Rethinking Dry Eye

Treatment
Lifestyle changes to control dry eye
Written by Drs. Travis Zigler and Jenna Zigler

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 Sick of Dry Eye?

Join our 7-Day Dry Eye Bootcamp Challenge, which is a great

adjunct to this book, and start rethinking your dry eye treatment
today.

www.DryEyeBootcampChallenge.com

Presented by:

Join the Dry Eye Syndrome Support Community on Facebook

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TABLE OF CONTENTS
Acknowledgements 9

Prologue by Dr. Edward H. Jaccoma, MD 10

Introduction 12

Part 1: Rethinking Dry Eye 20

Chapter 1 - Hydration and Drinking Plenty of Water 21

Chapter 2 - Introduction to the Power of Food 25

Chapter 3 - Chronic (Long-Standing) Inflammation 32

Chapter 4 - How Do We Reduce Inflammation? 35

Chapter 5 - Simple Meal Preparation 70

Chapter 6 - Move Your Body 83

Chapter 7 - Eliminating Toxins 88

Chapter 8 - Other Lifestyle Modifications 117

Part 2: Dry Eye Syndrome 137

Chapter 9 - What is Dry Eye? 139

Chapter 10 - Dry Eye Treatment According to DEWS II 143

Chapter 11 - What is Blepharitis? 164

Chapter 12 - What is Meibomian Gland Dysfunction? 167

Chapter 13 - What is Demodex? 175

Chapter 14 - What is Ocular Rosacea? 177

Chapter 15 - One Key to Successful Dry Eye Management 180

Wrapping Up - YOU CAN DO THIS 184

An Aside... 189

Sources & Reference Materials 190

Medical Disclaimer 192

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Acknowledgements
I wanted to thank my wife, Dr. Jenna Zigler, and my son, Jude, for
helping me write this book. They put everything into perspective for me
and, without them, this book would not have been possible.

I also wanted to thank the Dry Eye Syndrome Support Community.

Starting this group in 2016 has literally changed the entire course of my
life to serving those who suffer from dry eye. And it has been a fun ride
serving and learning from you!

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Prologue by Dr. Edward H. Jaccoma, MD

As a practicing ophthalmologist for over 30 years, I have seen all kinds of

dry eye and dry eye related problems (including my own). This practice
has taught me that dry eye is fast becoming a national epidemic – a
plague that is largely, though unknowingly, self-caused.

Fast food, fast living with more time devoted to staring at screens and
devices and less time to more physically recreational and then restful
endeavors, drives our eyes at a pace our little tear glands can’t keep up
with.

Worse, we train these glands that they are not needed because staring
begets weak blinking and only strong blinks “milk” the glands into
producing healthy tears. Without properly nourishing and using these
glands, they block up and whither (or turn into nasty pimples we call
styes). Without healthy tears, our quality of life declines. Eyes get red,
irritated, tired and productivity and the “joy of life” starts to sag.

Refining my treatments for these conditions, I came upon a standard

regimen that I called the “homework” and which I packaged into kits to
make the basic products easy to obtain and affordable for my patients. I
developed advice based on the work of others in the fields of sports
medicine and nutrition that I found to work best in conjunction with the
“homework” and I’ve taught this to countless doctors and patients over
the years.

My typical patient encounter includes reminders that “we are what we

eat” and that the glands important to making tears require good foods,
enough water and the constant full blinks to nourish and exercise these
glands into providing the tears that keep our eyes healthy and happy.

Looking for sources of reasonably priced products and easily accessed

packaging of these products and advice, I came across Drs. Jenna and
Travis Zigler and their company Eye Love. I found an echo of myself in

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their work. Much of what they tell you in this book is what I’ve tried to
instill in my practice and there isn’t a word here that I can’t endorse.

Modifying my own diet and eye habits has helped me in treating my dry
eye problem – as has the bountiful technologies that now help to better
diagnose and treat my issues – and those of my patients. Treating the
chronic, progressive disease we call “dry eye” requires the combined
efforts of the patient and their knowledgeable eye care provider.

This book is a great first step down the path leading to happy and healthy
eyes.

My advice: read this book, research the plentiful resources included on

their website and see a competent dry eye specialist. Do what you have
to in order to turn your problem around (or better yet, to prevent those
problems). Eyes are one of our most valued yet commonly neglected
organs and life is so much better appreciated when they are functioning
at their best!

Sincerely,
Edward H. Jaccoma, MD

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Introduction
“Nature knows when you are in harmony with yourself and your
environment… We frantically go to a doctor to see if they can fix [the
problem]. They can’t; only YOU can.” --Dr. Randine Lewis, PhD

Before we dive into this journey, I want to talk to all of you about the
struggle of dry eye disease and disease in general. Our healthcare crisis
in the United States has hit an epidemic. Diabetes, heart disease,
metabolic syndrome and other inflammatory conditions are increasing
dramatically with diabetes now affecting almost one out of every two
Americans.

The Centers for Disease Control and Prevention (CDC) shows that 37%
of Americans are obese.

THIS IS NOT YOUR FAULT.

It is the fault of a $1 trillion food industry trying to tell you what is

“healthy” and what is “unhealthy.” Low-fat, low-carb, gluten-free,
whole-grain, and high-fiber are all catchy terms used by the food industry
to make you think something is healthy.

Then you read article after article about fat being bad, then fat being
good, then eggs being bad, and then eggs being good, etc…, etc…

On top of that, conventional medicine simply throws medications on a

problem of a certain area of the body. For example, if you have diabetes,
take this pill to help your blood sugar levels. But rather than take a pill,
why not look to find the underlying cause of WHY your blood sugar levels
are off in the first place.

This is where functional medicine comes in. Functional medicine sees a

problem and tries to figure out what causes the problem. It then makes
changes to try and fix it.

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It doesn’t matter what your genetics tell you (my parents were diabetic so
I was destined to be too). You can reverse all that and live a happier,
healthier life without medications and surgery.

Regardless of where you are in this dry eye adventure, know that from
this moment forward, you have a choice - you can choose whether you
want to feel amazing or just get by.

Take this opportunity to set the bar for how you want to live the rest of
your life...feeling great or feeling lousy. The choice is YOURS. I promise
that if you follow the steps laid out in the upcoming chapters, you will be
feeling more incredible than you ever thought possible.

YOU are capable of far greater than what your limiting beliefs tell you.
YOU can do this if you believe that you can. If you are not willing to
make a change, then I would stop reading right here and reach out for a
full refund as you will not like this book.

The next few chapters are from my deep dive into books, functional and
holistic medicine, nutrition and conversations with leading experts in
these fields. I had given myself two days to write the section on food
helping your dry eye, and it took me almost a full year to complete
version one. You are now holding version two in your hands, which took
me another year on top of that. I am finishing this in January of 2019
more excited than ever to release this information and to help YOU on
this journey to heal yourself.

Thoughts on Western Medicine

Now before you think I am about to bash Western medicine in the next
section, I want to note that my wife, Dr. Jenna Zigler, and myself, Dr.
Travis Zigler, are both Western medicine trained doctors. We practiced
Western medicine for over 15 combined years. We still believe that
Western medicine is amazing and saves lives everyday.

The unfortunate realization is that Western medicine (which is only one

way of treatment) is this:

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 1. Patient has a problem that needs to be addressed, so they head to
their doctor.
2. We use the newest medication to treat the SYMPTOM of the
patient’s problem.
3. If that treatment doesn’t take, we switch to another medication.
4. Then, if that treatment doesn’t work, we have to resort to surgery to
fix the problem.

Western society (patients) and Western medicine (doctors) are after, far
too often, the quick remedies. We want results and we want them now.

We were taught this method of medicine...

We believed in this method of medicine...

Until our world came tumbling to a halt...

Our Shifting Belief from Western Medicine to Eastern

Medicine
It was early 2015, and we had just moved to South Carolina, from Ohio,
to start our two new optometry practices! I promised my wife that after
we moved, we could start trying for children.

So we did…

Five months into trying to have children, we realized that it was not as
easy as all our friends made it out to be. We started exploring what
could be causing this problem. I was tested to make sure I was fertile,
but that wasn’t the problem. Jenna was tested and found that she had
polycystic ovaries.

Numerous lab tests were run, but aside from polycystic ovaries shown on
ultrasound, hormone levels and nutrient levels were all normal. Because
it appeared Jenna was “healthy”, we were diagnosed with unexplained
infertility complicated by polycystic ovaries… the most frustrating of all
diagnoses in those trying to get pregnant!

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We began with a few monthly rounds of Clomid and metformin, which all
failed to achieve the desired result. We were then prescribed Letrozole,
in hopes that it would work in a different way. It didn’t. Through these
pharmaceutical interventions come a lot of undesired side effects
including sleeplessness, anxiety, mood swings, rage, thirst, and more.

Finally in July of 2016, we were told by our fertility doctor that we would
have to do In Vitro Fertilization (IVF) if we were ever going to get
pregnant. This costs anywhere from $10,000 to $25,000 with a 33%
chance of success. Not to mention, Jenna would have to put a massive
amount of expensive pharmaceuticals and chemicals into her body in
order to have that small chance to conceive.

This is not including the emotional toll of IVF on both the woman trying to
conceive and the husband as well. With that being said, there is a place
for IVF and it has done amazing things for families, we just didn’t think it
was for us.

The night before our first IVF appointment while lying in bed, I turned to
Jenna and told her that I didn’t believe that IVF was right for us. I
expressed that there had to be a better way, and she agreed. This led us
on a journey to explore additional routes of medicine including Eastern
medicine, which is about finding out what is causing this distress in your
body and healing it from the inside out.

We were already eating a plant-based diet, with minimal meat

consumption of about one time per month. We then switched to eating
only organic food.

At the recommendation of a few friends, Jenna started receiving weekly

acupuncture treatments. Her acupuncturist started her on a healthy, high
fat diet (more on this later) and reduced the amount of carbs and sugar
she was consuming. Four more months passed and still no results,
although her progress with acupuncture looked promising.

In February, our acupuncturist told us everything that month looked

perfect, and that we may conceive the next weekend. In the meantime,

10
losing hope after two and a half years of trying, we scheduled an
adoption meeting to begin the process.

The day before the adoption meeting, we took a pregnancy test… And it
was positive.

And here I am writing this section of our book one year after our son
Jude was born.

He is our miracle baby and continues to inspire and awe us everyday

because he wasn’t supposed to even be here.

This shifted my belief in how I practiced medicine as an eye doctor. I

started thinking that maybe every time I prescribe a medication I am just
covering up a symptom to a much larger problem going on with the body.
I started exploring different methods of healing disease from the inside
out. Which leads me to the present day and writing this book for you.

The unfortunate realization is that there is no magic bullet. You cannot

go on a diet, eliminate a food group, take a new medication or
supplement or eye drop and expect all disease to go away.

There is so much noise out there on cutting fat and lowering your carbs
to lose weight and fight disease, yet we are more stressed, sedentary,
sleepless, inflamed, and dying of chronic diseases like heart disease,
diabetes, cholesterol, and others. It doesn’t have to be this way, and that
is what this book will help with.

The realization is that you need to take the steps necessary to promote a
healthy lifestyle. You do not have to go through all of the
recommendations in this book at once. You will get overwhelmed and be
doomed to fail. What you can do is take it one step and one day at a
time. When you finish taking action on one chapter and have it
developed as a habit, move on to the next action item.

A brief summary of what this book will cover and how it will help you:
1. Hydration to flush and keep all systems going

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 2. Nutrition and food as the fuel your body needs to reduce
inflammation and repair itself
3. Movement to fill your body with oxygen
4. Minimizing toxins and reducing stress (my favorite section of all)
5. Supplementation
6. How we treat dry eye in practice and other traditional dry eye
treatments

Please know that the methods I discuss in this book are NOT just for dry
eye, but for healing the entire body of ailments such as high blood
pressure, diabetes, cholesterol, arthritis, infertility, and any other
symptoms you have.

With all that being said, let’s jump into the strategies that we now teach
to thousands of people around the world.

Enjoy this new opportunity to take back your life and TAKE ACTION to
feel happier with yourself and feel more confident than ever before.

REMEMBER ONE THING. YOU PICKED UP THIS BOOK BECAUSE

WHAT YOU ARE CURRENTLY DOING AND WHAT YOU ARE
CURRENTLY PRESCRIBED IS NOT WORKING TO YOUR
EXPECTATIONS, AND YOU ARE READY FOR A CHANGE.

This new journey starts with what you put into your body. Your body
wants to heal itself. It wants to be healthy and well, and it fights to do
this on a daily basis provided there is nothing getting in the way. One of
the biggest things that gets in the way is what we put into our body.

Food and water is powerful medicine, so let’s dive in.

At the end of each section or chapter there will be action items. To

get action item worksheets visit www.rethinkingdryeye.com to
download and print.

ACTION ITEM

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1. Throw out all your limiting beliefs, your can’ts, wont’s, and
excuses. You can do this if you believe you can do it. You are
here because you want a change in your life. You want to feel
better. Make that change and take back control of your life.

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14
Part 1: Rethinking Dry Eye

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Chapter 1 - Hydration and Drinking Plenty of
Water
Treatment for ALL disease should start with drinking plenty of water daily.
Seventy-five percent (75%!!!) of us walk around dehydrated. You should
be carrying around a reusable water bottle with you at all times (do
yourself and our planet a favor and avoid disposable plastic water
bottles).

Follow the motto, if you think, drink! This means that every time you
think about drinking water, you should take a drink. We have a survival
mechanism that tells us we are starting to get thirsty before we even do.

What Dehydration Causes…

Dehydration can cause a list of ailments and symptoms that are very
similar to disease. A lot of people who are just dehydrated are
diagnosed with disease, when a simple glass of water (or about ten
glasses per day) can help eliminate these symptoms. Dehydration can
cause dry eye, brain fog, fatigue, sickness, and overall malaise.

Does this sound familiar? Get drinking!

Symptoms of dehydration include:

● Thirst
● Dry mouth
● Fatigue
● Decreased urination or deep yellow or orange urine
● Headache
● Dizziness

How Much to Drink?

This obviously depends on the size of the person, but a typical
recommended amount per day is two liters, which is about 10-8 ounce
glasses of water (think dinner glasses). 10 glasses of water per day may
sound daunting but, I assure you, with a system and reusable water
bottle in place, it is easy to surpass that.
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Drink great quality water that is free of heavy metals (often found in tap
water). Make sure you have a heavy duty filter. Most refrigerator filters
do not filter out everything but are a good start. We purchased and
recommend the BIG Berkey water filtration countertop unit. You can
also have an in-house filtration system installed under your sink.

Avoid beverages and foods which have diuretic effects such as coffee,
caffeinated teas (limit to less than two cups per day), and alcohol (less
than one standard drink per day). If you must have your caffeine, make
sure you’re drinking at least that same amount of water right after to
avoid dehydration. Also drinking organic coffees and teas will make a
big difference in the amount of toxins you are putting in your body.

Toxins found in typical tap water and other drinks can build up over time
causing inflammation and other chronic problems. Investing in a high
quality filtration system will pay dividends for your health down the road.
The BIG Berkey, mentioned above, costs about $200 per year, which is
about the cost of one doctor visit. Drinking filtered water will save you at
least one doctor visit per year.

Side note: Dr. Travis Zigler drinks two liters right after waking up to
hyper-hydrate (more on this later). Dr. Jenna drinks at least 3-32 ounce
water bottles full daily, spacing it out throughout her day (one full bottle is
consumed before she eats anything that day).

Hyper-Hydration & The Effects of Proper Hydration

Hyper-hydration is a term given to drinking a lot of water in a short period
of time to flush the body with water. Wake up with a hyper-hydration
session of 16 to 32 ounces of water (two to four cups, 0.5 to 1.0 liter).
You can add a squeeze of lemon or apple cider vinegar to your water for
enhanced effects. It will take your body a few days to adjust to drinking
this much first thing, but the effects are well worth it!

Flushing the body with water and staying properly hydrated has
numerous effects on the body including boosting your metabolism by
30-50% for the next two hours (which is like working out). It will flush your

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circulatory and lymphatic system of toxins accumulated in the body
throughout the day before, as water is the purge vehicle for toxins.

Along with flushing the body of these toxins, proper hydration lowers the
noise in your body and connects your mind to your body, which means
less brain fog and more clarity. You will feel the effects of hydration after
three days of using hyper-hydration in the morning. You will feel clearer
and more alive than ever before.

Three-Step System To Stay Hydrated

1. Drink 16 to 32 ounces (0.5 to 1.0 liter) of water right after
waking up, before eating. The benefits of hyper-hydration first
thing in the morning are that you purge toxins, flush the circulatory
& lymphatic system, and boost metabolism.
2. Keep close proximity to water. Everytime you look at your water
bottle, take a drink.
3. If you think, drink! As stated above, if you think about drinking
water, it is your body’s way of telling you it needs some water. This
will help you stay hydrated all day and lead to a 30 to 50% increase
in metabolism.

ACTION ITEMS
1. Drink 16 to 32 ounces of water right after waking up
(hyper-hydration), before eating.
2. Drink 8 to 16 ounces of water 10 to 15 minutes before every
meal or snack.
3. Purchase a 32 ounce (or larger) water bottle and keep it near
you at all times. Whenever you look at your water bottle, take
a drink. “If you think, drink”.
4. Purchase a Camelback Backpack for working out.
5. Purchase a BIG Berkey Water Filtration Kit to decrease toxins
in your drinking water.

Head to www.RethinkingDryEye.com under the Hydration

tab to print your checklist for drinking more water. The
patients and readers who take action at the end of each
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chapter see exponentially better results and decrease their
dry eye symptoms significantly. TAKE ACTION!!

Sick of Dry Eye?

Join our 7-Day Dry Eye Bootcamp Challenge, which is a great

adjunct to this book, and start rethinking your dry eye treatment
today.

www.DryEyeBootcampChallenge.com

19
Chapter 2 - Introduction to the Power of Food
“Diet is HUGE! It has an enormous role in every aspect of our health
across the board. Switching to an anti-inflammatory diet is the number
one thing I recommend.” - Katherine Thurer, MD

The Word “Diet”

I use the term diet in this book a lot. I do not believe in dieting and the
word diet is used to describe what you will be eating. You are not going
on a diet. You are starting a new diet of healthy foods that will
completely transform your life, and if you stick to this healthy, new
lifestyle of eating, you can eat as much as you want inside of it.

Again, you are not going on a diet, but rather making a choice to live a
better, healthier life.

What is Disease?
The most commonly cited causes of disease are lack of oxygen,
inflammation, hormonal imbalance, and microorganisms (bacteria,
viruses, etc…). There are numerous culprits that can lead to any of
these four causes and they can include: animals, dairy, sugar, and toxic
chemicals.

These foods can increase estrogen levels, flood the body with toxic
chemicals, and carry life threatening bacteria. We will explore each
section in much more detail later.

What you put in your mouth is one of the biggest factors affecting how
your body works and feels. The cleaner, more oxygen-pumping,
anti-inflammatory, hormone balancing, and nutrient-filled food you put in
your body, the better your body can do what you ask of it.

I love the quote at the beginning of this chapter by Katherine Thurer, MD

and I think it is worth repeating and reading one more time. “Diet is
HUGE! It has an enormous role in every aspect of our health across the

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board. Switching to an anti-inflammatory diet is the number one thing I
recommend.”

Embracing Foods That Heal

Food can be the ultimate source of healing or the ultimate destruction of
your body. Once you clear away the junk that’s clogging your body from
years of poor diet, you will unclog your mind as well. You’ll be able to tap
into your healthiest and happiest you.

By the way, this junk food and poor diet that you might be eating is NOT
your fault. It is the fault of the government, big pharmaceutical
companies, and factory farms, which have deep pockets to fund
campaigns to make you think that what you are eating is healthy.

So where does this transformation begin?

All of this starts with plants!

A healthy, plant-based diet is the consumption of nutrient-dense plant

foods while minimizing (if not eliminating) processed foods, oils, and
animal foods (including dairy products and eggs). It encourages lots of
vegetables (cooked or raw), fruits, beans, peas, lentils, seeds, and nuts.

Plants help balance your hormones, maintain a stable blood sugar and
pressure, and generally fuel all of our systems in a cleaner, more efficient
way. Plant-based foods are nature’s way of giving us sun-powered
health in a delicious, ready-to-eat form.

There are virtually no nutrients in animal-based foods - including protein

and iron - that aren’t better provided by plants. Plants can supercharge
your body, reduce diseases like cancer, heart disease, diabetes,
osteoporosis, and help you live the life you’ve always dreamed of.

Research done by Drs. T Colin Campbell, Caldwell B Esselstyn Jr., and

John McDougall have shown that changing diet to include more plant
based foods and less animal-based foods can help you live longer, feel
younger, lose weight, have more energy, preserve your eyesight, keep

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your mind sharp, and have a more vibrant sex life. They also discuss
that it can eliminate your need for pharmaceutical drugs, especially for
treating things like depression, type 2 diabetes, and high blood pressure.

Fiber
Fiber is at the top of the list of health benefits of plants. Dietary fiber is
found in vegetables, fruits, whole grains, and legumes. Don’t worry
about the foods that contain all these healthy compounds right now,
because we will have lists and examples for you later in this book.

Fiber helps “scrub” our intestines clean of all the junk that inhabits them
on a daily basis. Fiber cannot be digested by our bodies and passes
intact throughout our digestive system, unlike fats, proteins, or
carbohydrates, which our body breaks down and absorbs.

Since we don’t digest fiber, it helps move things along from entrance to
exit, which helps prevent and relieve constipation. Fiber also absorbs
chemicals and toxins along the way. The more fiber you eat the lower
your risk for diabetes, high blood pressure, high cholesterol, and rectal
and colon cancer, while helping you maintain a healthy weight.

The easiest way to add more fiber to your diet? Eat more vegetables,
whole fruits (not juice) and beans.

A lack of fiber can cause constipation, bloating, hemorrhoids, gas, and

diseases like intestinal or colon cancer.

Also, when eating foods with high fiber, drink plenty of water as fiber
works best with water (you should be drinking more water anyway).

Phytochemicals
Phytochemicals, such as carotenoids, are found in plants and act like
shields that soak up invaders and keep them from harming the plants’
tissues. Our bodies cannot fight against these free radicals, industrial
pollutants, or toxins. These cause our bodies and tissues to start
breaking down, which can lead to Alzheimer’s, dementia, cataracts,
hardening of the arteries, cancer, emphysema, and arthritis.

22
If we eat plants, they lend us their powers to fight these toxins. Each
plant has its own fighting ability, which is why a variety of plants is key to
your diet.

A side bonus of phytochemicals is that they help with wrinkles by

protecting your skin from damage and helping your skin produce more
collagen. Whole grains are packed with B-complex vitamins which help
with glowing skin.

Carotenoids are responsible for giving fruits and vegetables like carrots,
tomatoes, and bell peppers their bright orange, yellow, and red hues.
Other plant-based foods with carotenoids include spinach, kale, squash,
kiwi, and grapes.

A few types of carotenoids, including zeaxanthin, lutein, and beta

carotene, play a critical role in maintaining eye health. They benefit our
eyes by guarding against vision loss, while improving one’s ability to see
colors and fine detail. Additionally they also play a role in protecting our
eyes against the damaging effects of UV light we encounter outdoors as
well as blue light from our computers, phones, tablets, and televisions.
The lutein and zeaxanthin pigments in foods and through
supplementation can also help prevent cataracts and worsening of
macular degeneration.

Fat
Oh fat… how I love thee, but you are one confusing nutrient.

The obesity epidemic that has hit the United States has been battled in a
very interesting and counter-productive way for the past several
decades. We were taught to believe (again by the food industry) that
eating low-fat products will help us lose the fat we have in our body.

To replace this low-fat want, carbohydrate intake has increased

dramatically. Dr. Sylvan Lee Weinburg, former president of the American
College of Cardiology said it best:

23
“The low-fat, high-carbohydrate diet… may well have played an
unintended role in the current epidemics of obesity, type 2 diabetes, and
metabolic syndromes. This diet can no longer be defended by appeal to
the authority of prestigious medical organizations.”

The opposite of this is true as well. A high-fat, low-carbohydrate diet

(looking at you Paleo and Dr. Atkins) can be just as harmful because
GOOD carbohydrates are needed to help fuel your body.

Finding the balance between GOOD fats (olive oil, avocados, nuts,
seeds, organic, naturally raised animal protein) and GOOD
carbohydrates (fibrous, energy making carbs) carry great nutrients that
our body needs. A more complete list and more compete meal charts
will be included later in this book.

The grocery store unfortunately makes things even more confusing as all
the labels discussed earlier are found in abundance and may have toxic
ingredients even though one thinks they are healthy. These labels
include, but are not limited to, low-fat, low-carb, gluten-free, whole-grain,
all-natural, and high-fiber.

Fat has its place in your diet and can be very healing, just make sure you
stick to the good fats, those that are organic, and usually plant based like
avocado oil, olive oil, and coconut oil, and avoid the bad fats that are
usually meats that are high in saturated fats and man-made oils like most
“vegetable” oils and margarine (more details later).

Sugar
Sugar is another interesting nutrient that has a ton of controversy. We
are told to eat low-sugar, which means low-carbohydrate diets in order to
lose weight. The key to this isn’t the sugar itself, but rather the form of
sugar you eat.

Sugar in its natural form, inside fruits and vegetables, is very good for the
body and can be used by the body. Eating whole fruits and vegetables is
a huge part of the meal plans that I will present later in this book. The

24
key thing with this is to make sure it is in whole food form and not broken
down and processed.

Where sugar takes a turn for the worse is when it is processed and
refined down to the little white crystals that you are so used to seeing.
Added sugar is everywhere and if you are not careful about reading the
ingredients on labels, then you could be consuming a ton of added sugar
in your diet on a daily basis.

Here is a brief list of added sugar food items: cakes, cookies, donuts,
crackers, pop (soda), bread, ice cream, fruit juices, jellies, jams, some
peanut butter, sauces, salad dressings, alcohol, coffee drinks (not black
coffee), sports drinks, energy drinks, and pies.

To know if the food you are eating contains added sugar you just need to
check the ingredient list for the word sugar… But wait, there are also a
ton of names that are given to other forms of sugar that is not made from
sugar cane but rather from corn. We actually consume more sugar from
corn than we do from sugar cane.

A list of sugar or sugar derivatives to watch out for in the ingredients list
of food is sugar, corn syrup, high fructose corn syrup, sucrose, barley
malt, dextrose, maltose, agave, cane juice, cane syrup, fruit juice
concentrates, honey, and rice syrup. This is a limited list as there are
others, but these are some of the most common to look for.

Sugar intake has been linked to many of the diseases that plague
Americans today, such as tooth decay, obesity, type 2 diabetes, heart
disease, high cholesterol and high triglyceride levels.

A side note on fruit juices. Juicing has become incredibly popular as well
as drinking orange juice or other juices from your grocery store. Stay
away from all fruit juices, as you are not getting any of the fiber of the
fruit itself and are just consuming sugar and water, which negates most
of the benefits of fruits and vegetables. Eliminating your daily orange
juice could mean dropping 10-15 pounds in the next few months. Try it
and see!

25
A key takeaway is to avoid anything in a box or can, as the likelihood of
sugar being added is high, and eat fruits in whole food and not juice
form. Another takeaway is that sugar is one of the leading causes of
inflammation that leads to disease. This includes inflammation that
contributes to dry eye disease.

Let’s dive into inflammation and what it causes.

