What a small yellow spot can tell you about your health
[Music]
it has
unfortunately been far too long
since i have visited a museum
but i do still love the idea of history
told through art
you are currently looking at a fresco
painted by students of the master
raphael
that depicts one of the turning points
in western history
the emperor constantine the first who
you can see in his golden armor
is preparing to fight the battle of the
milvian bridge
he looks up to the sky
turns his head at exactly the right
angle
and sees a glowing cross and adopts the
motto
by this conqueror
the battle is decisive
one year later the roman empire
officially recognizes christianity
as a religion which slowly spreads
throughout western civilization and the
rest
is history the cross
in the sky changed history and you
can see the exact same cross for
yourselves
just by walking outside on a clear day
looking up at the bright blue sky
and turning your heads at exactly
the right angle
the cross is known as heidinger’s
brushes
and here is why it happens
this is the view your optometrist or
ophthalmologist has
when they look through your pupil and
into the back
of your eye if you are able to see the
cross
it is only because sunlight enters your
eye
at exactly the right angle passes
through
and is absorbed by a little yellow spot
in the back called macular pigment
before tonight you may not have even
known
that you had a little yellow macular
pigment spot
in your eye but what if i told you
that knowing the density of that little
macular pigment spot
can tell us more about your health
your risk for disease and how
you will live and die than you could
possibly
imagine so what is macular pigment
other than one of the reasons that
christianity spread throughout western
civilization
well to answer that question we need to
know just a little bit more about the
foods
that you eat and what your body does
with those foods
macular pigment is made of lutein and
its isomers which have the same chemical
formula
but are structured just a little bit
differently for the sake of ease we will
speak more about lutein
than the others lutein is a carotenoid
which is a kind of
antioxidant anti-inflammatory plant
pigment
that you would find in healthy foods
like dark
green leafy veggies
now you don’t only eat dark green leafy
veggies and lutein is not
the only carotenoid in your diet
despite the fact that there are about
700
different carotenoids in nature your
body chooses lutein
and its isomers to use to build that
spot now we say trite
things all the time where our diets are
concerned like
you are what you eat but it must
physically be true we don’t make lutein
ourselves
if we don’t eat it we don’t have it
so why then does your body pick lutein
and reject
everything else well as it turns out
there are some really good reasons for
this biological pickiness
high on the list of things that people
complain about with advancing age
is degrading vision some of you may even
be a little bit worried about your drive
home tonight
because of the problem that you see on
your screen
glare your little macular pigment spot
as it turns out may actually be able to
improve
your visual function in challenging
visual conditions like these
or like these this is because macular
pigment absorbs bluish light
the very light that causes the glare in
the headlight
and obscures your view of the mountains
in the distance
as it turns out people with higher
macular pigment density
are less bothered by glare and can see
significantly farther outdoors
up to hundreds of feet farther than
people with
low macular pigment but otherwise
equally perfect vision
on an eye chart so if you had
no other reason to care about your
little macular pigment spot
better visual function and challenging
visual conditions is a
great reason for boosting your numbers
but as it turns out your little macular
pigment spot
may also be responsible for saving your
sight
as you age
in years of teaching i
asked my students the same
morbid semi-rhetorical hypothetical
question
people with sensory impairment do not
get to
choose which sense is affected
but what if you did what if you had to
choose
a sense to lose what would you pick
would you pick your sight
your hearing your sense of taste or
smell
your sense of touch
in years of asking this question almost
no one has
ever picked sight we are
visual animals so how can your little
macular pigment spot
save your sight well sight is
essentially a combination of
two things healthy eyes that tell a
healthy brain
what kind of a world to create
this is an image of a healthy retina
and this is an image of a retina with
age-related macular degeneration one of
the leading
causes of blindness all of those little
spots that you see
are essentially gunk bits of fats and
proteins
once part of the cells of the retina
that have become
so degenerated the retina pulls them out
and forms these little clumps
this is a slice of brain
with alzheimer’s disease
those plaques that you see encircled on
your screen
are made of almost the exact same
gunk as you see in the retina
in fact some people have gone as far as
to say
that age-related macular degeneration is
basically alzheimer’s disease
in the eye certainly
people with immaculate degeneration are
significantly more likely
to go on to develop alzheimer’s disease
in so many ways retina
is brain it’s like
a little piece of brain that’s detached
and pushed
forward in space where it serves as a
handy bellwether
for understanding the health of the rest
of the brain
