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