26
Chapter 3 - Chronic (Long-Standing)
Inflammation
Inflammation is a BIG deal. 98% of disease is some form of
inflammation, so battling inflammation is a key component to battling
your dry eye and other disease. An estimated 80% of visits to doctor’s
offices are for issues relating to a chronic disease, which stems from
chronic inflammation of the body. The CDC states that seven out of
every 10 Americans die of chronic disease.

According to Dr. Mercola in the article How Inflammation Affects Every

Aspect of Your Health,

“The presence of inflammation is what makes most disease perceptible

to an individual. It can and often does occur for years before it exists at
levels sufficient to be apparent or clinically significant… One could also
argue that without inflammation most disease would not even exist….
The fact that your immune system drives the inflammatory process in
disease is well established. Unfortunately Western medicine offers little
in the way of actual answers as to managing or overcoming the
Autoimmune process… The typical approach to therapy is generally to
suppress the immune response with Immunosuppressive agents or
sometimes steroids (Restasis and Xiidra perform this way for dry eye).
Both approaches are designed to reduce inflammation but neither stops
the underlying disease processes or allows for damaged tissues to
regenerate… Unless you turn OFF the actual cause of fire
(inflammation), all you have done is postponed the inevitable and
potentially destroyed more of the building (your body) in the process, by
allowing the fire (inflammation) to smolder in a subclinical fashion.”

Let’s also look at the DEWS II (The Tear Film and Ocular Surface
Society’s Dry Eye Workshop in 2017) definition of dry eye, in which it
states that inflammation is one of the key reasons for dry eye.

“Dry eye is a multifactorial disease of the ocular surface

characterized by a loss of homeostasis of the tear film, and

27
accompanied by ocular symptoms, in which tear film instability and
hyperosmolarity, ocular surface inflammation and damage, and
neurosensory abnormalities play etiological roles,”

Short Term Effects of Inflammation on the Body

● Dry Eye
● Headache
● Fatigue – feeling tired
● Dilated pupils
● Stiff neck and shoulder pain
● Back pain
● Increased heart rate
● Sweaty palms and feet
● Upset stomach
● Depression

Long Term Effects of Inflammation on the Body

● Dry Eye
● High Blood Pressure
● Type 2 Diabetes
● High Cholesterol
● Heart Attacks
● Strokes
● Heart Disease
● Alzheimer’s
● Thyroid Disease
● Arthritis
● Cancer
● Allergies
● Psoriasis and Eczema
● Osteoporosis
● Digestive conditions such as colitis and diverticulitis

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29
Chapter 4 - How Do We Reduce Inflammation?
Susan Levin, MD, RD, staff dietician with the Physicians Committee for
Responsible Medicine says:

“Women who follow vegan diets are often healthier than [those] who
consume meat, thanks to eating lower levels of saturated fats (BAD
omega-6’s) and cholesterol and higher levels of fiber, folate, and
cancer-fighting antioxidants and phytochemicals.”

#1 Way To Reduce Inflammation: A Plant-Based Alkaline

Diet
As quoted before, but worth repeating for the third time, Katherine
Thurer, MD explains:

“Diet is HUGE! It has an enormous role in every aspect of our health

across the board. Switching to an anti-inflammatory diet is the
number one thing I recommend to my patients.”

The quote above sums up the importance of eating to combat

inflammation. Plants have an incredible alkalizing effect on the body,
which fights inflammation. A diet high in whole plant foods can help
rebalance the body’s estrogen levels since all that fiber helps rid the
body of excess substances it doesn’t need, including detoxified
hormones.

Plant-based diets can also reverse obesity, which is linked to diabetes,

high cholesterol, and high blood pressure.

Why You Should Give Up Meat…

We don’t necessarily mean you have to give up all meat. Our
plant-based diet leans heavy on eating mostly vegetables, legumes
(beans), and fruits, but eating WILD fish and ORGANIC, GRASS-FED,
leaner meats like chicken on an occasional basis is okay as well.

30
We just want you to reduce your meat consumption to once a day,
preferably at dinner (good), once a week (better), or once a month/not at
all (best). If you decide to give it up completely, that will bring you the
best results. Unfortunately, it can be very hard to maintain this, which is
why we recommend eating it occasionally if your body craves it.

We eat about 90-95% plant-based, but occasionally feel like eating meat,
so we do. I eat meat usually about once per week, and my wife, Dr.
Jenna Zigler, eats it about once per month.

Stated previously, but worth repeating multiple times, going plant-based

will help you ward off chronic disease, like diabetes, cancer, high blood
pressure, and high cholesterol, while keeping you at a healthier weight
for years to come.

Reducing animal product consumption will also help reduce your

saturated fat intake, which is known to clog arteries, pores, and cause
skin problems. Conversely, nutrients in tomatoes (like lycopene) help
protect your skin from sun damage, while the vitamin C in sweet potatoes
stimulates the production of collagen to reduce wrinkles.

But I Can’t Live Without Meat!! - MYTH

Before we dive into what to eat, please take note. If you have not
eaten like this before your body has adapted to eating meat, dairy,
and processed food. Much like a long term smoker goes through a
detoxification, you will also go through a detoxification in which
your body may develop rashes, headaches, shakes, phlegm,
sleeplessness, constipation, diarrhea, or other forms of discomfort.
YOU WILL GET THROUGH THIS.

Don’t get overwhelmed with the lists of foods to eat and what foods to
eliminate. We have included a simple meal preparation chart further
along. Also, start adding healthier options into your diet and you will
naturally eliminate the worst ones.

Let’s dive into what to eat.

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Vegetables
I bet you didn’t see this one coming. A plant-based alkaline diet’s staple
is… PLANTS! Sounds boring, right? WRONG! Plants are one of the
most exciting things on this earth. Make sure to get plenty of variety with
vegetables, as colors are your friends to get those phytochemicals we
discussed earlier.

According to the CDC, 40 percent of Americans don’t eat a single fruit or

vegetable every day. Not even one apple or piece of lettuce in a day.

Instead of thinking of vegetables as sides, they need to be your main

dish. When picking vegetables to eat, focus on leafy green vegetables
taking up most of your plate. The healthiest options are organic frozen
vegetables then organic fresh vegetables. Frozen is healthier due to the
fact it is flash frozen right after being picked and doesn’t have time to
lose nutrients on the way to you.

What vegetables to eat (not an exhaustive list and be sure to choose

organic): spinach, kale, mustard greens, watercress, hearts of romaine,
raw broccoli, bok choy, swiss chard, collards, dandelion, boston lettuce,
cabbage, cauliflower, peas, carrots, peppers, celery, tomato, asparagus,
green beans, cucumber, zucchini, squash, and sweet potatoes.

Super-Powered Vegetables/Foods
Experiment with these exotic foods to add an extra super-power punch to
your dishes. These include umeboshi plums, miso, parsnips, rutabaga,
burdock root, daikon, lotus root, fermented vegetables, and sea
vegetables. Green leafy vegetables are included in super-powered foods
and are included in the above list.

Sea Vegetables
Don’t be intimidated by the weird names. Sea vegetables are filled with
vitamins and minerals and include nori, hijiki, arame, wakame, and
kombu. They are also high in protein, help alkalize the blood, are a great
detoxifying agent, reduce blood pressure, and inhibit cancerous growths.

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Fermented/Pickled Vegetables
Fermented veggies contain probiotics which are great for healing the gut
(stomach, intestines, and colon). Probiotics help your body absorb
nutrients, boost your immune system, and are great antioxidants.

Pickled vegetables include pickles, sauerkraut, and kimchi. However

DON’T buy these in the grocery aisle as they are full of preservatives, but
instead look in the refrigerator section for unpasteurized products, which
will contain many more probiotics and be better for you.

These can be added to any meal to add a little bit of flavor, tang, crunch,
or salt.

Grains
Whole grains are considered one of the best forms of energy that we can
eat. Believe it or not, these little gems are packed with protein, fiber, and
other nutrients. They help us break down protein, cleanse and detoxify
our system, protect our cells, release energy, and keep our hearts
healthy. They are also rich in B-complex vitamins.

Whenever you see “enriched” on a label, that essentially means that the
grain has been stripped of its nutrients and does nothing for us other
than cause a spike in blood sugar and fat stores. Stick to whole grains
and the list below.

Grains to eat include brown rice, buckwheat, millet, oats, quinoa,

sorghum, teff, and wild rice. Mix these up so you are not consuming the
same grains every week. Start with quick cooking grains first to allow for
easier digestion then move to the regular ones as your body adjusts.

Try to reduce or limit grains when trying to do a rapid detox or trying to

lose weight. These are a great staple in your everyday diet, though.

Beans
Beans, beans, the magical fruit… Literally, these things are magic.
There are a variety of ways to eat beans as well, such as in hummus,
tacos, burritos, soup, chili, and more.

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Beans to eat include black beans, chickpeas (garbanzo), cannellini
beans, edamame. lentils, navy beans, pinto beans, red kidney beans,
split peas, white beans, and yellow beans.

Like grains above and sugary fruits below, try to reduce or limit beans
when trying to do a rapid detox or trying to lose weight. These are also a
great staple in your everyday diet, though.

Fruit
Fruit does wonders for your body and contains vitamins, minerals,
phytochemicals, and fiber. It can help protect against cardiovascular
disease, diabetes, and cancer, but must be consumed in moderation.
We are going to divide fruit into three categories. Low sugar fruits can be
consumed pretty much anytime and daily, but try to avoid them after
lunch if possible. Moderate sugar fruits should be consumed minimally
(one to five times per week) and never consumed after lunch. High
sugar fruits should be avoided if at all possible and only consumed
occasionally (one to three times per week) on days of high physical
exertion or exercise days.

Also, avoid juices which do not contain the fiber of the fruit therefore just
giving you a heavy dose of sugar.

Low sugar organic fruits to add to your diet include all berries like
blackberries, blueberries, raspberries, strawberries, lemons, and limes.
Like stated above, these can be consumed daily, but try to avoid them
after lunch.

Moderate sugar organic fruits to add to your diet include granny smith
apples, apricots, cherries, grapefruit, kiwi, melon, nectarines, oranges,
peaches, pears, plums, pomegranate, prunes, pumpkin, and tangerines.
Like stated above, these should be consumed no more than five times
per week and never after lunch.

High sugar organic fruits to limit in your diet and consume only on
exercise days (limiting to a max of three per week) are bananas, dates,
grapes, mango, papaya, pineapple, and watermelon.

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#2 Way To Reduce Inflammation: AVOID these foods
Filling your diet with foods that are nutritionally deficient and have high
saturated fats is the quickest way to derail the balance of your body. If
your body is busy fighting the damage caused from foods like ice cream,
hamburgers, and pepperoni pizza after meal times, then you will lack
energy, feel depressed, and want to sleep due to all energy being
exerted to the meal you just had.

If you’ve eaten terribly your whole life, it is not too late. Choose to turn
the switch now to a healthier lifestyle and accept the challenges that
come with it. Start eating healthy today and your body will heal your past
wrongdoings, because of its incredible ability to heal.

This will be a tough challenge, so I always recommend a cheat day. This

is 12 hours in which you can eat anything and everything you have been
craving that whole week. Make it count, but then go back to the healthy,
feel-better foods for the other 156 hours in your week.

Try this out for a test… For a full day make a green smoothie for
breakfast, lunch, and dinner. Write down the answers to the following
questions:

Did I feel tired all day?

Did I feel like I needed an afternoon nap?

Was I unmotivated to do my most important work at my job?

Did I poop?

Was I bloated?

Did I feel like drinking more caffeine to stay awake?

35
Did I experience cramping?

How did I feel the day after I ate all this?

Now eat eggs, bacon, and toast for breakfast, a hamburger and fries for
lunch, and a steak with potatoes for dinner. Answer the same questions
above.

So, What Foods Should You Avoid?

You have been eating the wrong foods for almost your whole life.
However it is NOT your fault. It is the government, factory farms, and
large companies that are to blame. These are the people that told you
“Eat meat for strength,” “The other white meat,” “Drink milk for healthy
bones,” “Got Milk?” and “Eat fortified bread and cereal for your vitamins.”

Meat, dairy, and processed foods like cereal and bread are toxic to your
body. They’re clogging your arteries, raising your blood pressure, and
pumping you full of cholesterol, toxins, hormones, and antibiotics that
you don’t need. According to the World Health Organization (WHO), a
diet high in animal products such as meat, dairy, and eggs, as well as
high in sugar-laden and fat-laden processed foods such as breads,
cereals, chips, cakes, and cookies, cause an increase in the acidity of
your body, which causes bodywide inflammation. Diets that are heavy in
these sources (animal products and processed foods) cause 80% of
cardiovascular disease, more than 33% of all cancers, and virtually all
obesity and type 2 diabetes in this country.

Heart disease, for example, is the number one killer of women in the
United States and is linked to high amounts of saturated fat in animal
products. But it doesn’t just clog up the arteries around your heart (heart
disease). It clogs up ALL your arteries, leading to strokes, cancer, and
tissue death due to lack of oxygen.

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First Food To Avoid: Meat
Before throwing this book in the trash because I told you to become a
vegetarian, hold off until you read this whole section. Also, some meat
consumption is okay, but limit it to once per day max and try having a
meatless day, like meatless Mondays. If you do consume meat, make
sure it is organic and free-range as this allows the animal to be in their
healthiest environment and not grain fed an unnatural, corn infused diet.

Meat carries numerous hormones, antibiotics, pesticides, pollutants,

bacteria, and viruses into your body. We store all this in our body fat, so
it continues to fester inside our body even after it’s been digested. When
you stop eating meat, you stop eating extra hormones, you prevent
antibiotic overdose, avoid toxic pesticides, eliminate dangerous
pollutants, and decrease exposure to scary viruses and bacteria.

The FDA and USDA allow factory farmers to use hormones to promote
growth and milk production in their cattle. Two out of every three cattle
raised for slaughter are treated with natural and synthetic forms of
estrogen and progesterone and other hormones linked to breast cancer
and colon cancer in humans. These hormones cause a slew of
problems and affect the entire food chain as they get passed on to
humans that consume the animal product. The surrounding ecosystem,
including plants and fish, soaks up the hormones as well, causing an
imbalance in humans.

Due to the crowded nature of factory farms, livestock is literally standing

in feet of its own fecal matter which is filled with bacteria and can cause
widespread illness among the livestock. To combat this, factory farmers
mix low dose antibiotics into the feed and water. 80% of all antibiotics in
the US are sold to farmers for this purpose. Massive resistance to these
antibiotics is a huge problem that could potentially extinct the human
population (words for a different book). These are given to all livestock
to prevent disease in these crowded and unsanitary conditions.

Factory farmers use toxic pesticides to ward off insects, kill weeds, and
protect their financial investment. This is the same feed that is mixed

37
with antibiotics and hormones to feed the livestock. We can usually
wash most of this off our produce or completely avoid it with organic
produce, but animals absorb the pesticides in the food they eat, which
ends up in your dinner.

Persistent organic pollutants (POPs) are environmental chemicals from

industrial processes, pharmaceuticals, and pesticides that have soaked
in the water supply and soil. These POPs accumulate and continue
moving up the food chain to you. 89% of our POP intake comes from
meat sources and dairy, including eggs and fish. Some POPs like
dioxins, are Group 1 carcinogens, and cling to animal fats. Even low
level exposure has been shown to increase the incidence of infertility,
diabetes, learning disabilities, immune system suppression, and lung
problems.

Finally, according to the USDA, 70% of foodborne illness in the US is

from meat that is contaminated with bacteria like E.coli, listeria, and
campylobacter. This is most likely due to these animals being fed food
that is not meant to be digested in their intestines (grain versus grass).
Due to poor slaughtering practices, intestinal contents (poop) splash
across meat and contaminate it.

Aren’t you excited for the cocktail of hormones, antibiotics, pesticides,

pollutants, and bacteria that are on the plate of beef, chicken or pork
waiting for your consumption?

What About Fish?

Most fish have become too toxic to consume. Oceans are slowly
becoming so polluted with garbage that fish are beginning to eat our
garbage as part of their diet and it is showing up further up the food line
when we consume the fish. Fish also contain high levels of mercury,
organochlorines, polychlorinated biphenyls (PCBs) and other toxins that
can wreak havoc on your body.

Same as above with meat, eat fish that is in its most naturally occurring
environment, which means buying wild caught fish only.

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Omega-3 fatty acids are good at lowering the risk of heart disease,
improving blood vessel function, and improving overall health of people
with diabetes, cholesterol, and other diseases. However we can also get
these health benefits from vegan omega-3-rich sources like walnuts, chia
seeds, hemp seeds, and flaxseeds.

What About Eggs?

Eggs contain lutein, omega-3, and protein. They are an extremely viable
source of all three, but there are plant-based substitutes that are even
better like those listed above.

If you are going to eat eggs (and this is the one “meat” that we eat
regularly), make sure, again, that the hen is allowed to be in their most
natural environment, which means organic and free-range. You will not
only benefit from the extra health, but the flavor is so much better as a
result.

My final thoughts on meat: If you still, after reading that, want to

eat meat or have to have it, consider only eating organic,
free-range, and local meat where you know where it is coming from.
Do we still eat meat? Yes, about once a week. If you feel like you
have to eat it daily, limit it to dinner only.

I will challenge you to try a meatless week and see how you feel. Later
on we will discuss different plant-based ideas for breakfast, lunch,
snacks, and dinner.

Meats to avoid at all costs

Pork and shellfish tend to be considered “unclean” animals and are
bottom feeders in the animal kingdom, meaning they will eat pretty much
anything. Try to avoid pork (bacon, sausage, ham) and shellfish (lobster,
crab, shrimp) at all costs.

Second Food to Avoid: Dairy

Dairy has a very high allergy rate, according to WebMD, and an
estimated 30 million Americans having an allergy by age 20. This is an

39
immune response to the lactose in milk which can develop rashes,
bloating, gas, trouble breathing, and other allergy symptoms. Also, like
meat, dairy contains growth hormones and antibiotics due to animal
treatment explained above. Dairy has also been shown to cause
inflammation which leads to life-threatening illness like MS, type 1
diabetes, rheumatoid arthritis, and hyperthyroidism.

Consider that humans are the only animals on the planet that consume
another species’ milk. Cow’s milk is a fairly recent addition to our diets.
Milk protein is hard for humans to digest, if they can digest it at all, which
triggers an autoimmune attack and inflammation in the body.

Dairy products are also our biggest sources of saturated fats and sugar.
Lactose, which is the sugar in milk, contributes the same calorie load as
soda ounce for ounce according to Neal Barnard, president of the
Physicians Committee for Responsible Medicine.

Dairy is also heavily processed and that begins with pasteurization.

Pasteurization is the process of destroying pathogens in milk, which is
necessary because it is stored and driven all over the world for
consumption. The unfortunate truth of pasteurization is that it also
denatures the healthy bacteria, fats, proteins, and vitamins, therefore
eliminating the health benefits of milk.

Another processing component of dairy is homogenization, which is the

process of breaking down the fat to make it smooth, and this makes the
industry able to create skim milk, 1%, whole, etc…

If you want to consume milk, get it right from the source and not the
grocery store. Find a local farmer to purchase milk fresh from the cow.
You may want to even consider goat milk as an alternative if you find that
you love drinking milk but have problems with typical cow milk.

Foods to Eliminate Replace with

Milk Almond, Cashew, or Coconut Milk

Cheese Nutritional Yeast

40
 Yogurt Coconut, Almond, or Cashew Yogurt
(plain)

Cottage Cheese, Ricotta Cheese Coconut, Almond, or Cashew Yogurt

(plain)

Sour Cream Coconut, Almond, or Cashew Yogurt

(plain)

Third Food to Avoid: Sugar

Sugar causes inflammation, makes you overweight, leads to diabetes,
and is linked to cancer. How do you feel after consuming that sugary
cookie, cake, or donut? I feel like garbage and I’m sure you do too.
Headaches, mood swings, depression, and more are symptoms of sugar
intake.

Don’t worry though, because nature makes its own sweets. I challenge
you to throw away all the white, brown, and powdered sugar in your
cabinet, along with all the foods that contain these harmful granules.
After that, do not eat anything with added sugar for a week. If you get a
craving, reach for a nice bowl of ripe organic berries or better yet, make
some banana “nice” cream.

Refined sugar - along with dextrose, maltose, evaporated cane juice,

high-fructose corn syrup, and agave - can take your body on a blood
sugar roller coaster, which sends your pancreas into an insulin producing
craze, which significantly increases your risk for diabetes. Type 2
diabetes is when your insulin production cannot keep up with the sugar
overload and your pancreas may stop working. This sugar roller coaster
will also cause depression, mood swings, and cravings for more sugar,
creating a never ending cycle.

Artificial Sweeteners are chemical products made in a lab that have not
been studied for the effects on the human body. Avoid these at all costs.
This includes NutraSweet, Equal, Sweet ’N Low, and Splenda.

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I always get asked, “If I want to add a little sweetness to food or drinks,
what do I use?” This is a great question and this should be limited to
once per day or eliminated altogether. Artificial sweeteners make you
crave sweets even more. But if you want something a little sweeter try
one of these remedies: banana puree, whole apple sauce, or Stevia.

Foods to Eliminate Replace with

Soft Drinks/Pop/Soda (diet and regular) Flavored Sparkling Water (Perrier is

best)
Water with lemon, lime squeezed in
Water infused with cucumber, mint

Sugar-filled coffee beverages Organic Black Coffee (decaf or regular)

(lattes, mochas, cappuccino) Organic Green/Black Tea (decaf or
regular)

Cookies, cakes, pies, and brownies Organic Fruit and Organic Frozen Fruit

Ice cream Organic Banana-based Ice Cream

Fourth Food to Avoid: Processed Foods

Any food that comes in a box, bag, or can, which has a mile long list of
ingredients, that can sit unrefrigerated for days, is not good for you. If
you have trouble pronouncing an ingredient, it is most likely not good for
you.

Trans fats, or partially hydrogenated oils, became popular because they

kept cakes, doughnuts, french fries, and cookies fresh longer and feeling
less greasy. But these artificial oils are just a processed vegetable oil
that is solidified. These lead to an increase in cholesterol and
inflammation. Common culprits that you have heard of are margarine
and Crisco (although, watch out for partially hydrogenated oil in peanut
butter - it should only contain peanuts and maybe a little bit of salt!)

Excitotoxins, such as monosodium glutamate (MSG), corn protein,

glutamate, gelatin, wheat protein, yeast extract, and autolyzed yeast, are
used for flavoring and can cause all sorts of problems like asthma,
autism, ADD/ADHD, hyperactivity, and diabetes. The common culprits to
avoid that often contain excitotoxins are frozen meals, canned soups,
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chips, crackers, sauces, dressings, candy, gum, soda, CHILDREN’s
snack food and even some BABY food.

Fifth Food to Avoid: Genetically Modified Organisms (GMOs),

Pesticides, and Fertilizers
Genetically Modified Organisms (GMOs) are simply foods or organisms
that have been altered from their natural state to help combat heavy
pesticide use, extreme temperatures, resist disease, and/or to battle
insects. GMO labeling is required in 64 countries, but the United States
and Canada do not require it because of corporate pressure.

The most common GMO plants are corn, soybeans, cotton, potato,
alfalfa, canola, papaya, squash, apple, and sugar beet. According to
TIME magazine more than 90% of all soybean, cotton, and corn acreage
in the US is used to grow genetically engineered crops.

20 years ago, no genetically modified foods existed.

So what is the big deal with GMOs?

Crops are not genetically modified for nutritional reasons. They’re
modified for economic reasons such as faster growth, with pesticide
resistance so they can add more pesticides during growth. Pesticide use
continues to rise due to the creation of superweeds and hard-to-kill
insects that are becoming resistant to pesticides.

Pesticides are designed to be toxic. Think about what they are used for.
They are meant to kill weeds, pests, and insects, of which we are not that
different from. If it is toxic to them, it is toxic to us, yet we consume
thousands of pesticides daily, poisoning ourselves in the process, by not
eating organic food.

Fertilizers are also used to provide much needed nutrients to soils that
used to exist prior to the use of pesticides. Multiple USDA studies reveal
that the food currently grown on America’s chemical-intensive factory
farms contains drastically less vitamins and essential minerals than the

43
food produced 50 years ago, when pesticides and fertilizers were not
used as frequently.

Most food coming from factory farms is nutritionally deficient, laced with
pesticides, antibiotics, hormones, harmful bacteria and viruses,
genetically modified organisms (GMOs), and toxic chemicals. Factory
farms and traditional product from these farms are a hazard to your
health.

How to Avoid GMOs, Pesticides, & Fertilizers

Simply buy organic or foods labeled non-GMO, know the farmer you're
buying from (like at a farmer’s market), plant a garden, and eliminate the
ten crops listed above from your diet. If you are going to consume the
ten crops listed above, make sure they are organic. These include corn,
soybeans, cotton, potato, alfalfa, canola, papaya, squash, apple, and
sugar beet

For an easy start, go by the Environmental Working Group’s Dirty Dozen

and Clean Fifteen. However, for the easiest way to think about this just
always buy organic, which is what we do.

ALWAYS buy organic when it comes to the Dirty Dozen which includes
strawberries, spinach, nectarines, apples, peaches, celery, grapes,
pears, cherries, tomatoes, sweet bell peppers, peppers and potatoes.
Avoid these items if they are not organic.

The Clean Fifteen should still be bought organic if possible, but they
have less pesticide residue compared to other produce. This list
includes sweet corn, avocados, pineapple, cabbage, onions, sweet peas,
papayas, asparagus, mangoes, eggplant, honeydew melon, kiwi,
cantaloupe, cauliflower, and grapefruit.

Pesticide side effects include nausea, vomiting, diarrhea, stomach

cramps, headache, dizziness, weakness, confusion, excessive sweating,
chills, thirst, chest pains, difficulty breathing, cramps in your muscles,
and aches all over your body

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What about soy?
Soy is considered to be a great alternative to not eating meat. Tofu and
other meat substitutes have been gaining significant popularity, but soy is
very similar to corn as it is cheap to grow and easy to manufacture and
process into pretty much anything we want.

When choosing to eat soy, stick to the organic, whole food variety
(edamame) or eat fermented soy products like miso, soy sauce, and
tempeh. Fermentation changes a food in a natural way, which is most
similar to what our bodies would do with it. Try to avoid processed soy,
such as tofu.

#3 Way To Reduce Inflammation: Give Your Cells Oxygen

We can all agree, we need oxygen to live. Try holding your breath for 30
seconds and depriving yourself of oxygen. What happens? Your body
goes into a shocked state and starts to make every effort to take another
breath.

What you are eating is possibly doing this to the rest of your body without
you knowing it. You have 100 trillion cells in your body that rely on
oxygen on a daily basis. The cells of your body are in constant
regeneration, meaning they die and then new ones are created. As each
new cell is built, the body seeks proper building materials from which to
construct each cell. These building materials are what you put into your
body.

The number one thing that determines how operational and healthy
these cells will be is the fuel that they are given, which is also known as
the food you eat.

The expression, “you are what you eat” will take on a whole new
meaning after this section.

45
The cells in your body (each individual cell of the 100 trillion that you
have) are like a city, according to E.G. Heinrich. It is full of activity.
Water, oxygen, minerals, and amino acids (parts of protein) are the
primary parts of the inside of the cell. This is where life-sustaining
processes mainly occur. Cell membranes are the “walls” around the city
that allow things in and out, while protecting the cells. These cell
membranes are becoming unhealthy by the unhealthy oils you are
eating. This includes trans fat (likely from the Western diet of fried and
processed foods) and vegetable oils (corn, soybean, canola). These
unhealthy oils are resistive to oxygen and therefore your cells are starved
of oxygen, leading to a chronic inflammatory state.

