ODs must teach patients about proper nutrition

December 19, 2014
Stuart Richer, OD, PhD

Stuart Richer, OD, PhD, FAAO, is director of ocular preventive medicine at James Lovell Federal Health Care Facility in Chicago. He is also associate professor of family and preventative medicine at Chicago Medical School and assistant clinical professor

If the poor and disenfranchised cannot receive accurate health information from their doctors or the news media, whom can they trust? The percentage of Americans meeting average micronutrient-rich plant food consumption (vegetables and fruit) in the U.S., remains appallingly inadequate at 15 to 20 percent. It is worse for the poor.

If the poor and disenfranchised cannot receive accurate health information from their doctors or the news media, whom can they trust? The percentage of Americans meeting average micronutrient-rich plant food consumption (vegetables and fruit) in the U.S., remains appallingly inadequate at 15 to 20 percent. It is worse for the poor.1 Both the USDA and our First Lady think children, parents and adults can all make better nutritional choices. This is because science has shown cellular damage from micronutrient deficiency to be indistinguishable from cellular damage from radiation.2 The medical literature has also shown that micronutrient deficiency is associated with cardiovascular disease and cancer when “average man” randomized, placebo-controlled, drug-type clinical trials are scaled from lowest to highest micronutrient intake.3

The importance of micronutrients

Doctors already prescribe iron for women and children, calcium and vitamin D for bone and immune health, and sublingual and injectable B12 for pernicious anemia and neuropathy, respectively. These are all vitamins and minerals.

So, why is it that in 2014, few of our nations’ nearly 900,000 U.S. physicians directly inquire about daily total plant food consumption? Why is it that college-educated science reporters often (negatively) sensationalize nutrition research studies rather than provide context against published literature, or the “preponderance of scientific evidence?” Why is it that modern medicine is interested in early detection and multiple disease treatment(s), rather than early prevention and true prevention (no occurrence of disease) or even the cure of existing multiple chronic diseases? Why are most multivitamins all too often poorly formulated, weakly dosed-or overdosed in some circumstances (iron for full-grown males)-or unbalanced (zinc-copper, calcium-magnesium, folate/B12 masking, vitamin E from tocotrienols as well as tocopherols)?

SELECT trial scares patients away from fish oil

Why do we dwell on genetic testing which addresses ~2 percent of all chronic disease at the expense of environmental epigenetics and the body’s ability to heal itself? The body heals by creating its own protective systems (including endogenous antioxidants such as glutathione, catalase, SOD). This occurs under conditions of mild biological stress such as induced caloric nutrition or molecular mimicry of the same via intake of small molecular weight nutrient molecules (i.e., resveratrol from red wine or allicin from garlic). 

In this complex landscape, how do the poor receive trustworthy information? From you. As optometrists, we should at the very least, start talking about plant food consumption and the importance of vitamin C discussed briefly in most academic medical curricula.



Vitamin C

Vitamin C or ascorbic acid is the major water-soluble extracellular antioxidant in the human body that via a gene mutation is no longer synthesized by humans and must be consumed from plant food or dietary supplements. Vitamin C status has been persuasively linked to reduction of cardiovascular disease, stroke, cancer, and now, mortality.4,5 Compared to blood serum, high concentrations are found in all ocular tissues from the front (cornea) to the back of the eye (retina), and every ocular tissue in between. And let’s not forget that two prominent risk factors for age-related macular degeneration-aspirin and smoking-deplete vitamin C.6 One health journalist reminds us of the practical limits of “real-life individuals” achieving vitamin C sufficiency:7

1. A perfectly healthy adult who does not take any vitamin C-depleting drugs (aspirin, acetaminophen, steroids, diuretics, pain relievers)

2. Those who have no health habits that deplete vitamin C (smoking, excessive alcohol, refined sugars) and diabetes

3. A person not under excessive emotional or physical stress that depletes vitamin C from the adrenal glands

4. Those who do not have an onboard chronic or acute viral or bacterial infection that increase the need for vitamin C (hepatitis C, herpes, tuberculosis, cold or flu viruses)

5. Growing children who need more vitamin C to meet the challenges of growth and to build more connective tissue and bone

6. Pregnant or peak-menstrual cycle females whose high estrogen levels weaken blood capillaries that induce blood serum leakage and swelling

7. Typical older adults who don’t secrete sufficient stomach acid to properly absorb vitamin C, bruise easily, and have low platelet counts

8. The 52 percent of Americans with H. pylori that impairs vitamin C absorption due to the ability of this bacterium to shut off cells that secrete hydrochloric acid

9. Wound-healing patients who require more vitamin C

10. Allergy patients with raised blood histamine levels which higher dose vitamin C quells

11. Patients with Candida albicans overgrowth (~70 percent of Americans) that drastically reduce vitamin C levels

12. Anemic individuals who may require more vitamin C to absorb iron from foods and to release iron for availability

The most recent 30th annual report from the American Association of Poison Control Centers showed zero deaths from multiple vitamins and no deaths from vitamins A, B6, D, E, and yes, vitamin C.8 Wealth is not measured in dollars, but by correct application of knowledge.

Continuing the conversation on mesozeaxanthin



1. United States Department of Agriculture. California Nutrient Intakes, Percent of population 2 years old and over with adequate intakes based on average requirement. Available at http://www.ars.usda.gov/Services/docs.htm?docid=15672. Accessed 12/18/14.

2. Ames B. "Nutrients and Mitochondrial Health Presentation.” National Ocular Nutrition Society Lecture. Anaheim, CA. 10/21/08.

3. Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Natl Acad Sci U S A. 2006 Nov 21;103(47):17589-94.

4. Benzie IF, Choi SW. Antioxidants in food: content, measurement, significance, action, cautions, caveats, and research needs. Adv Food Nutr Res. 2014;71:1-53.

5. Goyal A, Terry MB, Siegel AB. Serum antioxidant nutrients, vitamin a, and mortality in US Adults. Cancer Epidemiol Biomarkers Prev. 2013 Dec;22(12):2202-11.

6. Sardi B. How to prevent the fastest growing cause of legal blindness with vitamin C. Knowledge of Health, Inc. Jan 21, 2013. Available at:

 http://knowledgeofhealth.com/how-prevent-fastest-growing-cause-legal-blindness-wet-macular-degeneration-vitamin-c/.  Accessed 12/18/14.

7. Sardi B. Vitamin C: myths and reality outside the research laboratory. LewRockwell.com. March 27, 2014. Available at http://www.lewrockwell.com/2014/03/bill-sardi/vitamin-c-2/. Accessed 12/18/14.

8. Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol(Phila). 2013 Dec;51(10):949-1229.


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