Similar Approaches to Diabetes and Macular Degeneration with Nutrition and Lifestyle - An Ophthalmologist's Perspective - Shalesh Kaushal, MD, PhD

Kirk’s video overview of Dr. Kaushal's interview (7:13 min) Kirk’s podcast with Dr. Kaushal (39:21 min)
India’s Diabetic Crisis

The WHO projects that India by 2020 will have 300 million new diabetics, China 200 million and the United States 100 million. The major cause of this diabetes epidemic is diet change. The traditionalIndian diet has changed considerably with the increased consumption and availability of fast, fried and processed foods. In Northern India there is a higher use of processed oils in preparing foods and in processed foods themselves.  There is also a higher consumption of processed sugars added to foods and carbonated soft drinks. As people migrate to the cities from rural areas for jobs there is more processed foods consumed with added fats, oils, sugar and animal products compared to the traditional rural diet. There has been a significant increase in non-vegetarians over the last 20-30 years in India.

How Does Dr. Kaushal Approach the Diabetic Patient?
Dr. Kaushal is a retinal specialist and ophthalmologist as well as having PhD in biochemistry, with a focus now on nutritional biochemistry and metabolic diseases.  The retina is the most metabolically active tissue in the body and has the largest oxygen supply. It has the largest blood supply per unit weight in the body.  Virtually every human disease has a retinal manifestation in the body. Hypertension and diabetes can be detected in the retina. So chronic diseases can be detected early by observing retinal changes.

Age-Related Macular Degeneration and Chronic Eye Conditions
The number one cause of blindness is cataracts, followed by glaucoma, macular degeneration and diabetic retinopathy, in particular swelling of leaky blood vessels in the area of central good vision which is called diabetic macular edema. The number one cause of missed work days in the United States is  diabetic macular edema. It is a very serious medical and economic problem. The same risk factors for macular degeneration are the same risk factors for coronary artery disease and Alzheimer’s disease. Insulin dysregulation appears be a significant factor in the initiation and progression of these and other chronic conditions, as well as the diabetic state. Statins don’t appear to help macular degeneration but are the number one cause of reversible muscle weakness and a cause of some reversible dementias.

Age Related Macular Degeneration (AMD), Diet and Lifestyle
Dr. Kaushal tells patients initially that AMD is similar to other chronic illnesses – diabetes, hypertension, coronary artery disease, obesity, age-related muscle loss and age-related bone marrow dysfunction because they are all found to be caused by low grade inflammation in the body or retina in AMD.

ARED Studies (Age-Related Eye Disease Study) on AMD
Dr. Kaushal is not a big fan of the AREDS eye supplement designed to treat AMD containing beta-carotene, vitamins C and E, and minerals zinc, copper because they showed a very minimal benefit in AMD and a very minimal improvement in vision. There are good epidemiology studies showing the average nutrient deficiencies in the body are more than 40 essential vitamins and minerals that the body requires for normal bodily function (production of enzymes and structural proteins). Research has shown that Americans are deficient in more than 80% of these essential nutrients. Dr. Kaushal questions why we would only replace five of 40 nutrients that are deficient with the AREDS product. (See National Eye Institute – “What the Age-Related Eye Disease Studies Mean for You”)

Nutraceuticals and AMD
Dr. Kaushal recommends a high potency vitamin and mineral supplement. He doesn’t test for all these nutrients. It is somewhat cost prohibitive. He also adds omega-3 fats because the retina has the highest concentration of omega-3 fats in the body. He educates his patients on how to lower their omega-6 fatty acid intake, which are proinflammatory, while simultaneously increasing their omega 3s by using fish oil, krill oil, cod liver oil, or omeg3 fatty acids from algae. It is critically important to lower the omega-6 side by reducing processed food consumption, their use in cooking, and consuming animal products where animals have been fed omega-6 fatty acid enriched acid feed to “fatten” the animals.  He wants individuals to consume any type of omega-3 fatty acids but he likes krill oil which is rich in astaxanthin. He also likes cod liver oil which has vitamins D and E and has compounds called the retinoids which can improve the functioning of the retinal cells.