Short term you may not notice a difference, but long term this creates
diseases like heart disease, diabetes, high cholesterol, arthritis, dry eyes,
and more. According to Brian Peskin, all disease involves a lack of
oxygen at the cellular level. If oxygen is in the cell, you will have good
health. Nobel Prize Winner Dr. Warburg stated that if a cell is denied
60% of its oxygen requirements, then cancer can occur.

The great news about this is that your cells regenerate every two days to
six months (depending on which part of the body we’re discussing). Your
body grows new cells in the eye every two days, new skin in six weeks, a
new liver in eight weeks, and new nerve cells in a period of months. As
each new cell is built, the body seeks proper building materials from
which to construct the cell. If it cannot find these, it will create unhealthy
cells, deprived of oxygen.

The body has an incredible ability to heal itself, IF provided with the
proper nutrition and building blocks. Starting today, you can make
changes that lead to a healthier, more fulfilling lifestyle that isn’t riddled
with disease and pain.

These changes include avoiding (at all costs) oxygen-resistive oils, like
corn, canola, or soybean oil and consuming oxygen-enabling oils such as
healthy omega-3 (high quality fish oil or flaxseed oil) and omega-6
(evening primrose oil or black currant seed oil).

46
Oils to Avoid are Modern Vegetable Oils (especially after being
heated):
● Margarine
● Shortening (Crisco)
● Fake Butter Substitutes (I Can’t Believe It’s Not Butter)
● Corn Oil
● Soybean Oil
● Canola Oil
● “Vegetable” Oil
● Peanut Oil
● Cottonseed Oil
● Grapeseed Oil
● Hydrogenated oils (check the ingredients list)
● Trans Fat (check the nutritional information)

Foods to Avoid (and Avoid Unhealthy Omega-6’s):

● All the oils listed above
● ANY fried foods (they fry them in the oils above)
● Salad dressing (they use the oils above) - substitute vinegar
instead, like balsamic
● Chips
● Fast Food - chicken fingers, french fries, hash browns, chicken
nuggets, McDonald’s
● Freezer meals
● Cookies, candy, cakes, pastries, muffins, candy bars, etc
● Pork products such as bacon, pork chops, pork loin, ham, etc
● Limit cheeses that are NOT white, but some is okay (see below)

Oils to EAT to Help Reduce Inflammation

These foods with healthy oils listed below help rebuild your cells into
healthier cells able to transfer oxygen and reduce inflammation and
disease. These healthier oils can also cross the blood/brain and
blood/eye barriers, which means they will benefit both the brain and eye,
helping with dry eye.

47
When using an oil in cooking (it is never recommended to heat an oil
above its smoking point), use either an organic, extra virgin,
cold-pressed coconut oil; organic, extra virgin olive oil; or organic
avocado oil. They key thing with cooking is to not let the oils get above
their smoking point. Once an oil is smoking it has been damaged, and
damaged oil causes damage to your body. When an oil is damaged, the
healthy fat molecules are broken down and they form free radicals, which
are cancerous.

If you are already a healthy individual (be honest), you should be getting
a 2:1 ratio of healthy omega-6 to healthy omega-3. However, if you
suffer from numerous diseases, are overweight, or eat terribly, you
should start by shifting your diet first (which we’ll discuss more in later
sections) and start with a ratio of 4:1 healthy omega-6 to healthy
omega-3 (some suggest even 8:1 to combat all that “bad” fat you have
been eating).

If you start to pay attention to this ratio and you can get it to 4:1, then you
will be more than doubling the amount of oxygen that moves from your
blood to your cells, which will decrease pain, inflammation, and disease.

The key with this ratio is to make sure the sources of omega-6 are
healthy, which are listed below. The typical North American diet consists
of up to 50:1 UNhealthy omega-6 to omega-3. This causes increased
inflammation, heart disease, blood vessel blockage, stroke, diabetes,
and more.

This is NOT a short term fix, though, and requires a lifestyle change.
What you are doing now is not working and causing you a tremendous
amount of pain... FIX IT. It is not up to a doctor to fix your problem, it is
on you! Below I list examples of healthy omega fatty acids for you to
include in your diet.

Healthy Vegetarian Omega-6’s

- Avocado (15:1 omega-6 to omega-3 ratio)
- Flaxseed oil (or ground)
- Chia seeds

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 - Evening primrose oil
- Black currant seed oil
- Walnuts
- Almonds (Almond butter)
- Sunflower seeds (Sunflower seed butter)
- Sesame seeds
- Pine nuts
- Brazil nuts
- Pecans
- Pumpkin seeds
- Hemp seeds

Healthy Vegetarian Omega-3’s

- Avocado (15:1 omega-6 to omega-3 ratio)
- Flaxseed oil (or ground)
- Chia seeds
- Evening primrose oil
- Black currant seed oil
- Walnuts
- Almonds (Almond butter)
- Sunflower seeds (Sunflower seed butter)
- Sesame seeds
- Pine nuts
- Brazil nuts
- Pecans
- Pumpkin seeds
- Hemp seeds
- Fresh basil
- Dried oregano
- Cloves
- Canned grape leaves

Healthy Meat Omega-6

- Organic, free-range eggs
- Organic cheese - try to stick to WHITE cheese such as cottage
cheese, parmesan, goat cheese, gruyere
- Organic whole milk
- Organic, grass-fed butter

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 - Organic, grass-fed, free-range beef
- Organic, grass-fed, free-range poultry

Healthy Meat Omega-3

- High quality wild caught fish (make sure it’s wild)
- Wild mackerel
- Wild Alaskan salmon
- Wild herring
- Wild caught tuna
- Wild caught sardines

#4 Way To Reduce Inflammation: Increasing Vitamins and

Essential Minerals with Whole Foods and Supplementation
Whenever you can eat a vitamin or mineral in a whole foods diet it is a
much better option than taking a supplement. A supplement is there to
do just as the name suggests... supplement, or enhance something else
when added to it. You should take supplements as an addition to an
already healthy diet as described above.

The world of supplements can be very confusing. There are

supplements for weight loss, diabetes, high blood pressure, cholesterol,
sex drive, dry eye, and pretty much everything else under the sun. The
goal of this guide is to point you in the right direction as to what is
needed to live a full balanced diet. Stay away from the gimmicky
supplements for weight loss, fat burning, and other “in the moment”
supplements your friends or coworkers tell you about.

Supplements are not a well regulated industry and should be cautiously

approached. Pretty much anyone can package, label, and sell a
supplement on the market today. Look on the label or ask the company
if they are third party tested, pass clinical good manufacturing practices,
and manufactured in an FDA registered facility. All products should
undergo rigorous testing before, during, and after production. Third party

50
testing is performed to ensure that all supplements contain the specified
ingredients and avoid unwanted chemicals, toxins, and materials.

We are asked all the time, which supplements we recommend for [fill in
the blank]. Instead of giving you a list of supplements that we
recommend or a list of supplements that we take, I am going to talk
about the benefits of supplements that you should be taking and whole
foods ways of taking them. Also, due to the fact that this list of
supplements that we take and recommend could change over time, I
didn’t want to make a list of them in this book. We keep an updated list
at www.RethinkingDryEye.com under the Supplementation section.

Multivitamin
Multivitamins are one of the most common vitamins taken in the world
today and we believe that everyone should be taking a multivitamin. But
which one to take is the big question. Drones of individuals turn to this
“one pill” in order to “keep themselves healthy.” Like we discussed
previously, though, supplements are made to complement an already
healthy lifestyle. And also as discussed earlier, not all supplements are
the same.

Multivitamins are meant to be the filler for what you miss in your
everyday diet. For the most part, your body will excrete any excess
vitamins and minerals it does not need. I am guessing you need this
bridge to get all your nutrients since 75% of people worldwide don’t get
their five daily servings of fruits and vegetables per day, and five is still
too low in my mind (hooray, green smoothies!)

Multivitamins will help where your diet falls short and will help increase
eye health, bone health, and blood health (preventing things like
anemia), as well as a possible connection to heart disease and cancer.

Taking a once daily “pellet” or a one-a-day might not be the most

beneficial vitamin as it is heavily compacted and hard to digest and get
all the nutrients out of that pellet. Instead I like to opt for a multivitamin
that is spread over the day. I personally take half my multivitamins in the
morning and half in the evening.

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Green Superfoods
If you couldn’t tell by now, we love our greens. A green smoothie has
been one of the most beneficial staples and additions to our diet since
we started it in 2015. We have also seen the huge impact that this has
had on our patients and customers in the dry eye community. The green
smoothie that we make every morning, and sometimes for lunch,
contains kale, spinach, or other greens (we also add a greens superfood
powder to our smoothie, in addition to our leafy greens).

A greens powder will give you a massive boost in energy, metabolism,

immune support, and detox your entire system. The energy comes
without the crash that coffee or sugary soft drinks give you. The blends of
fruits and vegetables gives you a potent boost of micronutrients that are
absorbed quickly. They also support your immune system and help with
detoxification through vitamins and minerals. Greens will help you focus
better than ever before and give you a better attitude.

It also isn’t just for your smoothies. You can mix it with only water and
take it for a quick greens kick on the go. Or you can even put a scoop in
oatmeal, yogurt, soups, or any other dishes you are making.

Something to note is that when you first start using a greens powder, or
start eating your green smoothies, you will go through three phases in
the first month or so. I call this my 21 day greens adjustment period.
The first seven days you might have unbearable stomach pain, gas,
constipation, diarrhea, and nausea. Sounds fun right?

PUSH THROUGH THIS!

Days seven through 14 will be uncomfortable. You may notice some

stomach irritation and bloating, but nothing too extreme. Your bowel
movements will start to become more regular and you will start going at
almost the same time everyday, without the help of coffee and caffeine.

52
After day 14, you become unstoppable. Your body will crave whatever
you feed it. Feed it pizza and chips daily and you will crave and eat
pizza and chips daily. Feed it broccoli daily and you will crave broccoli.
After day 14 you will begin to crave your greens and need them on a
daily basis.

We have done extensive research and trialed many multivitamins to

settle on the supplements we take. To see the multivitamin and greens
superfood powder that we take, visit www.RethinkingDryEye.com and
look under the Supplementation tab.

Probiotics
Leaky gut and healthy bacteria have been talked about quite a bit lately,
with good merit. The bacteria in our gut is so beneficial for helping us
absorb nutrients, digest food, and fight infection. Probiotics can also help
with diarrhea, irritable bowel syndrome, allergies, and even urinary tract
infections.

You can get healthy probiotics by supplementation and by eating

fermented foods such as kimchi, kombucha, yogurt, or fermented
vegetables (like refrigerated sauerkraut). When supplementing, you
want to find a high quality supplement that contains billions, with a B, of
live cultures and take this supplement first thing in the morning on an
empty stomach.

Vitamin A
Vitamin A is a fat-soluble vitamin that enhances healthy vision, skin,
bones and other tissues in the body. Vitamin A performs as an
antioxidant and anti-inflammatory agent and plays an important role in
the preservation of the heart, lungs, kidneys, and other vital organs.
Maintaining a healthy balance of vitamin A is essential to good health.

The American diet keeps most Americans from experiencing vitamin A

deficiency. However, some health problems and lack of nutrients in our
53
meals and snacks can lead to low levels of vitamin A and other nutrients,
and some people are more prone to vitamin A deficiency than others. A
vitamin A deficiency is directly linked to dry eyes. Cutting back on food to
slim down is usually how most people develop a vitamin A deficiency,
and it is more prevalent in undeveloped countries.

The surface of your eye has a clear lubricating membrane called the tear
film that nourishes and protects your eye. Vitamin A deficiency can cause
cell mutations within the cornea, disturbing the tear film and resulting in
dry, irritated eyes. You may experience surface irritation, redness, and
moments of blurred vision. Long-term deficiency may also cause damage
to the retina, which contributes to vision changes and can lead to vision
loss.

Fixing a vitamin A deficit is pretty simple...eat more whole foods with

vitamin A and take a multivitamin with vitamin A in it. The best foods for
vitamin A are leafy green veggies, sweet potatoes and, of course,
carrots.

There has been some effort to add vitamin A to eye drops in order to
have a quicker effect on dry eyes. But, as of yet, there isn't any evidence
that suggests that this actually works.

Speaking of vitamin A, there are derivatives such as retinoids that can

actually worsen dry eyes if used in large doses (think Accutane and
over-the-counter retinol skin creams).

Animal Food Sources High in Vitamin A

Eating foods rich in vitamin A can help to prevent dry eyes or alleviate
them as long as the damage to your eye is minimal. Incorporating some
of the following foods could help increase your intake of vitamin A.
Animal food sources are not water-soluble and are stored in body fat.
Therefore, overconsumption of vitamin A through animal food sources
can become toxic, so be careful with the following!
- Beef liver
- Chicken liver
- Ricotta cheese

54
 - Whole milk
- Butter
- Eggs

Also make sure that, if you choose to eat these meat sources, they are
organic, grass-fed sources.

Plant Sources High in Vitamin A

Plant sources are not stored in body fat and are therefore less
problematic. The following plant-based foods are rich in vitamin A and
are wonderful for treating dry eyes.
- Peaches
- Sweet Potato
- Carrots
- Cantaloupe
- Butternut squash
- Mangoes
- Apricots
- Broccoli
- Cayenne pepper or chili powder

Vitamin A is a key nutrient to optimal vision and general health. Be sure

to intake the amount you need without over doing the animal sources, or,
even better, stick with the plant sources and make sure your multivitamin
has vitamin A in it.

B-Complex
The B-Complex of vitamins are antioxidants, mood stabilizing, and
neuroprotective. Methylated versions of vitamin B supplements should
be used, such as folate instead of folic acid, because the nutrient is used
by the body instead of broken down.

Low Vitamin B6 is associated with inflammation, according to WebMD.

This can be found naturally in legumes and vegetables. Studies show

55
that people with the highest inflammation have the lowest levels of
vitamin B6 in their blood.

Your body excretes any excess B vitamins, therefore it is never retained.

Vitamin D and D3
Most people are actually vitamin D deficient. It is not found in the food
we eat in as much abundance as before, and we do not get as much
sunshine as we used to. Exposure to the sun will help your vitamin D
deficiency, but it will probably not completely resolve it, even in areas that
have loads of sunshine all year long.

Eating whole foods with vitamin D also helps, but supplementation with
vitamin D is usually recommended. Foods to eat include fatty fish, eggs,
and mushrooms. Supplementation is almost always recommended if you
are vitamin D deficient. The recommended daily amount to take is 800
IUs, according to the National Institute of Health, but most can take up to
4,000 IU safely.

Vitamin D has been shown to inhibit the inflammatory cascade, therefore

reducing inflammation. Vitamin D helps with calcium and phosphorus
absorption therefore a deficiency can show up as bone disease such as
rickets and osteoporosis. Vitamin D deficiency is also a known cause for
dry eyes. Lower quantities of vitamin D effect tear function that needs
vitamins to function properly. Other than that, Vitamin D improves the
coating on the surface of the eye and helps to protect it from
environmental factors.

Antioxidants: Vitamins C and E

Free radicals are found abundantly in the body. Free radicals wreak
havoc on our body causing cancer, macular degeneration, inflammation,
dry eye, heart disease, and other chronic illnesses. Our body can fight
free radicals on their own, but with the help of antioxidants the battle is
supercharged.
56
The best way to increase antioxidants is through whole foods, such as
colorful vegetables like red, yellow, and orange peppers, carrots, kale,
spinach, and pretty much any vegetable.

Vitamin C plays a vital role in relieving inflammation, boosting your

immune system, and protecting your joints. Your body excretes any
excess vitamin C therefore it is never retained. Vitamin E helps prevent
symptoms of dry eye, macular degeneration, cataracts, and damage to
the eye from diabetes. It also helps with heart disease, mental decline,
menopause symptoms, and some cancers.

Antioxidant: Phytochemicals
This section is earlier in this book, but worth repeating here.

Phytochemicals, such as carotenoids, are found in plants and act like

shields that soak up invaders and keep them from harming the plants’
tissues. Our bodies cannot fight against these free radicals, industrial
pollutants, or toxins hiding in animal foods. These cause our bodies and
tissues to start breaking down, which can lead to Alzheimer’s, dementia,
cataracts, hardening of the arteries, cancer, emphysema, and arthritis.

If we eat plants, they lend us their powers to fight these toxins. Each
plant has its own fighting ability, which is why a variety of plants is key to
your diet.

A side bonus of phytochemicals is that they help with wrinkles by

protecting your skin from damage and helping your skin produce more
collagen. Whole grains are packed with B-complex vitamins which help
with glowing skin.

Carotenoids are responsible for giving fruits and vegetables like carrots,
tomatoes, and bell peppers their bright orange, yellow, and red hues.
Other plant-based foods with carotenoids include spinach, kale, corn,
squash, kiwi, and grapes.

57
A few types of carotenoids, including zeaxanthin, lutein, and beta
carotene, play a critical role in maintaining eye health. They benefit our
eyes by guarding against vision loss, while improving one’s ability to see
colors and fine detail. Additionally they also play a role in protecting our
eyes against damaging effects of UV light we encounter outdoors as well
as blue light from our computers, phones, tablets, and TVs. The lutein
and zeaxanthin pigments in foods and through supplementation can also
help prevent cataracts and macular degeneration.

Our company has a few options for phytochemical and antioxidant

supplementation. We have a supplement that contains just lutein and
zeaxanthin (Heyedrate Lutein and Zeaxanthin), which is great if you are
eating a well balanced diet and take a great multivitamin. If you need a
little extra help in the vitamin department and are worried about macular
degeneration, then our Heyedrate Ocular Health Formula would be better
for you as it contains some added ingredients to help protect the macula
and retina inside your eyes. To check these out, look under the
supplementation section at www.RethinkingDryEye.com.

Magnesium
Magnesium is one of the most essential minerals needed by the body,
yet it is the most lacking mineral in the human diet. Unfortunately with
the current farming practices, it has been stripped from the soil so much
that we now need to supplement. A study of almost 4,000
postmenopausal women shows that 100 mg of magnesium per day was
associated with a significant reduction in various inflammatory markers.

Magnesium deficiency can lead to neurological malfunction, irregular

heart rhythm, macular degeneration, weak bones, and muscle cramping
and spasms. Magnesium is a vital part of your diet and needs to be
prioritized as one of the most essential minerals that you need to
function.

58
A good way to help replace essential minerals is supplementation.
Another way is replacing all the table salt in your house with Celtic Sea
Salt, which contains 82 trace minerals.

Nuts and vegetables are also a great way to increase your essential
minerals consumption. These foods include: pumpkin seeds, sunflower
seeds, almonds, hazelnut, Brazil nuts, spinach, kale, sweet potatoes,
peppers, sea vegetables, onions, asparagus, cabbage, brussel sprouts,
broccoli, kale, turnips, and beans.

Supplementation can take many forms with magnesium such as a pill,

liquid, or powder form. To make it more readily absorbed in the body,
magnesium should be coupled with a chelator (bound to an amino acid)
and in a form such as magnesium glycinate, malate, and taurate.

Other essential minerals to consider in your supplementation are

calcium, magnesium, zinc, selenium, copper, manganese, and
chromium. A great multivitamin will cover most of these for you including
the one that we recommend at www.RethinkingDryEye.com.

Omega-3 Fatty Acids

Omega-3 is a fatty acid that should be a core part of your diet. The
American diet consists of way too many unhealthy omega-6 fatty acids
and not enough omega-3 fatty acids. We discussed this in depth in the
previous chapter on healthy fats, so go back and read that to recollect
the importance of omega-3 fatty acid.

Having a healthy level of omega-3 can prevent a long list of severe

diseases as well. Things like prostate cancer, mental degeneration, heart
attack, strokes, epilepsy, insomnia, joint pain, and vision loss can
sometimes be prevented with omega-3 supplementation.

There are two ways to treat an omega-3 deficiency. The first is by

including oily fish in your daily diet. Fish eat algae to obtain a certain acid

59
called Eicosapentaenoic acid (EPA), which is the most commonly known
omega-3 fatty acid.

However, there might be some of you that don't like fish. If you dislike
fish, you should move on to the second way of obtaining this important
omega; omega-3 supplements. Now that we're on the topic of omega-3
supplements, we should talk about how all omega 3 supplements are not
created equal.

Look for an omega-3 supplement that is triglyceride based and has other
added nutrients to help with dry eyes. We make one called Heyedrate
Omega 3 for Eye Health, which you can access to purchase at
www.RethinkingDryEye.com

How much omega-3 is recommended?

While there are varied studies that say anywhere from 500 mg all the
way up to 4,000 mg per day, I think the real answer is that it depends. It
depends on how healthy you are and how healthy your diet is. If you eat
a lot of processed junk food, than your unhealthy omega-6 is going to be
much higher and therefore you need to take closer to the 4,000 mg of
omega-3 per day. Conversely if you are a pretty healthy individual that
does not eat a lot of processed, unhealthy omega-6 than you can do
1,000 mg to 2,000 mg per day.

We recommend most of our patients start out at 2,000 mg per day for the
first few months as they are adjusting their diet, and then they can
reduce to 1,000 mg per day. Talk with your doctor about the right dose for
you.

Eating a well balanced diet of fruits, vegetables, grains, and legumes,

you will not have much of a vitamin and mineral deficiency, but adding
supplementation will help ensure that you meet the recommended daily
dose needed to fully thrive and eliminate your dry eye and other disease
symptoms.

There is a such thing as too much of a good thing. Try to stick with the
recommended dose for most vitamins as some can become toxic in your

60
system if taken too much. Also consult your natural healthcare
practitioner if you are unsure about what to take.

61
ACTION ITEMS
1. This section on supplementation can be VERY overwhelming.
Don’t be overwhelmed by the information, as we have broken
it down into a few supplements that you can take to cover all
these bases. Most of the supplements recommended, we did
not create. However, some of them are ours.
a. Check out the list at www.RethinkingDryEye.com under
the Supplementation section.

2. Count how many items on this list you consume for three
straight days. Tally up your total and then the following three
days, cut it in half. Keep eliminating half until you are
essentially down to zero. How do you feel as you are cutting
back?
a. Head to www.RethinkingDryEye.com under the Food
Elimination tab to print your tally sheet.

Breads Brownies Cakes Candy

Cookies Crackers Donuts Ice Cream

Jams/Jellies Peanut Butter Pies Fake butter

(non-organic)

Milk Cheese Dairy yogurt Chips

Alcohol Coffee drinks (not Energy drinks

black)

Soft drinks Sports drinks Fruit juices

(pop/soda)

Margarine/Crisco Vegetable oil Salad dressing

62
63
 Sick of Dry Eye?

Join our 7-Day Dry Eye Bootcamp Challenge, which is a great

adjunct to this book, and start rethinking your dry eye treatment
today.

www.DryEyeBootcampChallenge.com

64
Chapter 5 - Simple Meal Preparation
We often eat a green smoothie for breakfast and lunch, which will start
your day with a ton of antioxidants, nutrients, vitamins, minerals, and
alkalizing foods to give your body a boost and make you feel full and
productive. It will also give you a boost after lunch instead of that tired,
food “coma” feeling that you usually have.

For dinners, we stick to the “detox” list of vegetables and occasionally put
a grain in from the “everyday” food list. To add flavor, we add vinegars,
oils, mustard, salt, pepper, and herbs, but we never use sauces like
BBQ, ketchup, mayonnaise, or other high sugar and highly processed
sauces.

With that being said, we do splurge. We control 90% of what we eat so

the other 10% we can do what we want. Drink a beer, a glass of wine,
have pizza, chicken wings, ice cream, pie, cake, a cookie, or a burger. If
you control 90% of what you are putting in your body you will see results
fast on this plan. If you need a four week “detox”, then strictly stick to the
foods in the detox area 100% of the time for that four weeks to get the
full benefits.

“Detox” Food Quick List

In this first section, stick to these fruits and vegetables if you want to see
even faster results from this book. I recommend sticking to this list every
so often when you feel like you need a “detox.” Usually this occurs after
holidays or a vacation to really get your body back into a healthier state.

This can also help tremendously to reduce inflammation quickly and

effectively, balance your hormones, and lose weight or fat. This will help
with blood sugar fluctuations, inflammation systemically and for dry eye,
autoimmune conditions, weight gain, high blood pressure, cholesterol or
triglycerides, and fatigue.

Try this detox diet for about four to eight weeks. On this “detox” eating, I
would also recommend a daily intermittent fast if it is healthy for you to
do so (consult your physician). This consists of 12 hours per day of no
eating. I recommend dinnertime (5:00 pm to 7:00 pm) to breakfast the

65
next morning (6:00 am to 8:00 am). This will allow your body to reset
and catch up to all the toxins that are constantly being put into it.

The goal when eating this way is to eliminate sugars and put your
body in a fat burning state.

Remember to choose organic whenever possible, and organic

frozen vegetables and fruits are just as good (sometimes better)
than fresh.

Healthy Fats and Protein are the staples of your diet. Make sure to buy organic and
raw. This should be about 50% of the calories you consume.

Almonds (Almond Butter) Cashews (Cashew Butter) Chia Seeds

Ground Flax Seeds Hemp Seeds Macadamia (Macadamia

Butter)

Pecans Pine Nuts Pumpkin Seeds (PS Butter)

Sesame Seeds (Raw Tahini) Sunflower Seeds Walnuts

Coconut should be a staple as well due to its abundance of healthy fats. Coconut
foods include:

Coconut Butter Coconut Chips Coconut Flour

Coconut Meat Coconut Milk (full fat in a

(Unsweetened) can)

Healthy oils can be used on salads, in soups, in your smoothie, or used to cook with
at a low temperature to avoid smoking (which means oils were damaged).

Avocado Oil (cook with) Extra Virgin Coconut Oil Extra Virgin Olive Oil (cook
(cook with) with)

Flaxseed Oil Hemp Seed Oil Walnut Oil

Vegetables that have low sugar and high fiber are good at any time of day and are
great for adding carbohydrates to your diet.

Arugula Asparagus Bamboo Shoots Bean Sprouts

Bell Pepper Broccoli Brussel Sprouts Cabbage

Cauliflower Chives Celery Collard Greens

Cucumber Eggplant Endive Fennel

Garlic Ginger Root Green Beans Jicama

Jalapeno Peppers Kale Lettuce Mushrooms

66
Parsley Mustard Greens Onions Radishes

Radicchio Snap Beans Snap Peas Shallots

Spinach Spaghetti Squash Summer Squash Swiss Chard

Tomatoes Turnip Greens Watercress Zucchini

Fruits that have lower sugar but still should NOT be consumed after lunchtime

Lemon Limes Blackberries

Blueberries Raspberries Strawberries

Meat and Dairy should be avoided if possible, but if not, buy organic, grass-fed,
free-range when possible.

Chicken Eggs Beef

Turkey Wild Fish Butter/Ghee

Kefir Yogurt (Greek, Plain) Raw Cheese (White, Hard)

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Everyday Food Quick List
In addition to the food above which are best to consume if wanting to
burn fat fast, eliminate disease, and really supercharge your
anti-inflammatory plan, here are some foods that you can add on an
everyday basis when NOT doing a detox plan.

Remember to choose organic whenever possible, and organic

frozen vegetables and fruits are just as good (sometimes better)
than fresh.

Vegetables and legumes that have more sugar and fiber than previously mentioned.
Eliminate these foods if you are trying to lose weight, decrease inflammation,
eliminate disease faster, and want to supercharge your results.

