While a spoonful of sugar might help the medicine go down, certain foods or supplements do not serve as a cure-all. Despite his most endearing and tenacious efforts, Adina did not fall in love with Nemorino because of his magic potion, an anticipated elixir of love. Rather, the elixir served as one of many components that helped him in a complex love conquest (L’elisir d’amore). The human body functions in a similar fashion because our body tends to perform more effectively when a healthy diet is one of many components supporting a balanced lifestyle.
While we do control certain aspects of our health, it is misleading to imply that our diet fully dictates whether we can prevent or even, cure a disease. For example, neither embracing the Gerson Protocol nor drinking snake venom will cure one of cancer. To a lesser degree, ingesting chocolate dipped garlic will not improve memory loss and consuming acai berries will not cure dry eye disease. Notwithstanding, testimonials abound from people who claim their medical problems were solved because of diet, without considering other factors in their lives.
Of course, nutrition is of crucial importance to our health, and many diseases are directly related to the underlying health condition of the entire body, the later influenced by what the body ingests. Laura Periman, MD, an energetic doctor who considers both western and eastern approaches to medicine, encourages her fellow peers to examine patients with this equilibrium in mind. She recounts the story of a 25 year-old male patient who not only looked 20 years older but whose whole body was suffering the consequences of multiple poor lifestyle choices. Although he was anxious and depressed, Dr. Periman saw a person “who had a golden opportunity to thrive” and gave him an assignment. He abided and followed the Whole 30 book, returning to her office a different person; having had completely changed the trajectory of his health and life through a series of diet and lifestyle changes.
As Dr. Periman recounted the story, I recalled how my mother inculcated in me ideas surrounding nutrition and lifestyle: eat food that is seasonal and unprocessed, ensure that your meals are balanced, never leave the house without lipstick, and don’t forget to sleep. As most young adults, I dismissed her advice and submitted to trends (fat free, alkaline free, or blood type diet, and most recently cold-press juicing) whilst working too hard, stressing too much and sleeping too little. The physical consequences were cumulative and damaging, but at least I never forgot to leave the house without lipstick. Over time, my approach has become more reasonable and I realize that whilst homemade broth may help alleviate my cold, it is not going to rid my husband of his congenital glaucoma, even if he drinks it during a full moon.
Dr. Periman’s mantra is that a doctor’s obligation is “not only treating the problem but treating what generated the problem.” And for this reason, she sat with her patient to determine the source of his ailment. She suggests there is increasing evidence that “the immune system gets educated in your gut,” and this journey into a holistic approach began with a medical school paper on complimentary medicine twenty-four years ago, as a means of exploring what healing means to patients. Despite being a highly specialized eye doctor, Dr. Periman considers that there is “so much room for seeing a patient as a complete, beautiful, whole person” and in this light, she asks patients about all aspects of their lives, inclusive of physical and emotional, so that she can view them “through a complete bio-psycho-social model rather than just as a pair of eyes.”
This high tech versus high touch perspective is fascinating on many levels. First, it demonstrates that specialized eye doctors are able to shift their focus from a pure clinical diagnosis to one that warrants for inquiry and observation on numerous less quantifiable fronts. In other words, it allows them to be a specialist while also looking at the body in its entirety. For example, even though cataract surgery is straightforward from a surgical perspective, the impact and meaning on an individual is often lost simply because market pressures result in shorter doctor time slots. In this light, Dr. Periman states “the growth of alternative supplement and device markets for chronic diseases in general (eg. Lyme Disease, Fibromyalgia, etc) is in part the consequence of our need for continued scientific breakthroughs, hunts for cures and also shortcomings as doctors.” Suffering from complex and chronic ophthalmologic diseases with multiple causes and variably effective treatments drive patients to look to alternative medicine and self-medicating strategies. Dr. Periman worries that “doctors are failing the patient by not trying to include a holistic approach in their medical approach.” Second, integrative medicine embraces nutrition, blending components of integrative and functional medicine and perhaps, as Dr. Periman argues, the human microbiome is a new frontier in medicine. Consider the revolutionary evidence suggesting that, instead of being isolated to the brain, some conditions might actually start in the gut.
In this light, Dr. Periman considers herself to be a student – an avid reader of “nerd literature” she is consistently trying to understand how different parts of the body work together (e.g. diet, human microbiome and impacts on the immune system) and how she, as a doctor, can more readily guide a patient back to health. Even though genetic predisposition increases susceptible people’s risk for many diseases, these conditions may be diminished by improvements in one’s diet. Having had said that, she strongly asserts that preventative health is more multifactorial than just what you eat.
I see her as a teacher. With experience, she has learned to “think, approach and process information differently” so that she can stay, even if uncomfortably, in a “space of exploration and wonder in order to maintain a growth mentality.” I once read that,
“knowledge of the discipline structure does not in itself guide the teacher.
For example, expert teachers are sensitive to those aspects of the discipline
that are especially hard or easy for new students to master. This means
that new teachers must develop the ability to “understand in a pedagogically
reflective way; they must not only know their own way around a discipline, but must
know the ‘conceptual barriers’ likely to hinder others” (McDonald and Naso, 1986:8).”
In this light, are many doctors resistant to addressing dry eye, and if so, how can we shift this toward engagement? Dr. Periman referenced The Vicious Circle, a systems based approach for addressing the multiple layers of Dry Eye Disease (Baudouin et al. BJO 2016). She agrees “breaking a multifactorial disease like Dry Eye down into a traditional, binary, algorithm type approach is inherently difficult to learn, frustrating and unsatisfying” whereas this paper’s fresh approach wisely reorganizes the approach into a series of circles: “ Vicious Circles (#1: Inflammation; #2 Compensatory Mechanisms). Adding on to this approach, we can then view the Lacrimal Functional Unit neurobiology as Vicious Circle #3 Neurologic Participants, and #4 as the BioPsychoSocial Impacts.” With an integrated, systems based approach, one can more readily understand how diet (Vicious Circle #1) and mindset (Vicious Circle #4) can both impact the patient’s experience with disease as well as effect its outcomes.
The result? Once you have a philosophical approach and organized conceptual framework, you can efficiently and holistically address a complex problem like Dry Eye. In fact, Dr. Periman claims, “it really doesn’t take a significant amount of extra time and her deep satisfaction as a doctor is enhanced.”
TFOS Staff Writer