasculature up close on every patient. And I think that this is an excellent
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to show patients the backs of their eyes and talk about that the retina is actually part of the brain. And what we do that’s healthy for the brain, that’s healthy for the heart is also healthy for the retina. So I think we, as a profession, are perfectly poised to kind of be on the forefront of prevention and wellness and talking about prevention and wellness. We are a specialty where prescribing nutraceuticals for our most common…
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cause of irreversible vision loss after 50 macular degeneration is our standard of care because of NIH trials, randomized controlled trials, the ARIDGE trials. Because of the trials, it is our standard of care to prescribe a nutraceutical antioxidants to slow the progression of one of our leading causes of irreversible vision loss. So I think that’s one of the reasons we are required.
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actually to talk about food and lifestyle with our macular degeneration patients. It is our standard of care. Anytime you talk about nutrition, anything actually, we have to be evidence-based. And again, we are really blessed that the NIH has good data that supports fatty fish. Fatty fish, twice a week, has been shown to slow the progression of macular degeneration.
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from the earliest stages and help prevent or delay the onset in offspring. We know that fatty fish twice a week is largely protective against geographic atrophy. And interestingly enough in these post-hoc analysis of the ARIDs data that was just published in the past few years by the NIH, it was the fatty fish and not the fish oil itself that was beneficial in slowing the progression. So again, fatty fish, recommending that to our patients, it’s evidence-based.
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We know that fatty fish twice a week, the data is pretty consistent across the board, beneficial for the neurological system, the cardiovascular system, the ocular system, from the front of the eye to the back of the eye, from dry eye all the way to the retina. Because of, you know, I worry about too much mercury in food, mercury is present in some fish and it can be very damaging to our bodies. So I like to give patients the word smash.
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when I talk about fatty fish twice a week. And that’s salmon, mackerel, anchovies, sardines, and herring. These are usually very safe fish to eat. So that’s one of the first things I talk about is fatty fish. You know, and the second thing, lutein and zeaxanthin, those beautiful carotenoids that the retina needs so much, carotenoids, the colors in nature, there’s about 750 carotenoids in nature. Of those 750, there’s about 50 different carotenoids or colors.
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pigments in our produce. Of those 50 different pigments, about 20 end up in our serum. And of those 20 that end up in our serum, the eye and the brain have a preferential uptake for two, and that’s lutein and zeaxanthin, those beautiful yellow carotenoids. Adequate levels of lutein in the macula and in the brain are so incredibly beneficial. Our standard American diet, we get one to two milligrams of lutein a day. The eye and the brain need
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anywhere between five to 20. And so most of us aren’t getting enough. So that’s the second thing. You know, I talk to my patients about, I show them their retinal photography. I show them the macula. I show them that beautiful yellow spot in the center of their pictures. And I talk to them. And I think if patients have a why behind something, they are more apt to make changes. I had a patient tell me the other day, she said, you know, Dr. Poteet.
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Every year for about three months after my exam with you, I eat so much better and I’m so much healthier. It’s like after I visit my doctor, I’m like, oh God, I’m borderline diabetic. Okay, I got to control my sugars for a few months. Then you forget. But I think if patients get a contiguous message or a continuous message amongst practitioners, if we have that we support each other in this journey and it becomes…
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kind of second nature to remember, hey, I need to eat my greens. I need to, you know, I think that that’s how we evoke change and it’s gotta start somewhere. You know, our healthcare system is more of a sick care system and we Americans, you know, one out of every two American adults is pre-diabetic or diabetic. One out of every three Medicare dollars is spent on type two diabetes. One out of every four US healthcare dollars is spent on type two diabetes. You know, when I was in school,
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I was taught that type two diabetes, we also called it adult onset diabetes, and it no longer is an adult onset disease. We see kids now with type two diabetes. One out of every four American U.S. teenagers is pre-diabetic, and this is scary. This is not sustainable. We know the longer someone has diabetes, the greater the risk of vision loss from diabetic retinopathy. So again, this is not sustainable.
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And we have to start somewhere. We have to talk. I talk to every single patient, whether you’re five or 95, about adding more produce in the diet, green leafy vegetables, fatty fish. And I think that was, you know, just to share a story, I had a patient who was diabetic and, you know, not controlled well and we were just…
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you know, talking because I had a little more time. And she said to me, you know, I have pasta for breakfast. And, you know, we start talking about her diet. And I’m like, but do you know that that’s very carby? And, you know, we talked a little bit about that. And she goes, no one’s ever told me that. And she was an elderly woman, but I was a little bit shocked about that. But I think we also assume as healthcare providers, right? I mean, I would never have thought somebody would be eating pasta in the morning, right? So I think we assume as healthcare providers,
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that our patients are eating healthy, even if they’re diabetic or they’re pre-diabetic, they just know what to do. But I think that, you know, I agree with what you said, like it’s collaborative healthcare. We all need to be talking about nutrition. So I wanna ask you something. Do you feel nutrition is the cause of all our health problems?