Artichokes Beets Black Beans Carrots

Chickpeas French Beans Great Northern Kidney Beans

(Garbanzo) Beans

Leeks Lentils Lima Beans Navy Beans

Okra Pinto Beans Pumpkin Split Peas

Sweet White Beans Yellow Beans

Potatoes/Yams

Fruits that have moderate sugar but still should NOT be consumed after lunchtime
(and in moderation)

Apples Apricots Cherries

Grapefruit Kiwi Melon

Nectarines Oranges Peaches

Pears Plums Pomegranate

Prunes Tangerines

Fruits that have high sugar should be avoided (or eaten at breakfast during exercise
days only)

Bananas Dates Grapes

Mango Pineapple Watermelon

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Grains should be avoided after lunchtime and limited to the more powerful ancient
grains. NEVER eat “enriched” anything, as it means it has been stripped of all
nutrients.

Buckwheat Millet Quinoa Sorghum

Teff Brown Rice Oats Wild Rice

69
Breakfast and Lunch Green Smoothie Chart
Green Smoothie Chart - Gift your body with 1 green smoothie a day and reap the
benefits!

Some Helpful Tips (Makes 1 large blender/2 servings)

● For the liquid base, you want 1 cup of filtered water and 1 cup of one of the
following:
○ Coconut Milk, Cashew Milk, or Almond Milk
● Blend in stages - liquid + greens first, then add everything else (we just throw it all
together)
● Organic Frozen Fruit is great for step 3. Then you do not need to add ice.
● Avoid sugar and artificial sweeteners (use bananas, mango, apples, pears, dates
instead)
● Make them ahead of time for lunches, snacks, and when you need a quick fix.
● T. = Tablespoon (you can use a normal spoon from your kitchen)

Step 1. Pick Your Liquid Base: 1-2 cups of Coconut Milk, Cashew Milk, Almond
Milk, Water

Step 2. Pick Your Greens: Pick 1 green and add 2-3 cups total or 2-3 handfuls

Spinach, Kale, Arugula, Broccoli, Celery, Collard Greens, Cucumber, Dandelion, Green
Beans, Parsley, Swiss Chard, Hearts of Romaine

Step 3. Pick 1-2 for Flavor: Pick 1-2 fruits (low sugar is best) and add 1-2 cups

Low Sugar (eat throughout day and stick to low sugar only on the “detox” plan):
Blackberries, Blueberries, Raspberries, Strawberries, Lemons, Limes

Moderate Sugar (minimal consumption, none after lunch): Granny Smith Apples,
Apricots, Carrot, Cherry, Grapefruit, Kiwi, Melon, Nectarine/Tangerine, Orange, Peaches,
Pears, Plums, Pomegranates, Prunes, Pumpkin

Higher-Sugar (limit to one on exercise days only): Bananas, Dates, Grapes, Mango,
Papaya, Pineapple, Watermelon

Step 4. Pick 2-3 Healthy Fats

½ Avocado, 2-3 T. Flax Seeds, 2-3 T. Chia Seeds, 2-3 T. Hemp Seeds, 1 T. Coconut Oil,
1-2 T. Almond Butter, ½ cup Walnuts, ½ cup Almonds, ½ cup Sunflower Seeds, ½ cup
Sesame Seeds, ½ cup Pine Nuts, ½ cup Brazil Nuts, ½ cup Pecans, ½ cup Pumpkin
Seeds

Step 5. Flavor Enhancers & Health Boosters (Add 2-4)

1 Scoop Protein Powder, 1 Scoop Greens Powder (or an All-In-One Powder), 1 cup
Frozen Cauliflower, 1-2 T. Cacao Powder, 1-2 T. Cinnamon, 1-2 T. Acai Powder’, 1 T.
Celtic Sea Salt, 1-2 T. Nutritional Yeast, ½ Lemon Squeezed, ½ Lime Squeezed, 1 t. of
various spices like Turmeric, Ginger, Cloves

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 Green Smoothie Grocery List
❏ Organic spinach (large box) or organic kale
❏ Bananas (2-3)
❏ Avocados
❏ Frozen blueberries or mixed berries
❏ Frozen peaches
❏ Frozen cherries
❏ Frozen mango
❏ Frozen cauliflower
❏ Organic, unrefined coconut oil
❏ Ground flaxseed/flaxseed meal
❏ Cinnamon
❏ Dark, unsweetened cocoa powder or cacao
❏ Unsweetened almond milk or unsweetened coconut milk
❏ Plant based protein powder

NOTE: These recipes make 2 servings

**Simplest Green Smoothie** **Low Sugar Morning Smoothie**
1 cup blueberries 1½ Cups unsweetened almond milk
½ avocado 2 Cups spinach
1½ cups unsweetened almond milk 2 Scoops plant based protein powder
2 cups spinach 2 tsp. cinnamon
OPTIONAL: 1 scoop vanilla/chocolate protein ½ avocado
powder 1 Cup frozen cauliflower

**Tropical Green Smoothie** HIGH SUGAR - **Peach Green Smoothie**

limit to once per week ½ cup blueberries
½ banana ½ cup frozen peaches
½ cup frozen mango 1½ cups unsweetened almond milk
1 1/2 cups unsweetened coconut milk 2 cups spinach
2 cups spinach 1 Tbsp ground flaxseed
1 Tbsp organic extra virgin unrefined coconut oil OPTIONAL: 1 scoop vanilla protein powder
OPTIONAL: 1 scoop vanilla protein powder

**Chocolate Cherry Green Smoothie** **Berry Green Smoothie**

½ cup frozen cherries 1 cup frozen blueberries or mixed berries
½ avocado 1½ cups unsweetened almond milk
1½ cups unsweetened almond milk 2 cups spinach
2 cups spinach 1 Tbsp ground flaxseed
2 Tbsp cacao powder ½ cup frozen cauliflower
OPTIONAL: 1 scoop chocolate protein powder OPTIONAL: 1 scoop vanilla protein powder

**Instructions for all:**

- Add liquid and leafy greens to blender and blend
- Add fruit and add-ins to blender and blend until smooth
- ENJOY!
- It is important to buy Organic ingredients when possible!
- Water can be added to thin out as desired
- Using at least one frozen fruit will ensure a chilled, creamy smoothie
- Frozen cauliflower can be substituted for the banana in any smoothie, for those
looking to avoid sugar
- If using a high powered blender, such as a Vitamix, you can add all ingredients to the
blender and blend all at once!

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Other Lunch Ideas
We usually do a green smoothie for lunch as well, but wanted to give you some other
options. If we don’t eat a green smoothie for lunch, we usually stick with a salad or
vegetarian yogurt mixture.
Lunch Salad Chart (Serves 1)

Some Helpful Tips

● ALWAYS buy organic when possible.
● An example is with spinach. You lose almost 90% of nutrients when buying
traditional spinach vs organic spinach.
● Plus there are over 52 pesticides found on traditional spinach.
● For Dressing, do NOT use ready-made dressing as they contain bad fats. Just use
the vinegar of your choice (I love putting a little hot sauce on as well) mixed with
avocado oil or extra virgin olive oil
● Balsamic Vinegar + organic avocado oil
● Local Honey + Mustard
● Tabasco Sauce or Frank’s Red Hot Sauce
● Add a little fruit to enhance the flavor as well (just not too much)
● Apple slices, strawberries, blueberries, blackberries, no sugar added pitted
dates, dried apricots, or raisins
● Save Meat (if you must eat it) for dinner only… Your body will thank you!
● T. = Tablespoon (You can use a normal spoon from your kitchen)

Step 1. Pick Your Greens: Pick 1 green and add 2-3 cups total or 2-3 handfuls

Spinach, Kale, Arugula, Collard Greens, Dandelion, Hearts of Romaine, Mustard Greens,
Radicchio, Swiss Chard, Turnip Greens, Watercress

Step 2. Pick Your Protein: 1 cup total (Eliminate or Limit on “Detox” Plan)

Beans: Black Beans, Chickpeas (Garbanza), Cannellini Beans, Edamame, Lentils, Navy
Beans, Pinto Beans, Red Kidney Beans, Split Peas, White Beans, Yellow Beans

Grains: Brown Rice, Buckwheat, Millet, Oats, Quinoa, Sorghum, Teff, Wild Rice

Step 4. Pick 2-3 Healthy Fats

½ Avocado, 2-3 T. Flax Seeds, 2-3 T. Chia Seeds, 2-3 T. Hemp Seeds, 1 T. Coconut Oil,
1-2 T. Almond Butter, ½ cup Walnuts, ½ cup Almonds, ½ cup Sunflower Seeds, ½ cup
Sesame Seeds, ½ cup Pine Nuts, ½ cup Brazil Nuts, ½ cup Pecans, ½ cup Pumpkin
Seeds

Step 5. Pick 1-10 Vegetables (NO LIMIT) :)

NO LIMIT: Asparagus, Bamboo Shoots, Bean Sprouts, Bell Pepper, Broccoli, Brussel
Sprouts, Cabbage, Cauliflower, Celery, Cucumber, Eggplant, Garlic, Green Beans,
Mushrooms, Parsley, Peppers, Onions, Radishes, Snap Peas, Spaghetti Squash,
Summer Squash, Tomatoes, Zucchini

LIMIT ON DETOX: Artichoke, Beets, Carrots, Peas, Pumpkin, Sweet Potatoes/Yams

72
Lunch Yogurt Chart (Serves 1)

Some Helpful Tips

● Do NOT buy flavored yogurt as it contains a TON of sugars and sweeteners
● T. = Tablespoon (You can use a normal spoon from your kitchen)
● Try to find an organic, plant-based protein instead of whey protein

Step 1. Pick Your Yogurt Base: ½ - 1 cup (plain, no flavor or sugar added)

Coconut Yogurt, Cashew Yogurt, Almond Yogurt, Greek Yogurt (not plant based)

Step 2. Pick 1-2 for Flavor: Pick 1-2 fruits (low sugar is best) and add 1-2 cups

Low Sugar (eat throughout day and stick to low sugar only on the “detox” plan):
Blackberries, Blueberries, Raspberries, Strawberries, Lemons, Limes

Moderate Sugar (minimal consumption, none after lunch): Granny Smith Apples,
Apricots, Carrot, Cherry, Grapefruit, Kiwi, Melon, Nectarine/Tangerine, Orange, Peaches,
Pears, Plums, Pomegranates, Prunes, Pumpkin

Higher-Sugar (limit to one on exercise days only): Bananas, Dates, Grapes, Mango,
Papaya, Pineapple, Watermelon

Step 3. Pick 2-3 Healthy Fats

½ Avocado, 2-3 T. Flax Seeds, 2-3 T. Chia Seeds, 2-3 T. Hemp Seeds, 1 T. Coconut Oil,
1-2 T. Almond Butter, ½ cup Walnuts, ½ cup Almonds, ½ cup Sunflower Seeds, ½ cup
Sesame Seeds, ½ cup Pine Nuts, ½ cup Brazil Nuts, ½ cup Pecans, ½ cup Pumpkin
Seeds

Step 4. Flavor Enhancers & Health Boosters (Add 2-4)

1 Scoop Protein Powder, 1 Scoop Greens Powder (or an All-In-One Powder), 1 cup
Frozen Cauliflower, 1-2 T. Cacao Powder, 1-2 T. Cinnamon, 1-2 T. Acai Powder’, 1 T.
Celtic Sea Salt, 1-2 T. Nutritional Yeast, ½ Lemon Squeezed, ½ Lime Squeezed, 1 t. of
various spices like Turmeric, Ginger, Cloves

73
Ideas for Dinner
This chart can be made into stir-fry, soup, or eaten raw (except meat) as in a salad or bowl.
Dinner Chart (Serves 1)

Some Helpful Tips

● Soup? Put all these ingredients in a crock pot or regular pot and add vegetable broth for a
tasty soup
○ Add fermented Miso paste for probiotic addition, just make sure it’s made from
barley and aged at least 2 years
■ The powdered Miso isn’t the same
● Stir-Fry? Put all these ingredients in a pan and heat them up at a low temperature!
● T. = Tablespoon (You can use a normal spoon from your kitchen)
● Save Meat (if you must eat it) for dinner only… Meat can be substituted in the protein
section below.
○ Organic, grass-fed, free range meat: Lean ground turkey, beef, or chicken
○ Wild salmon or wild tuna
○ Organic, free-range eggs (hard-boiled, scrambled, over-easy)

Step 1. Pick Your Greens: Pick 1 green and add 2-3 cups total or 2-3 handfuls

Spinach, Kale, Arugula, Collard Greens, Dandelion, Hearts of Romaine, Mustard Greens,
Radicchio, Swiss Chard, Turnip Greens, Watercress
- To cook, heat up organic avocado oil or organic extra virgin olive oil at a low temperature,
add greens, salt and pepper, and cover. Wait until slightly wilted.
- Also add veggies to cook as well.

Step 2. Pick Your Protein: 1 cup total (Eliminate or Limit on “Detox” Plan)

Beans: Black Beans, Chickpeas (Garbanza), Cannellini Beans, Edamame, Lentils, Navy Beans,
Pinto Beans, Red Kidney Beans, Split Peas, White Beans, Yellow Beans

Grains: Brown Rice, Buckwheat, Millet, Oats, Quinoa, Sorghum, Teff, Wild Rice

Step 3. Pick 2-3 Healthy Fats

½ Avocado, 2-3 T. Flax Seeds, 2-3 T. Chia Seeds, 2-3 T. Hemp Seeds, 1 T. Coconut Oil, 1-2 T.
Almond Butter, ½ cup Walnuts, ½ cup Almonds, ½ cup Sunflower Seeds, ½ cup Sesame Seeds, ½
cup Pine Nuts, ½ cup Brazil Nuts, ½ cup Pecans, ½ cup Pumpkin Seeds
- Drizzle with organic extra virgin olive oil, organic extra virgin coconut oil, or organic
avocado oil.

Step 4. Pick 1-10 Vegetables (NO LIMIT) :)

NO LIMIT: Asparagus, Bamboo Shoots, Bean Sprouts, Bell Pepper, Broccoli, Brussel Sprouts,
Cabbage, Cauliflower, Celery, Cucumber, Eggplant, Garlic, Green Beans, Mushrooms, Parsley,
Peppers, Onions, Radishes, Snap Peas, Spaghetti Squash, Summer Squash, Tomatoes, Zucchini

LIMIT ON DETOX: Artichoke, Beets, Carrots, Peas, Pumpkin, Sweet Potatoes/Yams

Step 5. Flavor Enhancers, Health Boosts, & Dressing: Pick 1-3 to add

Sauerkraut, Kimchi, Nutritional Yeast, Lemon Juice, Sesame Seeds, Balsamic Vinegar, Mustard,
Tabasco Sauce, Frank’s Red Hot Sauce, Hummus

DO NOT USE: Ketchup, Mayonnaise, Miracle Whip, Salad Dressing (Ranch), BBQ Sauce

74
Ideas for Snacks
Snacking can also be a healthy choice when done smart. This should
ideally be done between lunch and dinner and NOT after dinner. Some
of our favorite snacks include:
● Vegetables like broccoli, carrots, celery, and cauliflower dipped in
hummus
● Homemade kale chips (put kale in the oven and bake until crisp)
● Apples, peaches, or other fruits
● Organic raw nuts like walnuts, almonds, sunflower seeds, sesame
seeds, pine nuts, Brazil nuts, pecans, pumpkin seeds
● A spoonful of almond butter or sunflower seed butter

Ideas for Desserts

There are SO many sweet desserts in nature, you just choose to reach
for the cookies, cakes, brownies, candy, and ice cream instead. What
about all the fruits of this world? Frozen organic strawberries,
blueberries or fresh, organic, ripe blackberries, cherries, or raspberries
are wonderful options.

Nature’s dessert is fruit, so feel free to indulge in moderation when a

sweet tooth craving hits, but try not to do it at night. Limit to during the
day before lunch if possible OR right after dinner is okay, but not
recommended. Dessert at lunch? Yes please!

Banana “ice cream” is very easy to make. Take a banana and slice it up.
Place in the freezer for 24 hours. Put slices along with a splash of
almond milk into a food processor or blender and blend until smooth,
adding almond milk as needed. Add any healthy flavor boosters to make
the flavor you want. This includes protein powder, greens powder, cacao
powder, cinnamon, acai powder, local honey, and lemon or lime
squeezed. You can also add other frozen fruit, like blueberries.

75
ACTION ITEMS
1. Print full size versions of these charts, guides, a grocery list,
and a simple meal planning guide by visiting
www.RethinkingDryEye.com under the Simple Meal
Preparation section.
2. Make a Green Smoothie the staple of your mornings. This will
maximize your energy, keep you regular, and help you make
better choices throughout the day.
a. Try green smoothies for 21 straight days. You will go
through three phases when you first start out.
i. The unbearable stage is the first seven days where
you will be constipated, gassy, bloated, and
possibly have diarrhea. You will get through it.
ii. Days seven through 14 are the uncomfortable stage
where you will start to feel better but may still be
slightly uncomfortable.
iii. Days 14 and on are the unstoppable days where
you will start to CRAVE green smoothies every
morning and will not know how you functioned
without them.

OTHER HELPFUL TIPS

1. Don’t get overwhelmed and use the rule of addition. Add
better food choices into your diet before you start removing
foods. Eat these better food choices before eating the poor
choices. Start with adding mixed nuts, avocado, coconut oil,
fruit, celery, broccoli, and apples. This will not be something
that will happen overnight but gradual changes over time
make a huge difference.
a. Eliminate fast, fried food and sugary beverages (soft
drinks, sweet tea, sugary coffee drinks) IMMEDIATELY.
2. Focus on eating your more carbohydrate heavy foods in the
morning and at lunch. This includes fruits, higher sugar
vegetables, and beans. Focus on protein consumption for
dinner. Eat healthy fats throughout the day such as avocado,
nuts, coconut oil, olive oil, and avocado oil.

76
3. Fix cravings with the alternative item that we listed above.
4. Drink 16 ounces of water right when you wake up and 10
minutes before every meal.

Sick of Dry Eye?

Join our 7-Day Dry Eye Bootcamp Challenge, which is a great

adjunct to this book, and start rethinking your dry eye treatment
today.

www.DryEyeBootcampChallenge.com

77
Chapter 6 - Move Your Body
Treatment for ALL disease should start with drinking plenty of water and
exercising daily. According to the CDC, 80-90% of adults and teens do
not exercise. That is 8-9 out of every 10 people that do NOT exercise.
No wonder health care costs are rising and disease is rampant in the
United States.

The biggest problem we see as practitioners is that the advice we give

our patients about diet and exercise are completely ignored and patients
just want to feel relief from the symptoms of the disease. A disease is
your body’s way of telling you that you are doing something wrong (most
likely following a Western diet and failing to exercise).

With that being said, DO NOT RELY ON YOUR PRACTITIONER TO

CURE YOUR DISEASE. This is up to YOU and YOU alone. You can
choose today to start eating better, exercising daily, and healing your
body from the inside out.

What Are Some of the Benefits of Exercise?

Exercise is one of the most beneficial activities you can engage in to
improve your life, from your mood to your sex drive. Exercise helps
circulate blood in a more efficient manner, which delivers oxygen in a
much more efficient way. This delivery of oxygen will help in healing your
entire body from inflammation.

Also, a dopamine hit will come across you and last throughout the day.
Dopamine is responsible for increasing calmness, awareness, and your
presence in life while decreasing anxiety, depression, anger, and more.

Some other benefits of exercise include the following according to the

Mayo Clinic:
● Controls and helps you lose weight
● Combats health conditions and disease
● Improves your mood and combats depression
● Boosts energy levels
● Promotes better sleep
78
 ● Puts the spark back into your sex life!

What a Sedentary Lifestyle Causes…

Lack of physical activity can cause a list of ailments and symptoms which
increase your risk for developing disease. Sedentary lifestyles cause an
extreme dive opposite of those exercise-enhancing benefits above.
According to Men’s Health, these are:
● Depression, anxiety, restlessness, hopelessness, and fatigue
● SIGNIFICANT increased risk of cancer
● Memory loss
● Increased blood sugar and risk for diabetes
● No more sex… Or at least a decreased sex drive :(
● Terrible sleep
● Increased back pain (especially lower back)

How Much and What Kind of Exercise?

This depends on the shape that you are in, but we shoot for about 210
minutes of exercise per week (30 minutes per day). we know this
sounds like a daunting task, but we are going to give you a complete
action plan to get to 30 minutes per day. We now do 45-60 minutes per
day, five to six days per week. WE DIDN’T START HERE. We gradually
worked our way up to it and we blocked off time every morning to work
out.

Also, you don’t have to exercise all at once. You can do five to ten
minute bursts of exercise throughout your day, that won’t break a sweat
(sometimes) and will help give you more energy throughout your day.
You could also go to the gym in the morning and then take your dog for a
walk in the afternoon, for example.

79
Exercise Plan If You Are Currently NOT Exercising
How do you eat an elephant? It is a pretty big task that would be tough,
but you do it ONE BITE AT A TIME!

● Week one is all about getting back into the routine or creating a
routine
○ Start waking up an hour earlier, hyper-hydrating, and going
on a five minute brisk walk (or as long as you can)
○ Do this daily (Pain permitting, and soreness is not pain. Walk
through the soreness.)
○ FIVE MINUTES PER DAY is all you need to get a habit
started.
● Week two through six is all about adding time
○ Add five minutes per week.
■ Week two = 10 minutes of brisk walking per day
■ Week three = 15 minutes of brisk walking per day
■ Week four = 20 minutes of brisk walking per day
■ Week five = 25 minutes of brisk walking per day
■ Week six = 30 minutes of brisk walking per day
● After week six, maintain this 30 minutes per day at the VERY
LEAST
○ If you can, continue adding five minutes per week until you
get to 60 minutes per day

What we see with our patients that start doing this is they can’t stop and
exercise becomes an addiction, but a good one. We have seen
overweight 50 year olds lose 100 pounds and walk a half marathon
within a year of starting this. You can do it!

80
Exercise Plan If You Are Currently Exercising
Keep up the good work! See how you stack up against 210 minutes per
week and try to get there if you are not already there. You are on the
right path.

This can be in one 20 to 30 minute session in the morning or after you

get off work combined with short five to 10 minute bursts of exercise
throughout your workday or one big session in the morning or evening.
We prefer breaking it up throughout the day to get the heart rate
increased after sitting for a while.

You can also look into HIIT training. The problem with most of our
workouts is that we are just going through the motions of an exercise and
barely even challenging ourselves. Think about the last time you were
on the elliptical, did you change the resistance at all? HIIT stands for
High-Intensity Interval Training and can be done in as little as 15
minutes. 15 minutes of HIIT training is better than doing the elliptical or
running for an hour. HIIT burns a tremendous amount of calories in a
short time, raises your metabolic rate (fat burning) for hours afterwards,
helps you lose fat and gain muscle, improves oxygen consumption, and
reduces blood pressure and blood sugar.

By the way, sitting all day is KILLING us slowly and is as dangerous as

eating unhealthy food. Get up and move!

We all have breaks or should be taking breaks periodically while working.

I set a 25 minute timer and work hard on whatever I am working on at
that time (for example, writing this book). When the timer goes off I take
five to 10 minutes to get up, drink water, do some jumping jacks, planks,
run in place, burpees, squats, or whatever you are feeling at that time.
After the five to 10 minutes is up, I jump back in to what I am doing.

Also, don’t forget about stretching. Flexibility is a huge benefit to your

body and will help reduce pain and allow your body to move more freely
without pain. There is a reason that practices like Yoga, Pilates, and

81
stretching centers (yes, it’s true) exist. Stretching plays a vital role in
your health.

Meet Beth (True Story)

Beth was a patient of ours who was always cheerful and full of life. Beth
was about 210 pounds and 55 years old. She did not exercise or eat
well. One night, she fainted in her house. She was rushed to the
hospital with a blood sugar of over 700 and on the verge of dying. Beth
did survive and decided she was going to take matters into her own
hands.

She completely changed her diet, eliminated all processed foods

(breads, cereals, processed meats) and started an exercise program. In
90 days, she was able to lose 30 pounds and is feeling better than ever.
We are so thrilled!

She was a diabetic at that ER visit but is now medication free!

This is the power of diet, hydration, and exercise.

ACTION ITEM
1. Print your exercise guide chart by visiting
www.RethinkingDryEye.com under the Exercise tab.
2. Bookmark www.RethinkingDryEye.com to watch exercise
videos of varying time and intensity and build your way up to
30 minutes per day. Look for them under the Exercise tab.

82
Chapter 7 - Eliminating Toxins
Although everything mentioned above will create the biggest difference in
your dry eye battle, a few other lifestyle modifications should be taken
into account. We are constantly exposed, either directly or indirectly, to
toxins. Toxins in our water, food, air, home, and work are constantly
bombarding us whether we know it or not.

When a toxin is intense enough, or you’re exposed to a large dose, it can

cause a severe enough reaction in your body that we notice it. Toxins
can cause reactions such as vomiting, shaking, skin hives, rashes,
allergies, fever, dry eyes, eczema, asthma, trouble breathing, and other
forms of inflammation.

But the real problem comes when you are exposed to small amounts of
toxins, which don’t cause any acute or immediate reaction, over time and
they build up in your system causing problems such as cancer, ADHD,
hormonal imbalance, arthritis, and digestive issues. Most people think
that these conditions are just a normal part of aging, which couldn’t be
further from the truth. Your body wants to be healthy, you just have
to help it get there.

Your body has an amazing response to these toxins as it wants to keep

your body in a state of homeostasis or normalcy. We have systems and
organs in place to help detoxify our body such as the skin, liver, and
sweat glands. Our body is constantly fighting these toxins throughout
the day. The problem occurs when your body becomes too toxic and the
toxins start to win. This, again, comes in the form of cancer, arthritis,
chronic illnesses, etc.

Dr. B.J. Hardick from his book Align Your Health put a great perspective
on the difference between subtle toxic events and more intense toxic
events. He said:

“Consider a food sensitivity with a food allergy, or a gluten sensitivity vs

Celiac disease. Someone with a food or gluten sensitivity has a

83
legitimate problem with that food. Their body won’t break the food down
properly, and at some point there will be negative consequences. But
there are often symptoms that we confuse with other things, like a
stomach ache, inflammation, or congestion. Unless you’re looking for it,
you might not know it’s there. Meanwhile, a food intolerance or a gluten
intolerance at the level of Celiac disease usually makes itself known in
ways that are difficult to miss.”

What we are about to go over can be a little overwhelming as the amount

of toxins in our lives is vast. I made a special sheet for you at
www.RethinkingDryEye.com that will help you go through step-by-step
changes that you can easily make in your life that will make a huge
difference in the amount of toxins that you are exposed to. DO NOT TRY
TO DO EVERYTHING AT ONCE. You will get overwhelmed and revert
back to previous ways. My goal with this list is to have it with you at all
times to revert to and eventually memorize so that everything becomes
habit.

This is similar to the other changes that you are making throughout
this book. Make one change at a time and, when that change
becomes a habit, move on to the next change. You will truly learn
what benefits you more and what benefits you less.

We are going to present to you the most important toxins to watch for
and where they are located. We’ll then give you simple solutions to fix or
avoid these toxins. Remember the checklist at
www.RethinkingDryEye.com.