How Fast Can Change Be Seen                
Dr. Kaushal gives the analogy that turning AMD around is like turning a tanker around, not a speed boat. This chronic disease didn’t occur overnight, so while improvement can be seen very rapidly (within a month sometimes), the actual pathology of AMD reversal is a gradual process. He uses Saturday morning group visits to reinforcement these principles. Genomic predisposition and evaluation of the patient’s metabolic status including mTOR, autophagy, insulin signaling, inflammation, oxidative stress and nutrient sensing pathways are of value.          

Program for Diabetes and AMD
A whole food, mostly plant-based diet, with minimal processed carbohydrates with a high potency multivitamin and mineral, omega-3 fatty acids and additional nutrients which Dr. Kaushal labels as molecular rheostats are astaxanthin, Ashwagandha, turmeric, Lei Gong Teng (celestrol) and alpha lipoic acid (ALA). ALA improves mitochondrial function and number, and production of ATP. Acetyl-L-carnitine works synergistically with ALA in improving mitochondrial function. Nutraceuticals work differently than pharmaceuticals. Nature works by compounds that effect multiple cellular pathways all at once and are effective at re-stablishing cellular balance. They are useful in the retina, brain, heart, liver and other organs effecting chronic diseases. Exercising 30 minutes a day as a minimum can stimulate mitochondrial function as well. Chelation therapy may help with removal of toxic metals which can be oculo-toxic, but direct benefit of chelation studies showing benefit is lacking in AMD.

The Retinal and Alzheimer’s Connection
Both preservation of vision and memory are at the top of the list of patient concerns regarding healthy aging and independence preservation. Evaluating retinal health can also be an early detection tool for  Alzheimer’s disease. Dr. Kaushal noted his talk on AMD is very similar to neurologist Dale Bredesen MD’s talk on Alzheimer’s disease prevention and reversal recognizing their similar pathophysiology.

 Shalesh Kaushal, MD, PhD’s Background and Training
He was born in India and his family moved when he was 5 years old to Michigan where his father obtained a master’s degree in electrical engineering. His father previously had earned a masters in mathematics from India. They moved to Vermont where is father worked for IBM on the first PCs. He went to Yale University as an undergraduate and wanted to be a theoretical physicist but found he was good at solving problems and finished his undergraduate work in molecular biophysics and biochemistry. He went to John’s Hopkins Medical School and wanted to be a neurosurgeon. He had two mentors there in ophthalmology which influenced him greatly into becoming an ophthalmologist. He then wanted to pursue research and went to MIT. He did his ophthalmology residency at U.S.C., a retina fellowship at Washington University in St. Louis and did a year training in London at the Moorfield’s Eye Hospital. He worked for a short period at the University of Minnesota and work for many years at the University of Florida. He had an endowed chair and an endowed lab at the University of Florida and eventually transitioned to private practice in Florida. His practice’s website is and has two locations in Florida presently. They treat macular degeneration and other chronic conditions with the state-of-the art diagnostic equipment that would rival any academic center. At his clinic they evaluate vascular and autonomic system health with the Max Pulse, EndoPat and the Glycocalyx Check. They have outstanding noninvasive structure-function testing of the retina as well and other metabolic testing for chronic diseases. He is the lone physician ophthalmologist in his practice with a significant support team.              

Comprehensive Retina Consultants, Shalesh Kaushal, MD, PhD, 1501 N US HWY 441 Bldg 1100 , Ste 1106 The  Villages, FL 32159  Phone Number: 352-775-0852 /Fax: 352-751-1869  and 203 South Seminole Avenue Inverness, FL 34452 Phone: 352-794-1500 Fax: 352-341-3870

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