it’s like an early warning system that
disease is starting
in a tissue you can actually see
as it turns out that early warning
system is incredibly
beneficial because there is no cure for
age-related macular degeneration
or alzheimer’s disease
luckily though we do know a thing or two
about preventing
those diseases and that is where our
little yellow macular pigment spot
re-enters the picture
poor diet quality is a risk factor for
alzheimer’s disease
macular degeneration and a number of
other chronic diseases like heart
disease
type 2 diabetes and even acquired
cancers in essence
macular pigment is a measure of diet
quality
one that changes as your diet changes
so if your little macular pigment spot
predicts all of this
why don’t you know your numbers
you probably know your cholesterol you
probably know your blood pressure
you may even know if the long list of
acronyms and abbreviations
that stand for the labs that are drawn
at your annual checkup
are normal so why don’t you know
this one
well to impart the seriousness
of that particular question i would like
us to consider our own
morbid semi-rhetorical hypothetical
question
of our own and one that is a little bit
more serious
than which sense would you like to lose
i want you to think about your health
project yourself forward in time
and in your head answer this
at the end of the metaphorical day
what will your cause of death
be
will it be heart disease
cancer alzheimer’s disease
if you answered yes to any of those
statistically you’re probably right that
is what we tend to die of here in the
united states
and in a few other places in the world
but more important than the answer
to your question is the process that you
used to get there
you probably thought about your family
history
you probably thought about the foods you
eat
the exercise you may or may not get
the sleep that may or may not
come naturally to you
the stress you might be under
and those diseases that were tops on our
metaphorical list
they all have risk factors that overlap
with diet
being key among them
so now finally i want you to think about
the answer
to one more question
when was the last time your doctor
asked you about your diet
measured it tracked it
recommended changes to facilitate
healthy eating and then followed up with
you to see if you were successful
measuring diet is hard
tracking diet is harder and recommending
sustained dietary change when it’s not
particularly easy to measure or track
feels like an impossibility
on the screen you will see something
oddly important to my family and me
if you’re a healthcare provider you will
see in this list
of acronyms and abbreviations the labs
that we commonly order and some that we
not so commonly order
to be able to more confidently declare a
patient
healthy note that macular pigment does
not appear anywhere on this list
for years my father was in the airlines
an industry that extensively measures
and tracks
its workforce for the obvious reason
that a pilot
in danger of a sudden stroke or heart
attack
is a risk for a major disaster
at age 66 on my father’s last
physical he checked in
as perfectly normal
and because of that fact his doctors
didn’t necessarily feel a need
to follow up
just over one year
after that physical was completed my
father died
of stage four renal cancer
that had been growing slowly for years
and that neither he nor we
had any idea that he had
my father died on may 7th
2013 in the words of his
oncologist the healthiest
sick person you would ever meet
my dad’s doctors never measured his
behavior
his history as an air force veteran who
flew
during the vietnam war and in that
capacity
was exposed to agent orange the
herbicide we now know causes cancer
turns out that was a pretty important
part of his history to note
it was a tremendous knock to a body
that lived a pilot’s life
complete with frequent time zone changes
and lack of sleep
lots and lots of stress no time for
exercise and of course
airport food
my dad’s example is heartbreaking
and a little terrifying and it
represents a very significant
problem that we need to solve in
healthcare
today in under 10
minutes i could tell you the density of
your
little macular pigment spot and if i did
i would learn so much more about you
than just your risk for macular
degeneration
i would learn about your diet quality
how often you are eating those nutrient
dense foods that contain antioxidants
and anti-inflammatories
like lutein i would learn how
effectively your body is pulling
nutrition up from those foods and
depositing it into your tissues
to protect them and i would learn
something about a risk factor
that was common to all of our answers
to our morbid question
so maybe the little yellow spot
that changed history can be a catalyst
for changing health care
it is an innovative example of a
solution to a
seemingly otherwise intractable problem
how do we measure the complex
health behaviors that we know are so
important for our health outcomes but
that we are not measuring
and not even consistently talking about
today
at the end of the day health is not your
degree of normalcy
on a list of acronyms you have to google
to understand health
is behavior health is what we
do so
how do we get to a world
where our most complex health behaviors
are measured
concretely and accurately
by demanding one
innovation follows need
we are all patients including those of
you who are watching who are also health
care providers
when we patients demand answers to
questions
we can’t currently answer innovation
follows thank you