84
Toxins From Water | Detoxify With Edible Essential Oils In
Your Drink
Simply by drinking water, something we all must do to live, you put
yourself in contact with over 150,000 different toxins (including fluoride,
arsenic, and chlorine). This does not include the 500,000 other toxins we
experience due to foods and other beverages! Yikes…

Water systems in the United States have to pass certain EPA

(Environmental Protection Agency) standards in order to be considered
“safe.” The problem with this is that the EPA allows an “acceptable” level
of most toxins in your water, such as lead, arsenic, metals, antibiotics,
and other pharmaceuticals. On top of that, chemicals such as fluoride
are added to the water. Even if the EPA is regulating this, they are not
always below the acceptable levels. Remember what happened in Flint,
Michigan.

Unfortunately bottled water that is stored in plastic containers also

contains chemicals that are leaching out from the plastic, which results in
toxin contamination as well.

So what the heck are you supposed to do?

Take control of your water purity yourself.

To easily minimize the toxins you're exposed to in your water, first of all
make sure you're drinking filtered water. We love our Berkey Water
Filtration System, and we recommend it to everyone.

Next, consider adding essential oils such as Lemon, Tangerine, and

Grapefruit. All it takes is one drop to notice the difference. You can even
add a little Peppermint to your tea for an afternoon pick-me-up.

If you want a great detoxing "cleansing" recipe, try one of these below
(can be enjoyed daily):

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Dr. Zigler’s Morning Cocktail
1 ounce of Organic, Unfiltered, From-The-Mother Apple Cider Vinegar
1 pinch of Celtic Sea Salt
20 to 32 ounces of distilled or filtered water

"Grapefruit Juice"
3 drops Grapefruit essential oil
3 drops Spearmint essential oil
3 drops Tangerine essential oil
1 quart distilled or filtered water

"Lemonade"
3 drops Lemon Essential oil
1 quart distilled or filtered water

Stop Drinking Cow’s Milk

Yes, you heard that right. Stop it. Cow's milk can potentially be full of
antibiotics and hormones, and dairy has been shown to cause
inflammation in the body of many individuals (the opposite of what we're
trying to do here!)

Instead of enjoying that glass of milk, use the recipe above to feel more
alive and healthier than ever or try alternatives like unsweetened almond,
coconut, or cashew milk.

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Toxins From Food
We all love food but, as stated above, the food we're consuming contains
over 300,000 toxins, which may range from preservatives to MSG to
hydrogenated oils and artificial colors and flavorings. This is outrageous,
but there are obviously things you can do to minimize this load. This
should be your first point of attack to eliminate toxins in your life, but also
to help heal your dry eye and other inflammatory diseases like heart
disease, diabetes, arthritis, and high cholesterol.

First of all, avoid processed foods at all costs. Foods that contain a
laundry list of preservatives, artificial colorings, and artificial flavorings
have no place in your cabinet. If it is in a box, can, or can be stored
long-term then you should not be putting it in your body as the
preservation process contains numerous toxins. Switch to eating whole
foods, such as vegetables, fruits, and organic, grass fed meat or wild
caught fish (limit meat to once per day if needed).

Secondly, buy organic whenever possible. By doing so, you avoid

many of the fertilizers and pesticides that your produce and other items
often come in contact with. With that being said organic isn’t chemical
free, so be sure to wash your produce well! Organic is much better for
you than the conventionally raised produce with pesticides and fertilizers.

Thirdly, avoid genetically modified organisms which I discussed in

detail previously, but to summarize... a GMO is an organism, such as
corn, that has been genetically modified to be able to withstand harsh
conditions such as fertilizer use, temperature fluctuations, and other
harsh conditions. A key point to remember is that if something is
labeled “organic” that means it is both organic AND non-GMO.

A quick aside on the poisons of fertilizers and pesticide use. There is a

lake not too far from my home called Grand Lake Saint Marys in Ohio.
This once bustling lake is beautiful, with small Ohio towns set-up all
around to take advantage of the lake life and enjoy a little relaxation.
Over the last 10 to 15 years a small poison has been leaking into the
lake rendering it a “no contact” lake. Due to a blue-green algae species

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called Aphanizomenon gracile, residents are unable to use this lake
anymore. This algae species creates a foul odor and has killed off
thousands of fish in the area. It also releases liver and neurotoxins,
which is what makes this lake “no contact”.

So what is causing this problem with the lake? The root cause is very
clear and it comes from runoff manure and fertilizers from watershed
lands feeding the lake. The phosphorus in the fertilizers and manure
feed the algae. As the algae blooms and dies, it releases toxins and
robs the water of oxygen, which then kills the fish.

Think about that for a minute. A whole ecosystem taken down by toxic
fertilizers and pesticide use.

Number four on the list of things we can do to avoid toxins from

food is to eat more antioxidant rich food. A diet rich in colorful
vegetables is one of the best tools for scrubbing your blood, cells, and
the rest of your body clean of oxidative species and free radicals.

A fifth thing we can do is bring essential oils into our kitchen to cook
with. Cardamom, Ginger, Thyme, Coriander, and Cilantro can all easily
be incorporated into meals. How about Thyme in your next soup recipe?
Or Cilantro in your next guacamole dish? Coriander is great for flavoring
veggies, and Ginger is great in smoothies.

There are so many ways to incorporate essential oils into your cooking,
and this will accelerate your body's ability to detox from all of the harmful
chemicals that are so unavoidable.

Be very careful when adding essential oils to your cooking and add only
after the heating process has been done. Similar to above, you don’t
want to heat oils as it damages them. Damaged oils cause damage to
your body. Add essential oils AFTER the food is prepared.

Also, as stated above, be careful with how much you add. One drop
is potent enough to add flavor to any recipe. It is always easier to
add more than to take away. We’ve learned this the hard way!

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Finally, stop eating so much fast food and especially stop the
unhealthy fast food burger joints. Some healthier options for eating
out include a salad bowl at Chipotle (no barbacoa, carnitas, cheese, or
sour cream), salads at Subway (no dressing), salads at Wendy’s (no
dressing), salads at Panera Bread (no dressing), and there are many
more options. Just make sure that the food that you are consuming
looks like it would if it were growing in a tree or from the ground.

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Toxins From Air
Before we dive in, I want to talk a little bit about the toxins we come into
contact with daily. Unfortunately, they're largely unavoidable. But our
human bodies are designed to handle detox, and our bodies do a great
job of filtering out what they need and what they don't. However, with all
of the artificial chemicals and pollution in the air around us in this century,
our bodies can sometimes use a little detox boost. There are alternative
things you can do to both minimize and eliminate your exposure to
toxins, and the ideas I'll present are pretty easy to implement!

Did you know that there are about 200,000 different toxins floating in
the air around you? They may be from exhaust, cigarette smoke,
fertilizers in the cornfields nearby, or other pollutants. Even if you were
living in the far reaches of the rainforest, you'd still be subject to toxins in
the air (although yes, better off than someone in New York City).

Air Purifying Essential Oils for Aromatherapy to Detoxify the Air

Our air quality inside our home and workplace tend to be more toxic than
the outside air quality. Most think that with all the pollution in this world
that outdoor air is somehow more toxic (well maybe in Iran, India, Los
Angeles and Beijing). This couldn’t be further from the truth. Getting
outside, opening your windows to air out your house, and breathing in
fresh outdoor air is much better than the toxic air that we have in our
home.

We are going to take some steps in order to enhance the quality of air
inside your home, but know that you cannot stop it all. The construction
of your house, your walls, carpet, floors, couches, and beds all contain
toxins, so eliminating all the toxins is impossible. However, stressing
about it is doing nothing for you either (stop stressing, seriously, because
it’s worse than the toxins).

Let’s talk about some ways to enhance your air quality.

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Step number one, like stated above, get outside and enjoy the
outdoors. Also open your windows and air out your home as much as
possible.

Secondly since you can control some of the air quality in your home, why
not begin detoxing that air with essential oils? This is as easy as
buying a diffuser and a few key oils. Some great oils for air purification
include citrus oils like Orange and Lemon, Peppermint, Lavender, Clove,
and Ylang Ylang.

Simply place 3-4 drops mixed with water into your diffuser and let it run.
These oils aid the liver in detoxification as the oil diffuses from the lungs
into the blood steam. They can also help promote a sense of calm and
be energizing (at the same time).

A third thing you can do is buy an air purifier. Air purifiers can remove
up to 99.97% of in-air pollutants and allergens including mold spores,
dust, pollen, bacteria, and pet dander, while also capturing odors.

You can also add indoor plants to your home such as ferns, peace
lilies, bamboo, dragon trees, and/or a spider plant. These plants are
usually very easy to care for, thrive with or without sunlight, and survive
even the harshest black thumb (like that of my wife, Dr. Jenna). Plants
have been shown to help rid your house of formaldehyde, carbon
monoxide, benzene, and other harmful gases and toxins.

Another addition to detox the air quality of your home is avoiding the
use of toxic cleaners in your home. We are constantly using toxins to
clean our house, do our laundry, and on our body that we are exposing
ourselves to more toxins than we need to.

Let’s first discuss a couple of easier alternatives to what you are

currently using to clean your house, which can be one area of
constant toxins and chemicals. Walk down your local grocery store
cleaner aisle and you can smell all the chemicals, fragrances, and toxins
in the air. I personally get a headache from this and have to avoid the
aisle at all costs.

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A very simple fix for replacing your toilet bowl cleaner, kitchen cleaner,
bathroom cleaner, shower-head scrubber, window cleaner, and cleaners
for pet urine, carpet stains, coffee makers, mopping, and… well you get
the idea… Pretty much anything you want to clean can be cleaned with
organic white distilled vinegar.

Mix equal parts distilled or filtered water and vinegar in a spray bottle. It
is literally that simple. Spray this mixture on kitchen and bathroom
countertops, stovetops, backsplashes, toilet surfaces, tile, flooring and
almost any smooth surface you wish. Wipe it up with a paper towel or
sponge. Vinegar and water solutions can help eliminate dirt, soap scum,
sticky spills and hard water.

This vinegar “trick” will help eliminate a huge expense in cleaner, so your
wallet will thank you, but it will also decrease your toxin exposure
exponentially, which in turn will increase the quality of air inside your
home. Bonus points if you use organic white distilled vinegar.

Let’s move on to laundry. Dryer sheets, especially, and laundry

detergent are filled with unnecessary chemicals, fragrances, and toxins.

Replace your dryer sheets with organic wool balls. Think about this
for a second, your clothes are in constant contact with you. Get rid of the
chemicals and make the choice to be toxin free. Wool balls are made of,
you guessed it, organic wool. The best thing about wool balls is they
never go bad and will last forever. As of this writing, we are still using
wool balls we purchased four years ago and they look as good as new.

Wool balls are designed to keep your clothes soft and static-free. They
are also great for the environment as you are not constantly throwing
away dryer sheets with every batch of laundry. They can also reduce
your drying time by up to 40%, which means more savings on your
energy bill.

Moving on to laundry detergent. There are a few things that we

recommend in this department. For our everyday non-workout clothes,

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we use organic Eco Nuts. Eco Nuts are an organic soap berry that have
been used for centuries in the Himalayas where they natively grow in the
wild without fertilizers, pesticides, or chemicals. The berry shell naturally
contains soap.

Eco Nuts are safe and recommended for those with sensitive skin,
eczema, and allergies, because they are a chemical-free way to do your
laundry. Our experience with eco nuts has been nothing but positive,
except for with our workout clothes. It tends not to get all of the stink out
of those sweaty garments.

We wash our workout clothes separately and use a more natural laundry
detergent. The natural laundry detergent may change in the future, so to
get the most up to date list of everything we use with links to purchase,
visit www.RethinkingDryEye.com and check out the toxins section.

Let’s talk about your poop. No not literally, but we are going to discuss
that air freshener that you use around your house. The chemical and
toxic ridden aerosol that you spray joyfully into the air to make your
house smell “clean” is actually poisoning everyone who breathes it in.

Some better alternatives are the air purifier that we discussed above to
help eliminate odors, but also using essential oil based air fresheners.
We love the brand Poo-Pourri because it is a non-toxic air freshener
made up of essentially oils and other natural compounds, without the use
of harsh chemicals, aerosols, parabens, phthalates, or formaldehyde.
We use it for the bathroom, of course, but also to freshen up our sinks,
trashcans, laundry (spray it on the wool balls or use plain essential oils
on the wool balls), and the children’s rooms.

Let's get personal next (like poop wasn’t personal enough)…

What you use for personal care is another toxic environment because
you are putting these toxins and chemicals directly on your skin. From
makeup to lotion to deodorant to toothpaste to shampoo and body wash,
your personal care routine is filled with toxins.

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Let’s detox.

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Toxins From Heavy Metals
Not only are we exposed to all of the toxins above, but we're also
exposed to many heavy metals that can do harm to our bodies. Like
discussed above, heavy metals come from things like aluminum based
deodorants, commercial toothpaste, aluminum cans, light bulbs,
cosmetics, cookware, and even our mercury dental fillings.

Deodorant is filled with toxins and you are putting this on your body
non-stop. Once in the morning, after a workout, after a shower… Your
body never gets a break. Deodorant has cancer causing chemicals like
parabens, steareths, triclosans, TEA, and DEA. It also has other toxic
ingredients such as propylene glycol and aluminium. Aluminum is in all
antiperspirants to clog your pores and prevent sweating. This is not
healthy. Aluminium exposure has been shown to mess with hormone
levels, like estrogen, and contribute to Alzheimer’s disease.

Of course, you can absolutely make sure that you're using safe
deodorants. We recommend using all-natural deodorant that does not
contain aluminium. This will take a little bit of an adjustment, but once
adjusted you will notice less staining on the underarms of your shirts
(those are toxins being released, by the way) and you will notice less
reliance on deodorant.

Toothpaste is another hidden toxin-filled personal care item with

ingredients like triclosan (endocrine disruption), sodium lauryl sulfate
(SLS causes canker sores), artificial sweeteners, fluoride (yes fluoride),
propylene glycol (organ toxicity), and DEA (hormone disruptor).

If you get constant canker sores, make sure to find a toothpaste that
does not have sodium lauryl sulfate and I can almost guarantee you will
never have one again. This is from experience, because once we
dropped SLS from our toothpaste, I went from having one canker sore
per month to none. I don’t just mean a small canker sore, I mean a ten
out of ten pain, barely being able to eat canker sore.

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Instead, opt for a more natural, SLS-free, fluoride-free toothpaste. A few
that we recommend can be found under the toxins section at
www.RethinkingDryEye.com.

Lotion contains numerous chemicals and toxins. Try opting for

something more natural and organic such as a organic coconut oil or
organic jojoba oil.

Body wash and shampoo have become incredibly complicated and are
filled with toxins as well. There are many natural shampoo bars and bar
soaps that contain five ingredients or fewer. We actually make a soap,
Heyedrate Tea Tree Oil Soap, that can be used on the body, face, and as
shampoo. It works incredibly well for dry skin, dandruff, and blemishes.

Avoid coated cookware and use a cast iron skillet instead. Cast
iron skillets actually get better with age and become non-stick the more
you use them, which means you can avoid non-stick aerosols filled with
chemicals. They also maintain a uniform heat and can be used on the
stovetop as well as in the oven. Also, a side benefit is that a little iron
gets into your food which is great for battling anemia (spinach is good for
this too).

Avoid plastic storage containers and instead opt to reheat and store
food in glass containers, such as those from Pyrex. This avoids any
leaching of chemicals into your food, which can occur even if the plastic
container states it is BPA free.

How about having those old mercury amalgam fillings in your mouth
removed and replaced with new, non-toxic cavity fillings?

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Best Natural Eye Makeup for Sensitive Eyes, Eyelids, and Dry Eyes
It’s no secret that most women feel great when they wear makeup. It
gives them confidence and helps them shine in a world that is so focused
on outward appearance (sad, but true). But if you suffer from blepharitis,
meibomian gland dysfunction (MGD), demodex, or dry eyes of any kind,
makeup can be difficult for you to wear. There are so many irritants in
today's cosmetics, and we have to be careful to minimize this when we
have dry, irritated eyes, because conventional makeup will only
exacerbate the issue.

You can even try out some of the great natural makeup brands on the
market or make your own! Makeup is filled with toxic chemicals that
definitely affect your dry, irritated eyes and eyelids. Let’s discuss this
even more and go over some natural makeup brands that we
recommend. A big thank you goes out to Dr. Tracy Doll and her fantastic
lecture at the American Academy of Optometry about makeup. Also
thanks to my wife, Dr. Jenna Zigler, for writing up this section on makeup,
makeup removers, and eyelash extensions, as I do not even come close
to being as knowledgeable as her in this area.

Best Eyeshadow for Sensitive Eyes

Let's start with eyeshadow. This cosmetic comes in powder form,
creams, or sticks and can contain quite a few irritants. A few examples to
watch out for are mica or talc, pigments such as iron oxides, chrome
oxide, iron blue, manganese violet, and others, and emollients like
lanolin.

Your everyday drugstore eyeshadow is likely to contain many of these

ingredients, so you may want to check out some of the following. Omiana
matte loose powder as well as 100% Pure Fruit Pigmented eyeshadows
both have products that meet the needs of many dry eye sufferers, and
they're less likely to cause allergic reactions as well. Keep in mind,
anyone at any time can have an allergic reaction to anything, but these
suggestions are less likely to be problematic!

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Best Mascara for Sensitive Eyes
Ohh mascara...how I love you (says Dr. Jenna). Mascara falls into a few
basic categories including classic water-based and waterproof.
Waterproof mascara is definitely worse for you in terms of dry eyes,
ocular surface disease, and the potential for complications. Fiber lashes
are also an option now, but these are even worse than waterproof
because the small fibers can easily fall into the eyes and cause irritation.
Dr. Doll notes that problematic mascara ingredients may include
isoparaffins, polyvinylpyrrolidone resins, pigments, and stearic acid.

Another thing to note is that liquid makeups, such as mascara, should be

discarded at least every 3 months to prevent bacterial build-up. The
longer you wait to discard your liquid makeup, the more at risk you'll be
for eye infections, blepharitis, loss of eyelashes, and other irritations.

A few better brands to try include Lily Lolo, Omiana Barely There, and
Zorah Pure Argan Lengthening.

Best Eyeliner for Sensitive Eyes

Eyeliner is something that helps define our eyes and give us a more
"awake" look, yet it can be especially problematic in certain cases.
Whatever you do, NEVER tightline your eyelids (placing eyeliner on the
inner rim of your eyelids, directly over your meibomian glands...yikes!)
Eyeliners come in many forms including liquid, pencil, and gels. Those
which you can sharpen away (such as pencils) or wipe away the outer
layer before applying (such as twist-up pencils) tend to be safer because
you're able to remove some of the bacteria that may be present.
Ingredients that may be problematic for dry eye sufferers include silicone
resins such as trimethylsiloxysilicate and polymethylsilsesquioxane,
pigments, and preservatives.

If you can't give it up and you'd like to try a better eyeliner, check out
100% Pure's brand of fruit-pigmented eyeliners, Alima Pure Natural
Definition Eye Pencil, and Red Apple Lipstick Eyeliner. And for those of
you who think, "I'll just get it tattooed on!"...not so fast. Tattoo eyeliner is
not without risks, and it can still cause swelling, allergic reactions,

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scarring, and infections. It also doesn't last forever, and the pigment has
the potential to fade or migrate.

Best Eye Makeup Remover for Sensitive Eyes

Yes, makeup removers can even be harsh for your eyes! Although oil
based removers can sometimes be worse for MGD, depending on the
brand, they are exceptional at removing even waterproof makeup (and
this is super important!) No matter what eye makeup you choose, you
need to be sure you're completely removing it at the end of the day.

If you prefer an oil-based remover, you can simply use fractionated

coconut oil or an argan oil. If you want to go a step further and ensure
that you're also keeping demodex under control, choose an oil-based
remover that contains tea tree oil, like Heyedrate Tea Tree Oil Makeup
Remover, which contains organic grapeseed oil, organic jojoba oil,
vitamin E, and organic tea tree essential oil.

We all want to look beautiful, and makeup does help enhance our
features...but at what cost? If you're going to wear makeup, make sure
you're using brands that avoid harsh chemicals where possible, and
absolutely ensure that you're taking it off at the end of the day.

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Don’t Get Eyelash Extensions… Ever!
If you've ever longed to have long, thick eyelashes, this section is for
you. Unfortunately, for those with dry eyes, using loads of mascara is out
of the question because the ingredients can be irritating, cause allergies,
and lead to more inflammation of the eyes. You may think that eyelash
extensions are the next best option for fuller lashes, but this is not always
the case.

What Are Eyelash Extensions (or Lash Extensions)?

Lash extensions come in many different forms, including less expensive
synthetic false lashes, silk lashes, those made of mink, and even
magnetic lashes. Although some synthetic lashes can be bought in a
drugstore and applied at home, other forms are readily available for
application in salons around the world.

Once you've selected your type of eyelashes in a salon, the lashes are
applied one at a time using a semi-permanent glue. Sadly, this glue
often contains formaldehyde, latex, and other harsh ingredients that can
be horrible for sensitive eyes. Some lashes can actually be tied onto your
own, but these are still not free of complications. If you're set on having a
full set of lashes applied, you're in for a two hour appointment with
touch-ups recommended every few weeks. If you only wish to have a
little enhancement, you could also have them apply just a few lashes.

So, you might ask, what's the big deal? Yes, your eyes will be closed the
entire time the procedure is going on. If you're at a reputable, licensed
salon, they're going to have trained lash technicians who will avoid
getting the glue into your eyes at all costs. However, that doesn't mean
you're immune to complications. As we've said before, anyone can react
to anything at any time.

Eyelash Extension Care | How To Prevent Eyelash Extension

Complications
Complications from extensions can include allergic reactions to the
adhesive, natural eyelash loss, keratoconjunctivitis (inflammation of the
cornea and conjunctiva), styes, abrasions, and subconjunctival
hemorrhages.

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The first step to preventing complications from lash extensions is to
make sure you're at a salon with licensed lash technicians. These people
have been trained to prevent infection and complications when applying
your lashes. Make sure they use a better adhesive, such as Milante
Beauty Super Strip Lash Bond.

After applied, avoid getting water onto your eyelashes for 12-24 hours so
that the adhesive is able to fully set. Although further care depends on
what adhesive is used, it is generally accepted not to use alcohol or
oil-based makeup remover products on your eyelashes, as these can
damage the adhesive and cause your false eyelashes to fall off.

It is also incredibly important to keep the eyelids and lashes extremely

clean when you have lash extensions, because they can breed bacteria
and cause nasty infections, such a styes. We recommend using a
hypochlorous acid eyelid cleanser each morning and evening for best
results. The Heyedrate Lid and Lash Cleanser is perfect for this because
it contains no alcohol, no harsh chemicals, and no oil which could
damage your lashes. It also ensures you'll be less likely to get an
infection if you do decide to try lash extensions.

How To Remove False Eyelash Extensions

If we see a patient with lash extensions that is having problems with
them, especially those who have an infection, we can remove them in
office. This can also be done at home, although it is recommended to
have them removed by your doctor or esthetician.

First, a hot, damp compress can be applied to loosen the glue.

Then, oil is used to help soften and remove the adhesive. Oils that are
safe to use include olive oil, coconut oil, argan oil, or other similar oils.

By using heat and oil, the lashes can be mechanically removed with your
fingertips or with forceps (if you're having them removed by your doctor).

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Other ways to remove eyelash extensions include using commercially
available remover which, unfortunately, smells like nail polish remover
(which means it contains tons of chemicals). Whatever you use, it is best
to have them removed by a professional.

Other Forms of Eyelash Cosmetics and Extensions To Be Cautious

Of

Magnetic False Eyelashes

Although magnetic lashes do not use any adhesive, they can still be
problematic for those with irritated eyes to begin with. Magnetic lashes
are applied with magnets around your natural eyelashes. Risks can still
include mechanical trauma to your cornea, lashes that fall or break off
into the eyes, and bacteria build-up leading to styes and other infections
(since the lashes are reusable). Main brands include 3 Second Lash,
One Two Lash, ILash, and Ardell Magnetic. Use with caution!

Eyelash Perming
This is an interesting one! Eyelash perming is done by wrapping your
eyelashes around a metal or plastic rod while perming solution is applied
(NOTE: very close to the eyes!) Although the eyes are closed when this
procedure is performed, it is not impossible for the solution to get into the
eyes, just like eye makeup remover will get into your eyes because the
eyelids do not create a tight seal. Perming solution can cause a whole
host of issues including redness and inflammation, allergies to the
solution, and infection.

Eyelash Tinting
Eyelash tinting is another interesting one which uses hair dye very close
to the eyes. Keep in mind that hair dye is often "permanent" and cannot
be removed for weeks or months, so if you happen to be one of the
(un)lucky ones who reacts to the dye, you're going to be dealing with
complications for months. Allergies as well as contact
blepharoconjunctivitis are possible side effects here. Our opinion? Stay
away!

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Eyelash Growth Serums
Now you're thinking, "I'll just forget about mascara and extensions and
use growth serums instead"...Well, I hate to be the bearer of bad news,
but this isn't better for those with sensitive eyes either.

Latisse, the only FDA approved eyelash growth serum, was approved in
2008 and was quickly followed by other non-prescription growth serums
flooding the market. Nearly ALL growth serums contain synthetic
prostaglandins, which actually cause inflammation in your body. So if you
use an eyelash growth serum, you're bound to end up with red, irritated
eyes and eyelids, hyperpigmented skin, changes in eye color (light to
dark), itching, and other complications.

If you want to try one that may be less irritating, try a non-prostaglandin
formula like Ocusoft's Zoria. This still contains some potentially harsh
ingredients, but it's the best of the bunch when it comes to those with dry,
sensitive eyes.

Eyelid/Eyeliner Tattooing
Although this doesn't fall under the quest for long, beautiful eyelashes, it
does often go right along with it. Because some people with dry eyes
cannot tolerate commercially available eyeliner, they turn to tattooing.

However, just like eyelash extensions, this is not without complications!

Tattoo ink can cause allergic reactions and inflammation because it
contains iron oxides, aluminum silicate, and carbon nanoparticles.
Yum...This can cause bruising and swelling, allergies, infections,
scarring, granulomas, blepharitis, and the ink will actually fade over time.

So, if you wanted black eyeliner, you may eventually end up with blue
eyeliner. Great.

All women want to have lush, amazing eyelashes and defined eyes...but
at what cost?

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More Heavy Metal Toxin Solutions
There are so many ways that you can decrease the heavy metal
exposure in your home. Above we discussed replacing your household
cleaners, laundry detergents, dryer sheets, air fresheners, makeup, using
more natural deodorant, and others to help reduce heavy metal
exposure.

Another great way to eliminate heavy metals in the body is by using

chelating agents. A chelating agent is simple something that binds to a
heavy metal when it is exposed to it. Chelating foods exist in nature and
can be consumed on a daily basis to help eliminate heavy metals.
Adding sulfur rich foods, such as onion, garlic, eggs, cauliflower, brussel
sprouts, and cabbage (remember, always organic), will aid so much in
excreting heavy metals from your body. Another easy one to add is
cilantro, which can be added to avocado to make some delicious
guacamole.

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Toxins from Radiation | Block The Dangers of Microwaves
Lastly, you can imagine that our exposure to all forms of radiation has
increased in the past few decades. The microwave is a staple in nearly
every household, we're all glued to our cell phones, and many of us work
on a computer all day. Toxins from these electronic devices and even
hair dryers and fluorescent lighting can all wreak havoc on our bodies.

We need to combat this!

Step one… Avoid exposure to the instigator…. I realize that you are not
going to get rid of your smartphones or tablets or computers so let’s talk
about ways to help avoid these problems.