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That’s a, I know that’s a loaded question. I won’t quote you on it, but tell me your honest opinion. As an eye doctor, as a healthcare provider, do you feel nutrition is at least in your first two top things as the culprit? Absolutely. There was a New York Times opinion piece by Dr. Darius Mazafarian. Dr. Mazafarian is a cardiologist. He was head of Dean Tufts.
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nutrition school of nutrition. And now he’s the head of the Tufts Foodist Medicine movement. And he wrote an opinion piece with Representative Dan Glickman. And this is a quote, poor diet is the leading cause of mortality in the US causing more than half a million deaths per year. So poor diet, you know, we are what we eat. When I was growing up, diabetes wasn’t type two diabetes. It wasn’t as common as it is now. And, you know,
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neurodevelopmental disorders amongst children are skyrocketing. You know, behavioral problems are skyrocketing. You know, another thing that it is so simple, but yet complex, and such a pervasive problem is dry eye, dry eye disease. I used to never see dry eye problems in kids, and now I see it, it’s so common. And, you know, per the T-FOS lifestyle report, the Tear Film and Ocular Surface Society,
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Poor diet is the second leading cause, leading factor for dry eye disease. So what we put in our mouth is, food is medicine, food is medicine. With each bite we take, we’re either feeding disease or fighting it. And I think it’s time we wake up to this because we can’t sustain our current healthcare crisis of this chronic disease that’s driven by lifestyle factors. So.
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I completely agree with you. As healthcare providers, we are seeing more diabetics, younger ages, more every disease, not just diabetes, but more macular degeneration, more dry eye disease, more everything. So why do you, I mean, I know you don’t know the actual answer to this, but why do you feel that as healthcare providers, all healthcare providers, we don’t talk about nutrition enough? Is it because of our lack of education on nutrition?
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Or is it because we truly don’t believe that nutrition can cause all this? Why don’t healthcare providers talk about nutrition? One of the reasons why, okay, listen, nutrition is taught in less than 20% of medical schools, but that is changing. The second piece is time. We as healthcare providers, we just often don’t have the time to do it.
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The third thing is we live in a society where we practice prescription-pad medicine, right? It is something we just want to get paid. And even patients, they just want a pill for every ill. They don’t want to make dietary changes. Dietary changes are hard. I have one of my health care heroes, Dr. Sid Baker, another founder of functional medicine, he’s a Yale MD. He said in one of his lectures one time, he said, he quoted Margaret Mead. He said, it’s easier to change someone’s religion than their diet.
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Well, we have to try. We have to try. We have to. And I think one thing that COVID has, one positive thing that’s come out of COVID, it’s kind of a renaissance of health. People are more mindful now of what they can do to create health. I’m seeing a change. I mean, people are interested. People want to know what can I do to be healthy.
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But we as healthcare practitioners, we all need to jump on board with this. I had a type two diabetic patient the other day and I asked him, I said, you know, what does your endocrinologist tell you about what to eat? And he said, Dr. Potiti told me, he said, if it tastes good, spit it out. I mean, that’s his diet advice. That’s true. We can do better than that. We have to do better than that. Yeah. You know, you were talking a little bit about dry eyes disease, so it kind of got me thinking about inflammation, you know.
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Obviously there’s inflammatory eye conditions, inflammatory systemic conditions. We don’t have the chair time to talk about all the lovely foods that will help us. If you could recommend one or two foods to a patient to help with their inflammation that they should either be taking or decreasing, what would that be? I’m going to go back to the KISS principle. Keep it simple. Keep it super simple. Eat the rainbow. Produce in the diet. Fruits, vegetables. Make most of your plate.
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beautiful, colorful produce. And you can choose what you want. I mean, just different types of produce. Increased produce in the diet, fatty fish twice a week, and olive oil and nuts, those three things. And that’s just pretty simple. Every time I eat a meal, I want most of my plate to be colorful fruits and vegetables, or a large part. And that alone is gonna shift your body.