Your smartphone is probably the most radioactive device you come in

contact with on a consistent and constant basis so let’s discuss ways that
you can help reduce radiation. To start, if you don’t need to be reached,
turn your smartphone’s airplane mode on and check it every hour by
turning airplane mode off and then turning back on when you are done
with it.

When at work, you don’t need to have your smartphone in your pocket.
Take it out and leave it in your desk in airplane mode. And lastly, at
night. Turn your smartphone off, or turn airplane mode on for the night
and plug your smartphone in across the room or even better yet in
another room. Don’t bring it into bed with you or put it on your
nightstand. This will help promote better sleep, which we will discuss
later.

Try to avoid the use of a tablet or computer for long, extended periods of
time on your lap. And also just limit your time in general on all devices.
Get outside, get some fresh air, and get moving by going on a walk after
dinner. You’ll feel much better and more energized than if you went and
sat on the couch.

For the microwave, try to figure out ways to not use it. You wouldn’t
believe how easy this is. Use a toaster oven to heat up leftovers (or your

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oven), or grab the cast iron skillet and reheat leftovers. Boil water with a
tea kettle on the stove instead of using the microwave.

If you have to use the microwave, stand back 10 to 20 feet while it is

running. Not all the waves are contained inside that little box. Also try
this recipe out:

Fill a wooden bowl half full with peat moss and half full with hazelnuts.
Add 10 drops each of Tea Tree Oil, Rosemary oil, and Clove oil. Set the
bowl on top of your microwave or other appliance. This will actually
absorb any EMFs, microwaves, and energy radiation coming from the
device you set it on!

As you can see, there are so many amazing ways to detox your home
and your body. They don't have to be difficult or expensive, and these
tips can make a world of difference in the amount of toxins you and your
family are exposed to. We can't avoid them all, but we can all do a little
bit each day to decrease our exposure and live a healthier life!

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Toxins from Medications | Your Medication Could Be
Causing Dry Eyes
In this modern world, sometimes it seems just about everyone is taking
some kind of prescription drug – sometimes several —and the older the
person, the more likely they will be taking more than one prescription
medication. Many of these drugs have side-effects. They don’t always hit
everyone, but if you are regularly taking more than one, the side effects
can begin to add up. One common side effect to be aware of is dry eye!

Have you noticed your eyes becoming dry, feeling like there are
scratches on them, or just that you need to blink several times to get a
little moisture going? The root cause may lie in your medicine cabinet.
Here are several common drugs that can cause dry eye symptoms.

Antidepressants. Antidepressants change chemicals in your brain,

which means messages traveling through your nervous system get
rerouted and reinterpreted. Any drug that operates in that manner,
including ones used for the treatment of mental health issues, can have a
negative impact on vision, disrupting the messages received by the
cornea (the front of the eye) and optic nerve (the back of the eye).

As an example, Prozac is reported to have side effects including eye

pain, double vision, dry eye, and inflammation of the eyelids. A few other
examples are Zoloft and Paxil.

Antihistamines and Decongestants are medications that block

histamine receptors. Decongestants especially target the eyes and nasal
areas because the symptoms they treat are itchiness and runniness of
the eyes and nose, and they do this by drying out those areas. If you
suffer from allergies and dry eye problems, consider checking with your
doctor for something other than over-the-counter drugs. Allegra can often
help with both problems because it is site-specific in its effects. If
possible, taking an allergy formula without the decongestant can also
help.

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Hypertensive Agents like Beta Blockers. These are generally
prescribed for those with chronic high blood pressure, heart attacks, and
migraines, and one of their primary side effects is dry, itchy, and painful
eyes. Watch out for this! Beta blockers cause dry eye be reducing
aqueous production from your lacrimal gland. Some others to be aware
of are hydrochlorothiazide (HCTZ) and other diuretics.

You can do something about this. Talk to your physician about switching
to another high blood pressure medication that does not cause dry eyes.
I am in no way saying that you should go off your blood pressure
medication because you're probably on that for a very good reason and a
heart attack is a lot more deadly than dry eyes. Just make sure you talk
to them about alternatives. Speaking of alternatives to medication, a
healthy diet, exercise and hydration can really make quite an impact on
blood pressure as well.

Oral Antibiotics. Most of these can cause dry eyes, but Amoxicillin and
Penicillin can also both cause itching, dryness, and redness of the eyes.
For some, they even cause problems with balance – so while taking oral
antibiotics, consider adding in some Vitamin C and a probiotic to
counteract some of the worst side effects.

OTC Pain Relievers. If you are on a regular regime of over-the-counter

pain meds such as ibuprofen or acetaminophen, you may also
experience dry eye symptoms. If so, try lowering the dosage slightly and
drink more water to help solve the problem.

Hormones and Birth Control. Anything that messes with the hormones
in the body is going to cause dryness issues. This is often the reason
why many women in menopause experience dryness. A few examples
include Hormone Replacement Therapy (HRT) with estrogen, or even
progestin. This is pretty commonplace in a lot of women that are
postmenopausal. So, you might be in this group. There are additional
ways that you can combat the negative effects of HRT, and these include
hydration and eating a well balanced, vegetable rich diet.

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Accutane is taken for severe acne in teenagers and adults, but it can
have dire side effects. It actually can kill off your meibomian glands and
cause them to atrophy leaving you with no lipid layer of tears, which will
lead to severe evaporation and very dry eyes. Accutane is just a form of
vitamin A in really high doses, which is definitely not good for your eyes.
It’s a well known cause of dry eyes. Avoid this at all costs and look for
other ways to help calm your acne.

Gastrointestinal Medications: Prevacid, Prilosec, Nexium, Zantac,

and Tagamet
These medications are proton pump inhibitors and help with GERD (acid
reflux). Acid reflux, gas, and other digestive issues can usually be
resolved by figuring out what foods or drinks are causing the issue, and
eliminating those.

Up to 60% of Chemotherapy patients develop dry eyes. The most well

known medication to be of issue is Cytoxan. This is also, interestingly
enough, used to treat some ocular conditions, such as Sjogren's
syndrome, but as many as 60% of patients that take this medication
develop dry eye.

Antipsychotic Medications to manage Schizophrenia. Finally,

antipsychotic medications for schizophrenia can cause dry eye as well.
They usually decrease your aqueous secretion and symptoms are
usually dose dependent. So, if you take a higher dose of course you're
more likely to have dry eye.

This section on decreasing toxins was probably extremely

overwhelming with a lot of information. Like I said previously, I
made a checklist that you can move down at your own leisure, and I
recommend making one to two changes per week until it is habit or
until the more natural way takes over your way of doing things.

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ACTION ITEM
1. Print the checklist at www.RethinkingDryEye.com under the
Toxins tab and make 1-2 changes per week to decrease toxins
in your life.
a. Move through the whole list until you complete it.

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 Sick of Dry Eye?

Join our 7-Day Dry Eye Bootcamp Challenge, which is a great

adjunct to this book, and start rethinking your dry eye treatment
today.

www.DryEyeBootcampChallenge.com

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Chapter 8 - Other Lifestyle Modifications

Lifestyle Modification #1: STOP Smoking

Smoking affects dry eye in two different ways. The most devastating
way is through the inhalation of numerous toxins and chemicals that
flood your bloodstream with free radicals, which, as discussed above,
increases your risk for dry eye, heart disease, and cancer. Secondly,
the actual smoke is an eye irritant as well.

I don’t need to go into more detail, as smoking has been proven over and
over again to cause problems and you have probably heard it ad
nauseum. If you smoke, there’s never been a better time to quit!

Lifestyle Modification #2: Avoid Fans

Direct wind can cause a lot of irritation, whether it be from air
conditioning or heat in your car, overhead or direct fans at home, and
natural wind from mother nature. Turn your vents and fans away from
your face if you need to have them on.

To block natural wind, wear a great pair of polarized sunglasses that

wrap well and provide a barrier of protection.

Lifestyle Modifications #3: Wear Polarized Sunglasses

As stated above, find a pair that wraps well and blocks the wind, but any
sunglasses are better than none. Make sure you’re wearing sunglasses
whenever you’re outdoors. Sunglasses are not just for sunny days! UV
radiation can enter the eye even on cloudy days, and getting into the
habit of wearing them means your eyes will always be more comfortable.

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Lifestyle Modification #4: Avoid Excessive Phone, Tablet,
and Computer Use
So, why do your eyes feel tired after a long day? There are many causes
of eye fatigue, but a huge culprit is the technology we're surrounded with
daily. Working on a computer or even on your smartphone throughout the
day can make your eyes much more tired. This occurs because, when
you go to look at something small and close to you, the ciliary muscle
inside your eye contracts and changes the focusing system of your eye
to allow you to view up close. This small muscle is so important because
it controls your ability to focus far away, up close, and at all distances in
between!

The longer this muscle has to work, the more eye strain you may feel
(the ciliary muscle gets tired just like your other muscles do after a
weightlifting session!) Also, working on a computer that emits blue light
means that the contrast of what you're viewing is decreased, making it
tougher to see clearly.

Eye Strain Symptoms

Like I stated previously, eye strain is an annoying condition which often
plagues us with vague symptoms. For those who have experienced it,
you know this is true! But did you know that your computer, tablet, and
phone use is contributing to your dry eyes?

When someone complains of eye strain, they may complain of blurred

vision, pain in or around the eyes, dry eyes, headaches, general fatigue,
and even double vision.

How To Relieve Eye Strain

There are quite a few great ways to relieve eye strain. First of all, you
need to give your visual system a break throughout your work day or
while working on small-print or needlepoint tasks.

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We love to employ the 20-20-20 Rule. This is how it works: Every 20
minutes, look up from your computer (or cell phone, needlepoint project,
etc) and look 20 feet away for 20 seconds. Set a timer! This is the best
way to ensure that you're giving that ciliary muscle a rest every once in
awhile. It’s also a great way to ensure that you’re fully blinking, which we
neglect while doing near work.

It is often hard to start a new habit, especially if it is a healthy one. In

order to remember to take eye breaks every 20 minutes, it might be
helpful to set the alarm on your cell phone. However, this is distracting if
a person works in a cube in close proximity to other people, so an
alternative might be to set your timer to vibrate until you get in the habit
of naturally taking a short eye strain break every 20 minutes. There are
also apps and a Chrome extension that will pop up every 20 minutes to
remind you to take a break.

Also, make sure to adjust the lighting in your work space. Like stated
earlier, dark work environments make your eyes work harder, which isn't
what you want. Make sure your lighting is good!

Lastly, grab yourself a pair of blue light blocking glasses (or have blue
light technology put into your prescription lenses). This technology helps
prevent too much blue light from entering your eyes and can help relieve
symptoms of eye fatigue and dryness while you work throughout the day.
They can also help you sleep better, so that's a welcome bonus!

Blue Light Blocking Glasses

If you're in the market for a great way to decrease eye strain and dry
eyes while you're working, look into a pair of blue light blocking glasses.
The slightly yellow lenses help to absorb blue light from your computer
and smartphone screens and protect your eyes from the damaging
effects of blue light.

Blue light not only causes eye fatigue and makes it more difficult to fall
asleep and stay asleep at night, but studies are also starting to show that
excessive exposure can put you at risk for macular degeneration. To
prevent this, we recommend wearing blue light blocking glasses

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throughout your work day while you're on the computer or your
smartphone.

If you wear prescription glasses, talk to your optometrist or wherever you

buy glasses about getting a blue-light blocking coating added to your
lenses. You can also request a prescription for computer lenses and not
have to use your distance prescription on the computer.

Lifestyle Modification #5: Chiropractic Adjustments

Above, we discussed chemical interference on our body with what we put
in our body (food and water). Chiropractic focuses on eliminating the
physical interference. This can be one of the simplest steps that you can
take to make a difference in your life. According to Dr. B.J. Hardick in his
book Align Your Health, when you routinely visit a chiropractor the
adjustments are very simple but can have a profound effect on removing
interference in your body and allowing it to heal more naturally. This is
the first step that he recommends, as it is the easiest and can be the
most impactful.

Chiropractic is primarily focused on the nervous system, which affects

every part of your body. Think about the anatomy of the spine. Your
brain is attached to the spinal column, the spinal column releases
nerves, which communicate with every organ and cell inside your body.
If there is a blockage in these nerves then the organs and cells will be
affected by the lack of communication. This limitation by the blockage
will reduce the ability of everything else that you are doing to live a
healthier life.

As I write this book I am in my third week of chiropractic care, as I was

dealing with debilitating back pain that made it so I could barely play with
my son. After three weeks of care, I was able to run three miles pain
free, which I have not been able to do in about two years. Due to me
allowing this problem to go on for so long, I will be under chiropractic
care three times per week for twelve weeks, then reduce to once a week
for maintenance.

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Poor posture, trauma, and stress can all cause problems with your spine.
Visiting a local chiropractor can help improve your health physically and
profoundly. If you are unsure of which chiropractor to visit I recommend
looking up a MaxLiving chiropractor. I have no affiliation with MaxLiving,
and I’m just a very happy customer that had their life changed as a
result.

Lifestyle Modification #6: Believing in Yourself

In today's world, we've become so accustomed to dealing with diseases
and ailments with medications. Which drug works best? What pill can I
take to feel better? What eye drop is going to cure my dry eye?

Unfortunately, these are questions doctors now hear on a daily basis. But
have you ever considered the role of your mind in healing your dry eyes?
Since it may be much easier to simply take a pill or even make diet
changes to control dry eyes, we often forget about the power of belief
and the way we interact with the world around us.

Past studies have suggested a strong power in the placebo effect,

meaning that the patient will feel relief even when no medication is truly
given (the effects are much greater when they believe they have actually
been given the medication). It is truly fascinating that the effects of a drug
are greater when the subject actually believes they're receiving the drug
(or they see it being administered) vs. when they are unaware of the drug
being delivered.

Stated in a different way, the placebo effect is basically getting better

from a sugar pill or a sham treatment and the reason that it happens is it
actually causes a neurobiological change within your body, where
dopamine is released. It's pretty amazing that belief can shape the way
that your treatment works.

Past studies have suggested a really strong power to this placebo effect
and a lot of us are unaware that it can happen, but your beliefs can
actually make you feel better. So, if you believe that your treatment is
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going to work then you're much more likely to be successful with that
treatment then if you don't believe it's going to work. If you go into it and
you say “This is just going to be another treatment, it's not going to work,
it's going to be another waste of my money” it's definitely not going to
work for you because that's a bad attitude to start with. But if you go into
a treatment with a good attitude, you're much more likely to have a good
outcome from it.

Can Your Beliefs Help You Find Relief?

Recent studies imply that there's not just an objective aspect to disease,
but that there is a subjective aspect as well (which may be difficult to
measure in studies). You may very well have dry eye disease, but your
belief that you will get better plays a dramatic role on your treatment
journey.

One of the greatest tools you have is belief in yourself. Without this, none
of the results you wish to achieve will occur. If you want to live a healthier
life and finally find relief for your dry eyes or other ailments, you just have
to believe you can do it. It sounds cheesy, but it can very well be the
missing link in your search for health. For example, we often see patients
stop their treatment regimen when it's not going well or even make
changes to it constantly. You just have to keep pushing forward and
BELIEVE that you can get through the tough time.

This also goes along with faith. If you have faith in the treatment you are
performing or in the medication you are taking than you will perform
better. Also if you are Christian or Islamic or Hindu or whatever you
believe in, you will tend to heal faster as a result of having this faith, and
believing in something more than yourself is going to help in the healing
process.

We always talk about doing meditation. Believing in something other than

just what's around you can actually cause you to experience a more
enhanced life because you have faith in something other than just the
physical being that is in front of you.

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One of the greatest tools that we have is the belief in ourselves. Without
this, none of the results that you want to achieve are going to occur. If
you're setting out on a healthy lifestyle journey and you truly believe you
can make positive changes that will affect not only your eyes but your
overall health as well, it's the belief in yourself that will get you to the top
successfully. It might sound really crazy, but it can be the missing link in
your search for health.

I really believe that you can live a healthy lifestyle no matter what. We
hear all too often from patients “Oh I'm big-boned, so I can never lose
weight,” or “Diabetes runs in my family.” This is the biggest false belief.
It's just not true. It is a series of lifestyle choices over time that put you in
the position that you are in. THIS IS NOT YOUR FAULT. It is the false
information that the media throws around of what is and isn’t healthy.
Believing in yourself and believing that you are strong enough (because
you ARE strong enough) to make the changes to help your lifestyle, to
help eliminate your dry eye, and to help eliminate chronic disease is the
most important thing you can do.

Do you have that belief in yourself?

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Lifestyle Modification #7: Sleep
Sleep is one of the best ways for your body to restore and heal itself from
all the damage we put it through, throughout the day. This is a time for
your body to recover from the constant toxic exposure. When we sleep
we have more energy for creating new, healthier cells (if following a
plant-based diet) to replace the unhealthy cells that no longer work as
efficiently. Try to get at least seven hours (eight is ideal) of sleep per
night, and listen to your body! Sleep helps restore the tear layer and
repair the surface of the eyes. Most people don’t prioritize sleep like they
should. They instead stay up late watching TV or playing on their
smartphones. What is more important, liking that Facebook post or
healing your dry eyes (along with all the other great benefits of sleep)?

Sleep Benefits
Getting sufficient sleep (seven to eight hours) has many benefits which
include getting sick less often, less brain fog and thinking more clearly,
greater ability to focus and concentrate, better mood, better will power to
make better decisions, weight loss and maintaining a healthy weight,
lowering your risk for serious health problems such as diabetes, heart
disease, and dry eyes, allowing your body to repair, better memory, and
reducing stress.

Here are some tips on getting better sleep

1. Get 10 to 30 minutes of sunlight in the morning. More on this
below.
2. Cut off electronics 2 hours before sleep (TV, Phones, Computers).
After the sun goes down, blue light is reduced, which causes an
increase in melatonin production, which is your sleep hormone. All
our screens emit blue light therefore preventing this production
from occurring. Turning off your devices will help with this.
3. Wear Blue Light Blocking Glasses when working on a phone,
computer or watching TV AND 3 hours before bed. This will help
with the melatonin production as discussed above.
4. Get into your bed at the same time every night (wind down with a
paper book). We recommend thirty minutes before going to bed.

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 5. Get 8 hours of sleep scheduled (go to sleep and wake up at the
same time everyday). Consistency is one of the best ways to fall
asleep easily and sleep well through the night.
6. Turn fans and vents away from you. The constant breeze from
these will cause dryness in your eyes.
7. Make your room pitch black with black out curtains. The darker
your room is, the better you’ll sleep because any light can disrupt
your sleep patterns.
8. Plug your phone in another room to get rid of it as a distraction and
turn it on airplane mode, unless you really need to get notifications
in the middle of the night (in case of emergencies).
9. Remove the TV from your bedroom (bedrooms are for sleep and
sex only). It just keeps you up longer and disrupts your sleep.
10. Diffuse Lavender into your bedroom starting at 7:00 pm and
running all night. This will help reduce toxins in the bedroom and
put you in a calmer state.
11. Avoid caffeine after noon and avoid alcohol.
12. Move your body. Exercise and physical activity can help you fall
asleep and stay asleep. Also avoid exercising before bed and try
to do it in the morning if you can.
13. Fast before bedtime. Make your dinner the last thing you eat for
the day and don’t eat until breakfast. Fasting has other health
benefits as well, but will help you sleep and will help your body
recuperate.
14. If you stay up at night worrying or feeling anxious, try some of
the stress techniques outlined below. Yin Yoga or meditation right
before bed could help you fall asleep much faster.

What does getting 10 to 30 minutes of sunlight in the morning do

for you?
Sunlight in the correct doses is very good for health. The sun is our
ultimate energy source that provides us life on earth. With that being
said it is very powerful and should be approached with caution. The
sunlight we are recommending is before 10:00 am. According to Dr.
Jack Kruse, neurosurgeon and longtime proponent of morning sunlight,

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“Sunlight releases a[n] opiate (ß-endorphin) when we are exposed
to the sun. Guess why nature did that? Could it be that she wanted
us going in the sunlight often for its healing powers? …It turns out
that the combination of [ultraviolet] and [infrared] solar light
humans are designed to get in the AM also pre-treats the skin to
lower inflammation. The fact that [UV] light induces a small opiate
response tell us nature is trying to get us to come out into the solar
light in the morning.”

Who doesn't like a good sunbath? Getting as little as 10 minutes of

sunlight in the morning can provide numerous health benefits for you
later that day and for overall health and vitality.

A reduction in Vitamin D plays a large role in a ton of chronic diseases

including dry eye, asthma, type II diabetes, high blood pressure, and
more. Your skin will absorb the morning sunlight to be used later in the
day for vitamin D production which helps reduce the risk of these
diseases.

Speaking of using later in the day, morning sunlight increases your

serotonin production, which your body converts into melatonin later in the
day. Melatonin is increased when the sun goes down, and it starts to
signal to your body to go to sleep.

Avoid phones, TV's and other electronic devices at night as this inhibits
melatonin production therefore leading to worse sleep. Wearing a pair of
blue light blocking glasses will also help with increasing your melatonin
production.

Sunlight helps increase endorphins in the body, which help to decrease

stress and anxiety as well.

Sunlight has numerous other benefits as well:

1. Increases melatonin at night and regulates your circadian rhythm,
which is your sleep cycle
2. Increases your vitamin D production
3. Reduces risk of cancer
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4. Reduces major chronic diseases
5. Positively affects endocrine and hormonal levels
6. Improves mood and feelings of well being

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Lifestyle Modification #8: Reduce Stress
Life comes at us at such a rapid pace, it is no wonder mental and
emotional health is difficult to keep in check. Depression and anxiety are
at an all time high. Emotional stress can cause hormonal shifts, weight
gain, and inflammation. So, what is stress?

Adrenaline is pumping through your body, eyes are dilated, palms are
sweaty, heartbeat speeds up, muscles tense, breath is short… Sound
familiar? This is your body’s “fight or flight” response that occurs when
you are in a stressful situation.

Your nervous system releases hormones that prepare you to fight

whatever the offending agent is or to run. This is your body’s short-term
response to stress and it recovers quickly from this. This is a survival
mechanism in the body and does more good than harm.

Cortisol, or the "stress hormone," is an absolutely essential part of your

normal health and function helping control blood sugar levels, regulate
metabolism, help reduce inflammation, assist with memory, and help
control blood pressure.

However if this stress is present over a long period of time (chronic

stress), it can lead to more serious health problems. Aging more quickly,
decreased immune system, and higher disease prevalence are just a few
of the problems that can occur due to long term stress.

Stress’s effects on the blood and circulatory system are what is thought
to cause dry eyes. Blood is thicker, blood pressure is increased, and
blood supply to extremities (legs, skin, arms) is decreased, which also
affects the eyes and brain. This decrease in blood supply is thought to
cause dry eyes.

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What Causes Stress?
Everything causes some kind of stress on the body. It can be good
stress and bad stress. When we typically hear the word stress, we think
of bad stress, which can be caused by any of the following:

● Disability
● Death
● Divorce
● Getting Fired
● Unemployment
● Lack of job satisfaction
● Money
● Chronic disease
● Injury
● Depression, anxiety, anger, grief, low self-esteem or other
emotional problems
● Traumatic events like theft, rape, or violence against you
● Natural disasters such as hurricanes, tornadoes, or floods
● But not all stressors are bad
○ Marriage
○ Moving
○ Taking care of family
● MOST IMPORTANT = YOUR ATTITUDE
○ How you view the world
○ How you react to a particular situation
○ Unrealistic expectations

How To Relieve Stress.

Tip #1 Get Grounded

Grounding is the practice of getting back in touch with the naturally
negative charged free electrons that the earth has. Research has shown
that if you place your bare feet on the ground (grass, beach, ocean... not
concrete) after injury, electrons from the earth will migrate into your body
and spread through your tissues.

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During injury when our immune system responds, it releases many
chemicals that create an inflammatory cascade. One chemical released
is reactive oxygen species, or free radicals, which can leak into healthy
tissue causing inflammation in non-injured tissue. When grounding,
electrons from the earth travel to this area and naturally bind to these
free radicals, neutralizing them and making them harmless.

This is a process that is CONSTANTLY going on in your body, so

grounding daily is very beneficial. You have probably heard people talk
about the power of the beach and ocean? That is because we finally
take our rubber-soled, electron-blocking shoes off and walk barefoot.
You can also sit outside with your bare feet in the grass.

According to the Journal of Environmental and Public Health, grounding

benefits can include better sleep and reduced pain (from decreased
inflammation).

Tip #2: Just Breathe / Meditation

According to Merriam-Webster, meditation is to engage in mental
exercise (such as concentration on one's breathing or repetition of a
mantra) for the purpose of reaching a heightened level of spiritual
awareness. Now before you think I am going all spiritual, or foo-foo, on
you, please read this whole short section.

What if you could meditate in as short as 10 seconds per day?

What if this meditation could decrease stress levels, therefore decreasing

your risks of disease, such as dry eyes, heart disease, neck pain, and
more?

Meditation does NOT have to be an ultra spiritual, out-of-body

experience only reserved for Buddhists in the mountains of Nepal. It can
be, but it can also be highly beneficial for other reasons.

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For this article, I am going to teach you how to do meditation to help
decrease stress levels in as little as ten seconds by simply doing one
thing…

Deep breathing.

How to Meditate to Decrease Disease Risk by Breathing Deeply

This simple meditation technique can be used ANYWHERE. It can be
beneficial whenever you’re feeling stressed, depressed, anxious,
nervous, or just need to get refocused. I use it several times a day when
I am feeling flustered and need to get refocused or less stressed.

1. Close your eyes

2. Take a slow deep breath in. This deep breath in should take five
seconds and you should count the five seconds in your head.
3. Hold your breath for two seconds
4. Then a long slow exhale for five seconds

INHALE FOR 1… 2… 3… 4…
HOLD BREATH FOR 5… 6…
EXHALE FOR 7… 8… 9… 10…

I have a simple meditation guide and video for you at

www.RethinkingDryEye.com under the Lifestyle Modifications tab.

Tip #3: Yin Yoga

According to Wikipedia, Yin yoga is a slow paced style of yoga with
postures, or asanas, that are held for longer periods of time, usually 45
seconds up to five minutes or more. Yin yoga increases circulation in the
joints and improves flexibility. Yin yoga can also be combined with
meditation and it aims at cultivating awareness of silence and
interconnecting with your purpose or higher being.

This also allows us to slow down the mind, stretch the muscles, and
reduce our stress and anxiety, which will help you fall asleep at night.

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We tend to start our yin yoga practice around 9:00 pm at night and then
go to sleep afterwards.

The practice is usually 15 minutes to 60 minutes. You can do a quick

and easy search on YouTube for Yin Yoga or visit RethinkingDryEye.com
under the stress tab, to see some of my favorites.

Tip #4: Gratitude Journaling

This is by far one of the best tips on this list and another favorite of mine.
Gratitude journaling is as simple as writing down three or more things
everyday in a paper journal. Keep a paper journal beside your bed with
a pen. Every night before you go to sleep, write anything that happened
during that day that was positive and that you are grateful for.

Expressing gratitude on a nightly basis will help you look for positivity in
people and the world around you because you are starting to train your
brain to do so. Also, avoid negativity like the news, complainers, and
drama.

Gratitudes can be large or small. Here is an example journal entry:

1. I am grateful for Jenna doing the laundry today and making lunch for
me.
2. I am grateful that Jude is feeling better after a stomach ache from last
night.
3. I am grateful for the Espresso roast coffee that I had this morning.
4. I am grateful for having the freedom to be able to watch the World Cup
even though the US Soccer team did not make it :(
5. I am grateful for a beautiful sunny day.

Tip #5: Mind Dump Journaling

We live in an overwhelming world. Do you ever feel like you have WAY
too much to do and you can't figure out what to do first, so you end up
doing nothing at all? This is a result of that overwhelm. There is an easy

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way to deal with overwhelm, and it is what I like to call mind dump
journaling.

1. This is where I like to put on a 20 minute meditation song or video

and write down absolutely everything I have to do for work, health,
personal life, for my wife and son, and anything else that comes to
mind.

2. After about 5 minutes, take a look at your list and circle the most
important ones on your list.

3. Ask yourself, what is most important right now? You should have
less than 10 items circled on your list. Label these items in order of
importance, one being the most important and 10 being the least
important.

4. On a separate sheet of paper, write the top three things you have
to do as labeled one, two, and three.

Focus on finishing number one, before ever thinking about doing number
two. Once finished with number one, move on to number two, without
ever focusing on three.

Continue this process whenever you have a state of overwhelm.

Tip #6: Get Rid of Your Victim Mentality… Cause Is Greater Than
Effect
As Tony Robbins says, “What if life is happening FOR us and not TO
us?” What this means is that we need to stop thinking that everything
that happens in our life is happening TO us. Stop being the victim and
reacting to all scenarios. You get to choose how you react to that person
cutting you off or your colleague making fun of you. If you start thinking
of life happening FOR you, you start to think about what you can learn
from the situation.

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Instead of being reactive, be proactive. Choose to not react to the guy
cutting you off or the baby crying or the traffic accident that caused you
to be late to work (at least you’re not in the accident). If something
happens to you that is less than pleasant, close your eyes and take a
deep breath.

Go over tip #2 again, meditation. That is the exact technique I use

multiple times per day to avoid these problems and stay on the CAUSE
side of the equation. This technique can save you from doing something
that you will regret for the rest of your life.

Tip #7: Don’t Sweat the Small Stuff, and It’s All (almost) Small Stuff
We tend to stress out about every little thing that happens in our lives.
What if you approached each problem that you came across as just a
small bump in the road? I do realize that there are some things that are
harder to overcome than others, like a job loss, death in the family, or
something worse. But for the most part, everything we stress over on a
day-to-day basis is pretty small and inconsequential.

How I like to think of this is when I start to get upset, I ask myself “Will
this matter five days from now?” If it will not, then it is something small
and not anything to worry about.

Tip #8: Eliminate Bad Fats, Increase Good Fats

Here it is again. The importance of good fats in your diet. Eating fats in
our diet has received a bad rep for several years, but not all fats are
created equal. If you increase the amount of good fats in your diet, this
will significantly reduce your dry eyes, depression, and anxiety.

Eliminate, or eat in moderation, bad saturated fats. These are found in

most foods in the Western diet. This includes fried foods, baked goods
(cookies, cakes, pies), most desserts (ice cream), most fast foods,
pastries, mayonnaise, and more.

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Instead focus on whole foods that are high in quality omega-6 and
omega-3 for your fat intake. Some of the best sources of omega-3s
include fish oil in salmon, sardines, halibut or you can take an omega-3
fish oil supplement. Vegetarian sources include flax seed, chia seeds,
walnuts, brussel sprouts, kale, and spinach.

Tip #9: Laugh

Laughter could very well be the best medicine. Here are just a few of the
benefits of laughter: relaxes your whole body, boosts your immune
system, releases endorphins (happy hormones), protects the heart,
burns calories, and may even help you live longer.

ACTION ITEM
1. Print the checklist at www.RethinkingDryEye.com under the
Lifestyle Modifications tab and add or change one thing per
week. There are also accompanying video tutorials for some
changes.

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131
 Part 2: Dry Eye Syndrome
I know by now you are probably thinking… I thought this book was about
dry eye and how to treat it. The single most effective way to treat dry eye
is to detox your life, hydrate yourself, change your diet, exercise,
decrease stress, and sleep better, which I discussed in the first part of
this book.

The goal of everything we have gone over so far is to bring your body’s
homeostasis back to normal, which in turn will decrease inflammation
and damage throughout the body. This will decrease inflammation on
the eyes, increase tear film stability, decrease damage on the surface of
the eye, and therefore decrease your dry eye symptoms.

You will notice instant relief from some of these changes, like when you
start drinking the correct amount of filtered water per day, but most of
these changes take time to fully work. The damage that has been
done to your eyes and body was an accumulation of events over
the last months, or years, or even decades of your life. Getting
back to normal will take time and dedication.

Follow what we outlined in the book above, along with a few simple at
home dry eye remedies, and you will feel results.

Let’s now discuss the different ocular surface diseases like dry eye,
blepharitis, meibomian gland dysfunction, demodex, and rosacea and
how these all play a role in how your eyes feel and how they contribute to
dry eye symptoms. After that we will discuss treatments for each
condition. The good news is that most treatments, for all these
conditions, are very similar and we will show you a very simple daytime
and nighttime routine to help with your symptoms.

If you want to skip right to the routines to get started on those right
away, head to www.RethinkingDryEye.com under the Dry Eye
Treatment tab where we have made videos for you as well as a daily
dry eye checklist.

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 Also, full disclosure, in this section we will be discussing a few
different products to help with the conditions listed below and to
help with finding relief. Some of these products are ours, and we
have come out with these products as a result of years of practice
and seeing what works.

If you purchase our products, from Eye Love and Heyedrate, which I
mention by name, GREAT!! :)
If not, don’t disregard the messaging as a sales message, but take
action on the message itself. An example of this is increasing your
omega-3 intake with our Heyedrate Omega-3 supplement. Don’t
think I am just saying this because we sell an omega-3. We
released an omega-3 because we saw the importance of it. Taking a
good high quality omega-3 is the goal of that statement, and if you
decide not to take ours, that is okay.

With that out of the way, let’s dig in...

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Chapter 9 - What is Dry Eye?
Let’s go back to the DEWS II (The Tear Film and Ocular Surface
Society’s Dry Eye Workshop in 2017) definition of dry eye, in which it
states that inflammation is one of the key reasons for dry eye.

“Dry eye is a multifactorial disease of the ocular surface

characterized by a loss of homeostasis of the tear film, and
accompanied by ocular symptoms, in which tear film instability and
hyperosmolarity, ocular surface inflammation and damage, and
neurosensory abnormalities play etiological roles.”

Let’s break down this definition a little bit to make it more palatable. “Dry
eye is a multifactorial disease” means that there isn’t one thing that is
causing your dry eye. It is a combination of a lot of things that may be
causing it to occur. The problems that are occuring lead to “loss of
homeostasis of the tear film,” meaning that the tear film is no longer
functioning like it was designed to. “Accompanied by ocular
symptoms” means that you may notice the typical dry eye symptoms
listed below.

“Hyperosmolarity” means that the tears actually contain a high salt

content, which is a sign that there is “ocular surface inflammation and
damage.” Damage to the ocular surface means inflammation, or
irritation, on the front surface of the eye. “Neurosensory abnormalities”
means that the nerves of the eye are damaged and you may not have as
much “feeling” in the eyes as you used to or nerve innervation is not what
it used to be. On the other hand, your eyes may become even more
sensitive.

Dry Eye Symptoms

Tears рlау a key role in promoting сlеаr vіѕіоn, warding оff infection, and
keeping the frоnt ѕurfасе оf thе еуе сlеаn, moist, and comfortable. We
will go into more information on the tears and the three layers that are
involved in a later chapter.

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Symptoms оf drу еуе саn include:
- Stіngіng, burning, or gritty feeling іn thе еуе
- Strіngу dіѕсhаrgе from the еуе
- Blurry vіѕіоn, dоublе vіѕіоn, оr vision loss
- Lіght sensitivity
- Rеdnеѕѕ оf the еуеs
- Dесrеаѕеd tolerance of activities rеԛuіrіng рrоlоngеd реrіоdѕ оf
visual attention (such аѕ rеаdіng оr working оn thе соmрutеr)
- Eуе fatigue
- Dіѕсоmfоrt whеn wеаrіng соntасt lеnѕеѕ
- Exсеѕѕ watering оf thе eyes, followed bу periods of drуnеѕs

Why Is My Eye Watering?

This is probably one of the most common symptoms we hear in our
clinics regarding dry eyes. And when we tell our patients, “Your eyes are
watering because you have dry eyes”, they look at us like we have two
heads.

You know the feeling. Your eye keeps watering. It just won't stop! You
continue to wipe away the tears. You're not crying or emotional, but your
eyes just won't stop pouring. For some, this can be not only debilitating
but embarrassing as well. So, what could be going on?

Believe it or not, epiphora (the medical term for teary eyes) occurs
because the eyes are dry. How can this be? Well, the tears of your eyes
are made up of three layers, and these three layers must function
properly for the eyes to feel and look great. If even one of the layers is
not doing its job, the other layers end up running off of the front surface
of the eyes...right onto your cheeks.

What Are The Causes of Excessive Eye Watering?

Let's dive in a little deeper into why your eyes might be watering. Your
tears are composed of three layers; An oily (lipid) layer, a watery
(aqueous) layer, and a mucin layer. The outer layer of the tear film is the
oil one, which seals in the tears and prevents evaporation. The

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lubricating watery layer is in the middle, and the innermost layer is the
mucin layer, which functions to keep the rest of the tears stuck to your
eyeball.

When you have meibomian gland dysfunction (MGD), dry eye, or

blepharitis, the layers of the tears are disrupted, which can lead to watery
eyes. Also, if your eyelids are not positioned tightly against your eyeball,
the tears that should stay on your eyes may begin flowing down your
cheeks. Another reason for epiphora may be a drainage problem,
meaning that the tiny hole where the tears drain may be closed off (this is
known as nasolacrimal duct obstruction).

Dry Eye Causes

There are a number of rеаѕоnѕ whу уоu may be getting drу eyes. Aѕ wе
get оldеr, thе rіѕk оf getting drу еуеѕ increases, but thеrе аrе ѕоmе
mеdіcаl соndіtіоnѕ, mеdісаtіоnѕ, аnd lifestyle factors that саn mаkе уоu
mоrе lіkеlу tо develop drу eye:
- Mеdісаtіоnѕ ѕuсh as antihistamines, nasal dесоngеѕtаntѕ,
hоrmоnе rерlасеmеnt thеrару, birth соntrоl pills, аntіdерrеѕѕаntѕ,
retinoids, dіurеtісѕ, and blood pressure mеdісіnеѕ
- Allergies thаt affect your eyes
- Infrequent blinking due to ѕtаrіng at соmрutеr ѕсrееnѕ or еlесtrоnіс
dеvісеѕ for long реrіоdѕ of tіmе
- Long-term uѕе of соntасt lеnѕеѕ
- Cоmрlісаtіоnѕ rеѕultіng frоm rheumatoid аrthrіtіѕ, luрuѕ, Sjоgrеn'ѕ
ѕуndrоmе, аnd other аutоіmmunе dіѕоrdеrѕ
- Chrоnіс соnjunсtіvіtіѕ
- Skіn соndіtіоnѕ, such аѕ psoriasis оr rosacea
- Fat malabsorption or dеfісіеnсу
- Nutritional dеfісіеnсіеѕ (lіkе discussed above, vіtаmіn A оr vitamin
B12 dеfісіеnсу)
- Cіgаrеttе ѕmоkіng and alcohol use

Our рrесіоuѕ еуеѕ wіll ѕеrvе uѕ for a lifetime, so it іѕ important that we

сhооѕе the right ѕоlutіоn to our еуе problems. We want the kind of
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treatments that not only treat the ѕуmрtоmѕ, but dіrесtlу аddrеѕѕ thе root
саuѕе оf those problems. Thе same рrіnсірlе аррlіеѕ tо drу еуе; a major
vision concern аffесtіng аn еѕtіmаtеd 30 mіllіоn Americans, whether they
know it or not.

Thе саuѕеѕ of dry eye range from іmmunе dіѕоrdеrѕ to the more
common causes, like a lасk of tear production. Aѕ a result, thіѕ рrоduсеѕ
іnflаmmаtіоn аnd the surface of the eye аnd the inner еуеlіds bесоmе
drу.

Some ѕуmрtоmѕ mау include itchy еуеѕ and ѕеnѕіtіvіtу tо lіght. Bеfоrе
ѕееkіng ѕоlutіоnѕ yourself, it іѕ сrіtісаllу important to соnѕult уоur еуе
саrе рrоfеѕѕіоnаl in mоrе ѕеrіоuѕ саѕеѕ. Fоr еxаmрlе, Dr. Emil Sеnау,
the mеdіcаl соrrеѕроndеnt fоr thе CBS Early Show, ѕtаtеd thаt, in ѕоmе
cases, сhrоnіс dry еуе mау bе аn іndісаtіоn of dіаbеtеѕ аnd, if left
untrеаtеd, саn lеаd to соrnеаl іnfесtіоnѕ and corneal ѕсаrrіng that may
damage thе еуеѕ.

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Chapter 10 - Dry Eye Treatment According to
DEWS II
There are a LOT of dry eye treatment options out there. What we are
going to do for the rest of this book is go over the accepted treatment
options according to severity level and the Dry Eye Workshop (2017)
definition. I try not to mention specific products here, but I do mention
some. For a complete updated list of our product recommendations,
head to www.RethinkingDryEye.com and look under the Dry Eye
Treatment tab.

Trace to mild dry eye syndrome

- Modifying the local environment (getting rid of fans, moving your
computer screen, etc)
- Dietary modifications (eg, increasing omega-3 fatty acids and
increasing leafy green vegetable consumption)
- Eliminating offending systemic and topical medications, like
antihistamines, hormone replacement, and others
- Eliminating medications, drops, and food with preservatives
- Regarding ocular lubricants, they recommend lipid-containing eye
drops if there is meibomian gland disease present
- Lid hygiene
- Warm compresses

The treatment and modifications listed above should be done by ALL dry
eye syndrome sufferers and are what the basis of this entire book is
about. This is also the basis to treatment for all disease. These are
crucial for anyone that has dry eye and other diseases to implement.
Don’t think that because you have severe dry eyes, that you can avoid
these modifications, because these very well could make the greatest
difference in your relief.

Remember that a disease is your body's way of telling you that

something YOU are doing is wrong.

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Mild to moderate dry eye syndrome
- Changing to a non-preserved topical lubrication
- Using tea tree oil products if demodex is present
- Tear conservation, such as punctal occlusion
- Moisture chamber spectacles or goggles
- Overnight treatments such as ointments
- With meibomian gland dysfunction, in-office treatments such as
LipiFlow® or intense pulsed light (IPL) therapy
- Topical antibiotics or antibiotic/steroid combinations
- Limited-duration topical steroids
- Topical secretagogues
- Topical anti-inflammatory medications such as cyclosporine
(Restasis®)
- Topical LFA-1 antagonists such as lifitegrast (Xiidra®)
- Oral macrolide or tetracycline antibiotics (such as doxycycline)

Moderate to severe dry eye syndrome

- Oral secretagogues
- Autologous serum
- Therapeutic soft contact lenses
- Rigid [gas-permeable] scleral lenses (eg, BostonSight® PROSE or
others)

Severe dry eye syndrome

● Topical steroids of longer duration (though, of course, this comes
with an increased risk for potential side effects)
● Amniotic membrane grafts
● Surgical punctal occlusion with cautery
● Permanent lateral or even central tarsorrhaphy
● Salivary gland transplantation

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Natural Dry Eye Remedies
We have already discussed most of these quite a bit, but they are worth
summarizing again. As we discuss other conditions like blepharitis,
meibomian gland dysfunction, demodex, and rosacea, you are going to
see similarities between treating all these. Treatment is again aimed at
reducing inflammation by finding the cause and not just covering the
symptoms.

Let’s summarize and briefly touch on natural ways to heal your dry eye.

1. Clean your eyelids right before bed and right upon waking with a
hypochlorous based eyelid cleanser (more on this later). Bacteria live
normally on your eyelids, but if they become overpopulated this leads to
biofilm formation (a collection of bacteria), which leads to inflammation.
Dry eyes are caused from inflammation. So keep your eyelids clean and
reduce symptoms of dry eyes, blepharitis, meibomian gland dysfunction,
demodex, and more.

2. You are what you eat. If you eat unhealthy food that causes
inflammation (processed foods, sugar, fast food, anything fried), then
your body is going to be inflamed and in pain, and you may notice joint
pain, dry eyes, or you will have diseases like high blood pressure, high
cholesterol, and diabetes. Instead, embrace a plant-based, alkaline diet
that is rich in leafy green vegetables like spinach and kale.

3. Flood your cells with oxygen by taking in omega-3 fatty acids and
healthy fats. Add avocados, coconut oil, ground flaxseed, and chia seeds
into your diet. Take an omega-3 supplement that is formulated for dry
eye. Also, exercise helps bring more oxygen to the rest of your body
resulting in less inflammation and a healthier you.

4. Hydrate yourself. You should drink 32 ounces right when you wake up
and 16 ounces before you eat any meal. Also, keep a water bottle with
you and drink throughout the day. Each time you think, drink, meaning if
you think about water, drink some. Did you know that 80% of the
population is dehydrated? Dehydration can lead to a plethora of disease

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symptoms. Another bonus is that hydrating first thing in the morning
boosts your metabolism by 30%, which is just as good as a workout!

5. Make sure you're not deficient in vitamins and minerals. Up your

intake of magnesium, and ensure that you're taking in enough of
Vitamins A, C, B6, D, and E.

6. Sleep more, stress less. Get outside and ground yourself daily (walk
in the grass without your shoes on!) Keep a daily gratitude journal. Try to
get 7-8 hours of restful sleep per night.

7. Cut off TV, smartphone, and computer use two to three hours
before you go to bed. Remove all electronic devices from your
bedroom. The blue light that back lights most screens can also be
disruptive to your sleep, and fatigue aggravates dry eye symptoms.

8. Eye blinking exercises аrе hіghlу bеnеfісіаl in rеlіеvіng drу еуеѕ and
can іnсrеаѕе tear production. Thіѕ tесhnіԛuе is called Sԛuееzе Blinking,
which іѕ соnѕіdеrеd an effective therapy for dry еуеѕ. Kеер уоur eyes
shut tіghtlу fоr 3 ѕесоndѕ аnd thеn ореn thеm once аgаіn tо ѕtаrt
blinking ѕеvеrаl times. Rереаt thіѕ рrосеѕѕ 5 or 6 tіmеѕ untіl tеаr
рrоduсtіоn іnсrеаѕеѕ, and try to do this multiple times throughout your
day.

9. Eliminate toxins. Toxins are everywhere. Learn how to eliminate

them throughout your life, house, and food and reap the benefits. Read
the toxins section for more ideas.

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Prescription Dry Eye Medications and Their Uses

Restasis

What is Restasis?
If you've been searching high and low for an effective treatment for your
dry eye disease, you've likely stumbled upon Restasis (cyclosporine
ophthalmic emulsion 0.05%). Maybe you've even given it a try! Restasis
is a prescription medication FDA approved to help treat dry eyes by
making more of your own tears. It helps strengthen your body's natural
ability to produce the tears it should, which is often an issue when
dealing with inflammation from chronic dry eye.

Restasis comes in both single dose vials and a multidose bottle, and
both act in the same way to produce the same results. It is
recommended to make Restasis part of your daily routine and use it
twice per day, morning and evening, for best results. From our
experience in practice, it can often take patients six months or more to
notice a change in their symptoms.

We've found Restasis to be especially great for those planning to have

ocular surgery (such as LASIK or cataract surgery). It also works well
post-surgery, when many of these patients find that their eyes get even
drier.

Restasis Side Effects

What can you expect when using Restasis for the first time? To begin
with, anyone with any degree of redness and inflammation on their eyes
(i.e. ALL dry eye patients) will experience a temporary burning or stinging
sensation. This is normal for any drop that you will put in with
inflammation and should not be a cause for concern.

The drop may even seem to cause a bit more redness and dryness, but
this is due to that inflammation. If either of these persists, make sure to
discuss it with your eye doctor, but it should not be a reason to

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discontinue the medication unless there is an allergy. Some patients note
that keeping the eye drops in the refrigerator helps with the burning, and
we have found this to be quite true.

Another very common but harmless side effect you'll likely notice is a bad
taste in the back of the mouth. Because the eyes, nose, sinuses, and
mouth are all connected, when you put eye drops in you'll often be able
to taste them in the throat. If this is bothersome for you, we recommend
drinking a large glass of water or a smoothie directly after using the
drops. This will help decrease that taste and you'll also get a little extra
hydration in, which is always helpful for those with dry eyes!

Restasis Costs and Coupon Information

So, let's talk pricing. The biggest complaint we hear about Restasis in
our practice is that it's too expensive for most people to afford and it is
often not covered by insurance. Well, you're in luck! Restasis does have
coupons available through your eye doctor and online. We always
recommend that our patients get 3-month supplies, since this medication
can take up to six months to notice benefits. At this time, many
insurances will often help cover some of the cost, and you may only need
to pay your usual copay.

Restasis Generic and Alternatives

If you don't want to worry yourself with affording Restasis, there are SO
many other things you can do to begin finding relief for your dry eyes.
First of all, diet and hydration are key and are the first things you should
be changing in your life. Make sure you're drinking at least half your
body weight in ounces of water per day, and get rid of the processed
foods, sugary beverages, dairy, and other inflammatory meals. I find
repeating this point over and over again is essential to really emphasize
that it is that important.

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Xiidra

What Is Xiidra®?
Xiidra® (lifitegrast ophthalmic solution 5%) became FDA approved in
mid-July 2016 and has been widely successful since its release.
However, this is still considered a new medication that’s still finding its
way into the pharmaceutical marketplace. Some things have yet to be
determined, but sharing what is known is important for the millions of
people who could benefit from this medication.

During FDA trials, Xiidra was found to start working in test subjects as
early as two weeks after the beginning of the application and most felt a
positive difference in their dry eyes within 12 weeks. The efficacy and
safety of this medication was studied in four well-controlled trials over a
period of 12 weeks, and over 2100 patients were studied. Improved
symptom relief was noted in two of the four studies at two, six, and 12
weeks.

Also at 12 weeks, Xiidra was shown to improve the signs of dry eyes,
measured by inferior corneal staining. This is a huge jump forward from
Restasis (cyclosporine ophthalmic emulsion 0.05%), which typically
takes about six months before a real difference is felt by users or seen by
your eye doctor. We’ll go into a bit more about Restasis vs. Xiidra later.

How Does Xiidra Work?

Xiidra is FDA approved to treat the signs and symptoms of dry eye
disease, or keratoconjunctivitis sicca, as we discussed above. We know
this can get a little confusing, but it basically works by inhibiting the
binding of inflammatory cells.

This mechanism decreases inflammation mediated by T lymphocytes (a

type of white blood cell that plays a critical role in your body’s immunity),
therefore improving dry eye signs and symptoms. More specifically,
Xiidra blocks the interaction of ICAM-1 and LFA-1, which are key players

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of the inflammation behind dry eye. Although we know all of this, the
exact mechanism of action is still unknown.

Xiidra comes in a preservative-free solution in eye drop form and is

dispensed in small, single-use vials as a 30-day supply. It is prescribed
as one drop in each eye, twice per day, morning and evening.

Xiidra Side Effects

Keep in mind, the FDA trials tested only a few thousand subjects, so
further side effects could be found as the drops hit the market and are
used more comprehensively for dry eye patients. But the side effects
determined by the trial are noted to be the following:
- Between 5-25% of those using the drops felt burning in their eyes
when they first put them in
- Blurry vision immediately after insertion
- A strange or bad taste in the mouth (dysgeusia) immediately after
application
- Between 1-5% reported a headache, redness of the eyes, watering
eyes, discharge from the eyes, and runny nose, to name a few
relatively insignificant others

It is important to note that, if your eyes are inflamed (as most are with dry
eye disease), anything you put into your eyes has the potential to sting or
burn. Xiidra is no different, and it is very common for the medication to
burn for a few seconds to minutes after instillation. This side effect,
although very common, is harmless and will subside as your eyes heal.

Xiidra Cost and Coupon Information

According to GoodRx, Xiidra, as of this writing in 2019, is going to cost
you over $500 without insurance or coupons. Of course, even if you do
have an insurance plan, everyone’s insurance is different. We know that
many will cover some of the cost of Xiidra, which is a huge help for the
millions of Americans that need it. It’s estimated that about 30% of
Medicare plans will cover this medication, so you’ll be left with a small

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copay. Even better, if you’re eligible, you can use a coupon through
Xiidra’s website.

Xiidra Generic and Alternatives

Xiidra is so new that there is no generic for this medication. However,
there are loads of alternative ways to treat your dry eyes, as we’ve
already discussed in this book.

Xiidra vs Restasis
Now onto this important distinction and one of the main questions we are
asked when discussing either of these medications.

Which is better?

Well, one main difference between Restasis, a decade-old medication

used to treat dry eye, and Xiidra, is that Xiidra is approved to treat not
just dry eye signs but its symptoms as well. That distinction is because of
the nature of the product.

Xiidra stops a chemical chain reaction in the cells. When the drop hits the
eye, the drop binds with proteins in the cells that stop the signals that
would otherwise create many of the problems and symptoms of dry eye
including itching, burning, pain, and redness. This effect can be noticed
quite quickly!

Restasis, on the other hand, is a slower process. Although the exact

mechanism of action is also unknown, we do know that it contains a
topical immunomodulator with anti-inflammatory effects. Over time, this
medication helps the eyes produce more of their own high quality tears
which, in turn, helps the patient feel relief.

The important thing to note with both of these medications is that they
are not artificial tears. They’re not designed to give you immediate relief
because they’re healing your eyes from the inside out, not simply putting
a bandaid on the problem. Healing takes time.

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Cequa

What is Cequa?
Recently, Cequa (cyclosporine ophthalmic solution 0.09%) became only
the third dry eye medication to be approved by the FDA in the past 19
years. This is exciting for those of us suffering from dry eyes, as well as
for those who treat it.

FDA approved to treat dry eye disease by enhancing tear production, it

works as an immunomodulator in a similar fashion to its earlier
competitor. Like Restasis that we know all too well, Cequa uses
cyclosporine but in a much higher concentration. This higher
concentration is also part of a formula that includes nanomicelles.
Micelles are gelatinous congregates of hydrophilic and hydrophobic
molecules that can help with absorption of a substance. Sun Pharma (the
manufacturer of Cequa) says these will help increase the ability of Cequa
to penetrate the ocular tissues and overcome any solubility changes.

For the patient, this means a more effective medication, because

penetration into the cells of the cornea and conjunctiva will be enhanced.
Hopefully, this also means the medication will work more quickly, since it
is well known that Restasis can sometimes take six months for the
patient to notice changes in their dry eye symptoms.

Cequa was evaluated in two randomized studies with over 1000 patients
suffering from dry eye disease. Compared to control at day 84, use of
Cequa for 12 weeks showed a statistically significant increase in tear
production (measured by Schirmer Score). Corneal and conjunctival
staining was evaluated earlier, and positive changes were noted as early
as four weeks.

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Now available from Sun Ophthalmics in the US, Cequa is dosed just like
Restasis and Xiidra twice per day, 12 hours apart, morning and evening.
The new medication comes in single-use vials that should be discarded
immediately after each use.