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the state of your health of your body tremendously. I find the hardest part for me is the cooking of the meal. I would love to have those vegetables after work, but you’re so tired that you just don’t want to cook them. So that’s a whole nother episode on meal prep. We eat a lot of salads. We eat a ton of salads. If you had, like I know in this day and age, you mentioned kids and I’m…
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can only imagine the next generation if they don’t take their nutrition seriously where we’re headed. What is advice that you could give parents or children for their children on a few changes that should be made in their day-to-day, whether it’s their snacks, their lunches, but changes that we need to make, or even just routines, right? A lot of children are snacking a lot. So what kind of advice would you give them?
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I talk because I see a lot of kids as patients and I show them their retinal picture and I show them the macula and I show them the color of the macula and I tell them why it’s that color and what we need to do to eat to keep it healthy. And so, you know, I talk to patients, I talk to every child I see, I ask them, do you eat your vegetables? Tell me about what you eat. And they always invariably they will smile and look at their mom for the mom to answer the question.
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And I just don’t give moms advice. Listen, smoothies, smoothies are a great way to sneak in spinach. Spinach is one of the highest in lutein of any vegetable and produce. Spinach in your smoothies, the more produce, and in gardens, gardens are a great way to kind of teach kids about produce. But I think it’s gotta be a message that they hear over and over and over.
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I try every patient I see, every child I see, I talk to them about it. Do you remember a time where it kind of impacted a patient, nutrition really impacted a patient of yours? Yeah, a lot. Well, I’m just because this is fresh in my mind. This happened the other day. And I think healthcare practitioners, we, especially, listen, eye doctors, I mean, I share with my colleagues.
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have opportunities to change lives. We really do. I had a 51 year old lady come to see me the other day, recent breast cancer survivor, husband just divorced her, and she’s just ready for a new start on life. You know, she’s, and she looks at me and she says, Dr. Poteet, I’ve always wanted to wear contacts, but I was told my eyes are too dry and I need multifocals and I just.
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I was talked out of it and I’m just told I’m just not a candidate. I like a challenge and I said, if you want to wear contacts, I’m going to do everything I can to get you and get you happy. I worked with her and worked with her. The first thing we had to do, we did have to address her dry eyes. Listen, dry eye disease is largely influenced by diet. There are actually, there’s a great new nutraceutical that’s a blend of four active ingredients that decreases…
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inflammation on the ocular surface also nourishes the retina. But I addressed the drives from the inside out through diet and from topical therapies. And I was able to get her into contact lenses and out of glasses for the first time since she was a kid. And she actually walked out of my office the other day with her hand over her heart, tears running down her face, and she said, thank you.
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Just, I mean, something as simple as that and what we do again, I mean, we have the power to really change lives and evoke change. And I used to take it for granted, but I don’t take it for granted anymore. But just something as simple as that. I mean, every single one of us in the eye care addresses dry eyes. Every single one of us contacts. I mean, it’s just something we can address on every patient. So we don’t have to be someone who.
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treats macular degeneration or it could be something as simple as dry eyes. Yeah. I love that because I think that all healthcare professionals, including optometrists, everybody should be addressing nutrition in some way or form or finding out what their patients are eating and addressing that or encouraging them to see a dietitian, a nutritionist, somebody to help them with their diet. So thank you for that. If…
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If you could give one piece of advice to our listeners, what would it be? I believe in life. We see what we look for. We live in a society where we are bombarded with negativity. And I’m someone who believes nutrition is not just food, it’s what we expose ourselves to. And every day, I’ve rewired my brain because every day I look.
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I look for things to be grateful for. It’s made me a different person. So again, I just, there’s always something good if we just look for it. So. That is so beautiful. Yeah. I have to say, I mean, you are definitely a beautiful person inside and out. And you know, just so our listeners know from the get-go, just, you know, we were talking a little bit and communicating prior to this podcast. And you know, I just knew that you were somebody who…
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really cared, cared about people and cared about your patients and educated others. So thank you for that. And I really appreciate all you’re doing for the profession. Can you tell our listeners where they can find you? Sure. I’m on LinkedIn, Julie Poteet. I just have a website that is up and running IntegrativeOD.com. It’s still kind of in the early stages. And you know, just reach out to me on LinkedIn.
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I love our patients and I love taking care of people. I love the profession of optometry. I love helping people see and I’m honored. Such an honor to be on your podcast. Thank you so much for your time today. Thank you. Thank you listeners and viewers for tuning in. If you want to catch more episodes of Uncover Your Eyes, make sure to follow or subscribe on your favorite podcast platform and on YouTube. To learn more about me, follow me on Instagram @Dr.MeenalAgarwal Until next time, keep those eyes uncovered!