Cequa Side Effects

As with any medication, Cequa has a few common side effects. 22% of
those studied experienced a burning or pain sensation upon instillation.
6% of those people noticed redness of the eyes, but both of these should
subside within a few moments of using the medication. Typically, burning
and redness are very common side effects for any eye drop, especially
when inflammation is present. With dry eyes, inflammation is going to
make burning and redness much more likely side effects no matter what
is instilled into the eyes.

Other reactions noted were blepharitis, eye irritation, headache, and

urinary tract infection, which is interesting. There are no adequate
studies to show that Cequa is safe for pregnant and nursing mothers, so
this should be either avoided or discussed with your doctor, weighing the
benefits of the medication versus the risk to the unborn child or infant.

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Autologous Serum Drops
Autologous serum drops have been specifically shown to be beneficial
for those with dry eyes due to Sjogren's Syndrome. But these aren't just
normal artificial tears, and they're not designed to lubricate the eyes.
They're designed to repair tissue, meaning that they can provide relief for
those with Recurrent Corneal Erosions (RCE), exposure keratitis,
aqueous deficient dry eye, and other conditions that negatively affect the
ocular surface.

The pH, osmolarity, and many growth factors are roughly the same as
your tears, meaning that they do a wonderful job at healing the surface of
the eyes.

While artificial tears may be alright for occasional use to supplement the
tears in someone with mild dry eye, autologous serum is a much better
route to take in those with a more severe condition. Autologous serum is
an eye drop made by separating the cellular and liquid components of a
patient’s blood. This serum is a much more effective tear substitute
because it contains the exact biological nutrients that are included in the
patient’s own tears. There have been few studies performed on this
subject, but we’ve had great success using autologous serum in our
clinics.

The process is simple. Your eye doctor will write a prescription for 20%
autologous serum eye drops for use every few hours during the day.
Blood can be drawn anywhere that is convenient, and the blood and
prescription are taken to a compounding pharmacy to be made into the
eye drops. The drops will come in individual vials that must be discarded
after use, and they last in the refrigerator unopened for a few months.
Usually, there are minimal adverse effects because the eye drops are
being made directly from the patient’s own blood. This is definitely an
interesting treatment, but the success has been worth mentioning.

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Avenova Hypochlorous Acid Eyelid Cleanser
Avеnоvа is a prescription hypochlorous acid (HOCl) eyelid cleanser that
is intended for uѕе undеr the supervision of hеаlthсаrе professionals fоr
сlеаnѕіng and removal of foreign mаtеrіаl, іnсludіng: microorganisms аnd
dеbrіѕ frоm wоundѕ, сlеаnіng mіnоr сutѕ, minor burns, ѕuреrfісіаl
аbrаѕіоnѕ, аnd mіnоr іrrіtаtіоnѕ of the ѕkіn, as well аѕ mоіѕtеnіng
аbѕоrbеnt wound dressings.

Avenova is a hypochlorous acid eyelid cleanser that оffеrѕ раtіеntѕ relief

from their red, sore, асhу еуеѕ. In ѕоlutіоn, Avеnоvа has аntіmісrоbіаl
асtіvіtу and lаbоrаtоrу rеѕultѕ demonstrate аntі-іnflаmmаtоrу activity as
well.

We used this in our clinic as an eyelid cleanser, because cleaner eyelids

lead to less dry eye, blepharitis, meibomian glands dysfunction (MGD),
demodex infestation, and contact lens intolerance, so an eyelid hygiene
regimen such as this is very important.

Other Hypochlorous Acid Eyelid Cleansers

A few over-the-counter hypochlorous acid eyelid cleansing рrоduсtѕ have
recently come out on the market with promising results. This includes
Heyedrate Lid and Lash Cleanser, which works well to soothe eyelids
suffering from blepharitis and MGD because it helps to keep the eyelids
clean.

What is Hypochlorous Acid?

Hypochlorous acid is an organic, completely natural substance released
from the body's neutrophil cells. HOCl functions in the body as an
antimicrobial agent, and it also neutralizes bacteria, toxins, and
inflammatory mediators in the body. It works to prevent biofilm formation
as well as deactivate problematic enzymes.

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As you can see, this important substance is a vital one for keeping the
body healthy! Because of its antimicrobial activity, HOCl is the perfect
replacement for many antibiotics and antiseptics used in medicine today.

Much of the research on hypochlorous acid promotes its use as a wound

care agent because it is a bactericidal compound, meaning it kills
bacteria in and on the body. It also demonstrates very low toxicity, which
makes it a great candidate for use throughout the body. Aside from
wound care, research is being done which uses HOCl as an antiseptic
prior to surgery, meaning we could potentially avoid the messy iodine
that is now used.

In dentistry, HOCl has been shown to be great for cleaning

biofilm-contaminated implant surfaces, has the potential to be used
during dental surgery, and is an effective oral rinse. In eye care, this
natural compound eliminates microorganisms on the skin and mucous
membranes making it a very effective eyelid and eyelash cleaner.

How To Use Hypochlorous Acid Eyelid Cleansers

Sіmрlу ѕрrау twісе оntо a соttоn round or make-up pad, аnd rub the
eyelids two оr three tіmеѕ, twісе реr day. If you find this too daunting, you
can simply spray the solution onto your closed eyelids, rub it in with your
clean fingertips, and let it dry. Simple as that!

Most раtіеntѕ ѕtаrt to оbtаіn relief in as little as a few days, but many
have found best results in two weeks.

Brush, Floss, Clean Your Eyelids

Wе аll knоw that good dеntаl care іnсludеѕ daily bruѕhіng with periodic
еxаmѕ. Wе nоw rесоgnіzе thаt thе рrеvеntіоn and trеаtmеnt of
blерhаrіtіѕ and drу eye is a lоng tеrm рrосеѕѕ ѕіmіlаr tо dеntаl care.
Avеnоvа and Heyedrate Lid and Lash Cleanser are іdеаl products for
dаіlу uѕе in thоѕе раtіеntѕ with сhrоnіс lid dіѕеаѕе аѕ раrt оf daily eyelіd
hygiene thеrару.

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Avеnоvа and Heyedrate Lid and Lash Cleanser are a major
breakthrough in the рrеvеntіоn of blерhаrіtіѕ and drу еуе. Lack of
bacterial rеѕіѕtаnсе tо thіѕ product іѕ unique and a compelling reason for
both eye doctors and patients to use it.

Other Dry Eye Options

Scleral Lenses
Scleral lenses are also being utilized for the treatment of severe dry eye
disease. In general, we usually think of contact lenses as being
bothersome to dry eye, and scleral lenses in particular are usually
utilized for those with corneal shape irregularities like keratoconus and
extensive scarring. However, scleral lenses can be a wonderful option for
dry eye treatment. These large, rigid lenses are so beneficial for dry eye
because they can vault over the entire cornea and literally bathe the eye
in tears all day.

When scleral lenses are fit for dry eye, they will be fit so that they
completely vault over the cornea. Lenses are inserted by placing the lens
onto a small plunger that holds the lens upright. It is then filled with
non-preserved saline solution or non-preserved artificial tears before the
lens is placed onto the eye. Using non-preserved solution ensures that
no extra preservatives or irritants are introduced to the front of the eye.

During wear, vision should be optimal. If vision ever clouds over during
the day, the lenses may need to be removed so that new artificial tears
can be added into the lens.

While a great option for dry eye, scleral lenses do require special care to
ensure the health of the eyes. Usually, a hydrogen peroxide cleaning
solution will be prescribed so that when the lenses are removed at night,
they can be optimally cleaned. While it may seem cumbersome to wear
large, rigid lenses in order to improve dryness, it makes sense! These
lenses allow the eyes to bathe in tears all day, and they can be a game

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changer for many people who have found no relief from their dry eyes
otherwise.

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Amniotic Membranes

What is an Amniotic Membrane?

An amniotic membrane is actually the innermost layer of the placenta, an
organ which a woman's body makes naturally when carrying a child. No
fetal tissue is harvested or disturbed while these membranes are
collected and made, and most membranes come from women who had a
planned cesarean section.

This avascular membrane requires no tissue typing because it carries no

Human Leukocyte Antigen (HLA), which is responsible for tissue typing
in humans. This makes it easy to use in medicine, because there's no
worry about graft failure or problems with a patient rejecting the
membrane.

These membranes can be used in a few ways. First, they can act as
grafts post surgery. And second, they can be used as bandages for a
variety of different eye conditions. When used in this way, the actual
tissue does not integrate with the host tissue but rather acts as a
temporary cover while the eye heals.

Why are amniotic membranes so amazing? Amniotic membranes contain

many anti-inflammatory and antimicrobial properties that make them
super useful in eye care. They contain cytokines and growth factors that
can be used to regenerate corneal and conjunctival cells in conditions
like Stevens-Johnson syndrome, ocular cicatricial pemphigoid, persistent
epithelial defects from recurrent corneal erosions (RCE) and epithelial
basement membrane dystrophy (EBMD), neurotrophic ulcers, and even
severe dry eye.

Amniotic Membrane Types, Costs, and Side Effects

Amniotic membranes must be either cryopreserved or dehydrated before
use because using a fresh membrane can carry disease transmission
risks. Cryopreservation involves slow freezing at –80°C using
DMEM/glycerol to allow for slow-rate freezing without ice formation. This

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allows the tissue to maintain the natural quantity and quality of key
biological components needed for healing, including hyaluronic acid. The
tissue must be stored in a –80°C freezer and brought to room
temperature as needed for use on a patient.

Freeze dried, dehydrated membranes are another option, and these are
preserved using a vacuum with low temperature heat to retain devitalized
cellular components. There are conflicting thoughts on whether or not
these maintain all of their helpful, healing components throughout this
process, but they are still healing for many conditions. These are
conveniently able to be kept at room temperature, but they must be
rehydrated for use on a patient.

To cover the cost a bit, amniotic membranes (depending on the type) will
cost your eye doctor anywhere from $300-1000 each. This means that
the cost will be higher for you. However, insurance will often cover this
service or at least relieve some of the financial burden. Your doctor will
likely attempt to get prior approval from your insurance company, but
they will still have you sign a financial statement, insurance
preauthorization form, and informed consent.

As far as side effects go, they are minimal because most people tolerate
them very well. The biggest side effect is going to be blurred vision,
because the membrane is opaque (you can expect 20/200 vision,
usually). The only membrane which will not interfere as much with vision
is the ProKera Clear, which has a 6mm opening for optimal vision. Some
people will also report irritation with the ProKera brand of membranes
because they do contain a large ring holding the membrane in place.

ProKera by BioTissue
ProKera makes the only cryopreserved amniotic membranes available
for ocular use, and they are made using the proprietary CryoTek process
to maintain the extracellular matrix of the membrane and allow it to
support the regenerative process. They are FDA approved for reducing
inflammation and promoting scarless healing of the eye.
Contraindications include those who have a glaucoma filtering bleb and
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those with allergies to Ciprofloxacin or Amphotericin B (which the
membrane is stored in).

The ProKera comes in ProKera Slim, which is thinner, more comfortable,

and works well for a wide variety of conditions, the ProKera Plus for
those with more severe issues, and the ProKera Clear, which has a 6mm
opening for optimal vision during the treatment. The ProKera Clear may
make the most sense for those with limbal stem cell deficiency or for
those with dry eyes.

AmbioDisk by IOP
Each AmbioDisk is cleaned, dehydrated, and sterilized before use on a
patient. Most of the time, freeze dried or dehydrated amniotic membrane
allografts are used along with a bandage contact lens to ensure that the
membrane stays in place. This is great news for those who have issues
with the comfort of membranes such as the ProKera. There is no large
ring on the AmbioDisk, and it's as thin as tissue paper, so you'll notice it
much less.

VisiDisc and OculoMatrix by Skye Biologics

These two are preserved by a controlled moisture HydraTek process,
which preserves a viable extracellular matrix with biologic components
needed to support tissue function, reduce scar formation, and modulate
inflammation. Each membrane can be applied in either direction, forward
or backward, with no orientation issues, making for super easy
application for your clinician. No bandage contact lens is needed either,
which is helpful and even more comfortable for the patient. These are
available in a thin, amnion-only or a thicker chorion-based variety for
improved handling and optimal treatment coverage.

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Punctal Plugs
If you suffer from dry eyes and your eyes do not produce enough tears,
punctal plugs might be a valid treatment option. These tiny plugs are
inserted into the tear ducts to stop the tears from flowing out of your
eyes. Instead, they force the tears into the eyes, which increases the tear
film and bathes the cornea in tears. Most plugs are about the size of a
grain of rice. Usually, these become an option if eye drops and gels do
not help keep the eyes wet enough.

Types of Plugs
At this point, there are two types of plugs — though that could always
change in the future. The first type are semi-permanent plugs that are
made of silicone and are meant to last a long time. The other type are
dissolvable plugs made of materials easily absorbed by the body, such
as collagen. Temporary plugs can last anywhere from a few days to a
couple of months and may be used primarily to determine if the plugs
work for that patient before upgrading to the semi-permanent varieties.

Plugs come in many shapes and designs to fit the individual patient, and
materials used in making them are collagen, silicone, hydrogel,
polydioxanone, and hydrophobic acrylic polymer. Some of them even
have a slick coating on the surface to make insertion easier for the
doctor.

What’s the Process?

First, your eye doctor will take a look at your puncta (or tear ducts) and
may measure the openings. A proper fit is vital to balance both comfort
and keeping the plugs firmly in place. However, there are also some
versions of the plugs that conform to fit almost all eyes without needing
to measure. Your eye doctor should know the fit choice for you, but don’t
be afraid to ask questions or know the other options as well and why
your specialist thinks one is better than another.

In many cases, there won’t be a need for any anesthetic, but your doctor
may suggest it to make you more comfortable. Let your professional
know if you have particularly low tolerance for pain, or if you prefer not to

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have any drugs. These plugs may be inserted into the tear duct openings
of your lower lids, your upper lids, or both.

After Insertion
Most patients say they feel some initial discomfort, but the eyes easily
adjust to the change and after that, you shouldn’t feel them at all. They
can be removed if there’s a problem, but that also needs to be done by
an eye specialist. Side effects are rare, but rubbing the eyes can
dislodge the plugs and then you may have irritation in the eyes from the
material being where it shouldn’t be. Also, eye infections can occur, but
this is not common.

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Chapter 11 - What is Blepharitis?
Eyelids are more complex than they appear with the naked eye. Your
eyelids contain millions of bacteria living on the surface that help keep
your eyelids in a normal state. There are also many glands that secrete
oils and tears on to your eyes, keeping them comfortable. If any of this
becomes disrupted, dry eyes and eyelids can lead to irritation,
inflammation, redness, and more uncomfortable situations. This
inflammation of the eyelids is known as blepharitis.

What is Blepharitis?
Blepharitis is, by definition, an inflammation of the eyelids. There are two
different types of blepharitis: anterior (front) and posterior (back)
blepharitis which is location dependant. Anterior blepharitis is sometimes
called Staph Blepharitis as it is an overgrowth of the normal
Staphylococcus Aureus that lives on our eyelids. Posterior blepharitis is
also called meibomian gland dysfunction (MGD), which we will discuss in
the next section.

Anterior Blepharitis Symptoms and Signs

Anterior blepharitis, like stated above, tends to be more bacterial-related.
We have normal bacteria that live on our eyelids that can become
overpopulated.

When this occurs, it is going to cause the following signs and symptoms
of blepharitis:
- Red, inflamed eyelids
- Itchy eyelids
- Lids stuck shut upon awakening
- Dandruff on the eyelashes
- Irritated eyelids
- Dry eyes

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Blepharitis Treatment With Eyelid Hygiene
If you have these signs and symptoms, treatment is simply keeping your
eyelids cleaner with a hypochlorous acid eyelid cleanser. This spray is a
natural antiseptic and mimics your body’s natural ability to heal. It is free
of any harsh chemicals, alcohol, parabens, sulfates, or other
preservatives.

Some examples of hypochlorous acid eyelid cleansers are Heyedrate Lid

and Lash Cleanser (our brand and OTC), Avenova (prescription only),
and Acuicyn (prescription only). Eyelid hygiene should be performed
twice daily, both morning and evening.

What Eyelid Hygiene NOT to Use?

In the 90’s and early 00’s, it was common practice for eye care
practitioners to prescribe baby shampoo as eyelid hygiene. With further
research into this, it has been shown to actually make your eyelids
WORSE! Baby shampoo contains a mild detergent which may cause
irritation to the eyes. It was not designed for eyelid use. With the
availability of better products on the market, you owe it to yourself to
upgrade and treat your eyelids right!

Baby shampoo contains multiple synthetic ingredients and detergents

that throw off the pH balance of your eyelids, and many of the ingredients
can actually lead to eye allergies (including Cocamidopropyl Betaine,
PEG-80 Sorbitan Laurate, Phenoxyethanol, and fragrance). It's difficult
to even pronounce most of the ingredients.

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161
Chapter 12 - What is Meibomian Gland
Dysfunction?

What Are Meibomian Glands?

Meibomian glands are located on the posterior or back surface of your
eyelid. Their primary responsibility is to secrete an oil called meibum into
the eye which prevents your tears from evaporating. This leads to more
comfortable and less dry eyes. If meibomian glands are disrupted in any
way, it can lead to meibomian gland dysfunction (MGD), which results in
symptoms of dry eyes, grittiness, irritation, inflammation, redness, and
that feeling like you have sand in your eye.

Meibomian glands have little oil producing factories, called acini, that
produce oil. Acini release the oil into the meibomian gland and, with the
help of the eyelid muscle (the orbicularis oculi), oil is milked down the
gland and out the opening, called the terminal duct. This occurs every
time you blink. The oil is then released onto the eye’s surface to help
prevent evaporation of your tears.

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What is Meibomian Gland Dysfunction?
Meibomian gland dysfunction (MGD), or posterior blepharitis, occurs
when any part of the process discussed above is dysfunctional. The
muscle can lose its function, the oil factories can stop working, and the
opening can become clogged. This disease is a progressive, obstructive
disease that advances from the production of normal, healthy oils of the
tear film into thicker secretions that cause stagnation and blurry vision. If
left untreated, the glands can become completely obstructed and
eventually atrophy. Unfortunately, this disease currently has no cure, but
there are ways to effectively treat it and reverse some of the issues.

MGD Symptoms and Signs

Meibomian gland dysfunction (MGD) is going to cause the following
signs and symptoms of blepharitis:
- Red, inflamed eyes and eyelids
- Itchy eyes
- Gritty eyes
- Irritated eyes
- Dry eyes

MGD Treatment: At Home

Step 1: Warm Compresses

Warm compresses are best performed with a mask that is specifically
formulated for dry eye. You can also make a warm compress by taking
dry rice or whole flaxseed and putting it into a clean sock.

Instructions for our Home Spa Therapy (aka Warm Compresses)

1. Microwave your warm compress for 20 seconds.
2. Shake the mask to ensure even heating.
3. Test on the inside of your wrist for temperature as to not burn the
eyelids.
4. Place over closed eyes and secure onto head.
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 5. RELAX…. For 15-20 minutes! You may need to reheat the mask
as necessary to maintain a higher heat.

We recommend applying warm compresses at least every night, but you

cannot overdose, so feel free to do it as often as you want for symptom
relief. More recent studies have shown that warm compresses are not
as effective as other treatment options for meibomian gland dysfunction,
but we still consider it a staple in the routine of our dry eye patients.
Other treatment options are more expensive, but not as convenient. We
will discuss these briefly below and in more detail later.

Step 2: Meibomian Gland Expression After Warm Compresses

Meibomian gland expression is the process of expressing the meibomian
glands after heating. Heating up your meibomian glands helps turn the
oil into more of a liquid (think of placing a stick of butter on the stove... it
melts). After doing this you can milk the glands by rolling a q-tip starting
away from your eyelid margin and rolling towards it (or you can use your
finger).

Step 3: Use a Hypochlorous Acid Cleanser

After you perform your warm compresses and meibomian gland
expression, it is essential to clean your eyelids with a great eyelid scrub
to eliminate all the exfoliated oil and debris from the surface. We
recommend a hypochlorous acid eyelid cleanser in our clinic, like our
Heyedrate Lid and Lash Cleanser.

Simply spray the solution onto your closed eyelids. Rubbing the solution
in and then letting it dry is enough, although some people prefer to spray
onto a cotton ball or round before application. Either is fine and very
effective at keeping the skin clean! A hypochlorous acid cleanser should
be used twice per day for maintenance of clean eyelids.

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Step 4: Increase Intake of Omega-3 Fatty Acids
Omega-3 fatty acids are so important for those with MGD. Because the
meibomian gland oils of those with MGD are of poor quality, it is
imperative to ensure you're ingesting a good ratio of Omega-3 to
Omega-6 either through food or supplementation. A healthy Omega-6 to
Omega-3 ratio is 4:1 but, sadly, our Western diet almost guarantees that
yours may be closer to 20:1 or even 50:1. To make sure your ratio is
healthy, eliminate all processed and fried foods and sugars and replace
them with healthy omegas like wild caught salmon, mackerel, walnuts,
chia seeds, flaxseed, and avocados.

For those who wish to supplement, find a triglyceride-based omega-3

supplement that is fished sustainably. We made Heyedrate Omega-3 for
Eye Health due to the lack of quality control in the omega market. We
wanted to create something that we felt comfortable taking ourselves and
recommending for our patients.

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MGD Treatment: In Office

Lipiflow

What is LipiFlow?
The LipiFlow Thermal Pulsation System is a medical device proven to
improve the function of the meibomian glands in those who suffer from
meibomian gland dysfunction (MGD). The device consists of a computer
console and single-use activators that are used directly on the eyelids.

When you're at your eye doctor's office, they may offer you this
procedure if you have dry eyes and MGD. During the actual procedure,
an anesthetic drop will be instilled in your eyes. The single-use activators
are then placed on your eyelids, one side between your eyelids and your
eyeball and the other side on the top of your lids (this ensures heating
from both sides of the eyelid).

The activators have a corneal protector that vaults over the front of the
eye, so it is completely protected from heat and pressure. The device is
turned on and delivers heat and pulsation to the eyelids for
approximately 12 minutes.

This system is great because not only is it heated (to 42.5 degrees
Celsius, to be exact), but it also pulses in a peristaltic motion that works
oil from the beginning of the glands to the terminal ends. Obstructed oil in
the meibomian glands is able to be liquified and released onto the eyes,
therefore working to prevent dry eyes.

LipiFlow Cost
LipiFlow is, unfortunately, not covered by insurance and can be quite
pricey. The cost of the computer system for your doctor's office is around
$100,000 and offices normally charge between $1000-1500 for each
procedure.

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The reason for the expense is because the single-use activators used on
your eyelids are incredibly expensive for your eye doctor to purchase.
However, many offices will offer payment plans that make this procedure
a bit more accessible to those who need it.

Is the procedure worth it? We believe it absolutely is, especially for those
with diagnosed MGD with meibomian gland atrophy. Small studies are
beginning to show that LipiFlow may be able to reverse meibomian gland
atrophy in those who have the procedure performed regularly.

Some patients will be able to go up to two years without needing another

LipiFlow treatment (because their symptoms have improved), but many
will need to be retreated every six to 12 months for lasting benefits.

Does LipiFlow Work?

The safety and long-term effectiveness of LipiFlow has been proven in
quite a few peer reviewed studies. They have shown that, after one
treatment, over 85% of people saw sustained relief of their symptoms
and improved meibomian gland secretions for up to 12 months, when
compared to the usual warm compresses and eyelid hygiene used twice
per day.

LipiFlow Side Effects

Of course, we do need to discuss a few side effects of the LipiFlow
procedure. Because the single-use activators are heating up and pulsing
that stagnant oil out of your eyelids and onto your eyes, there is bound to
be some inflammation afterward.

Your eyes may become red and inflamed following the procedure, which
is quite common. It is also common to experience burning, stinging,
tearing, itching, and discharge. You may be given a steroid or
combination steroid-antibiotic eye drop to use following the procedure,
which will help with all of the above.

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It is possible that the eyelids can become irritated and swollen due to the
activators, yet this is less common, and you may experience blurred
vision, which will go away on its own shortly after.

TearCare System by Sight Sciences

This system is a new device that will be available in many dry eye
practices soon. The wearable eyelid technology provides adjustable heat
treatment to the upper and lower eyelids without the need for closed
eyes. This is important because it is able to use the full functionality of
the blink to release meibum onto the eye. You can even scroll Facebook
while you're having the treatment done! The thin films used in this
procedure attach to the eyelids and are adjustable to reach every
meibomian gland. The treatment has, so far, been shown to be much
more effective in relieving the symptoms of MGD vs. warm compresses
alone.

MiBo Thermoflo
Similar to other procedures discussed here, MiBo Thermoflo uses heat to
help loosen the oils of the meibomian glands so that normal, healthy oil
can continue to be released onto the eyes. It uses a proprietary
thermoelectric heat pump to deliver consistent heat to the glands, and
this is done in the comfort of your doctor's office. MiBo Thermoflo has a
spa-like feel that delivers consistent heat for ten minutes, which will lead
to a melting of hardened oil leading to less symptoms and signs of
meibomian gland dysfunction. This is usually more affordable than
Lipiflow.

A technician will perform the procedure on your upper and lower eyelids,
and this device does not make the use of anything actually attached to
the eyelids, so it might be better for those who get squeamish with
devices close to the eyes.

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iLux Dry Eye Treatment Device by Tear Film Innovations
This neat device uses an LED light-based heat source to heat your
meibomian glands in your doctor's office. After warming the glands, the
technician will apply gentle pressure with the device onto your glands,
helping to express them. Throughout the procedure, the technician is
able to view your glands and oil secretions through a small magnifying
lens on the device. The process is usually performed on two areas of the
lower lids (nasal and temporal) and two areas of the upper.

Intense Pulsed Light (IPL) Therapy

Originally used as a treatment for Rosacea, patients that were having
IPL, or Intense Pulsed Light Therapy, on their skin condition noticed
improvement in their dry eye symptoms. IPL is also used for laser hair
removal. IPL gives brief, powerful bursts of light that cause changes in
the blood vessels near the surface of the skin, which raise the skin's
temperature, and this eliminates problematic flora (bacteria) on the skin
and eyes.

For meibomian gland dysfunction, the increase in temperature acts like

the world’s best warm compress and helps eliminate stagnant oil from
the glands. It will also decrease inflammation from the treatment area
due to changes in the blood vessels.

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Chapter 13 - What is Demodex?

Demodex Overview
Demodex are tiny mites found in or near hair follicles. They are most
commonly found on the face and around the eyelashes. They are
usually about 0.3 mm long, have eight legs, and their body is covered in
scales for anchoring into a hair follicle. They eat skin cells and oils which
accumulate in hair follicles. Demodex is mostly nocturnal and can be
transferred via contact. Itchy yet?!

Infestation is very common, especially in the elderly, and usually does

not cause symptoms, but skin disease can develop from demodex. They
are considered parasitic, however most of the time no adverse symptoms
are observed.

Demodex Symptoms and Signs

If your immune system is compromised or if the mite population grows
uncontrollably, then symptoms can develop.

Symptoms include:
- Red, inflamed eyelids
- Itchy eyelids
- Blepharitis
- Dandruff on eyelashes
- Itchy eyes
- Gritty eyes
- Irritated eyes
- Dry eyes

Demodex Treatment
Demodex treatment is centered around using a tea tree based product
on your hair, face, and eyelashes every day to prevent and eliminate
demodex. Do not use straight tea tree essential oil, as it is very powerful
and toxic. Use a product that contains tea tree oil and has been specially
formulated.
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Tea tree essential oil has known antibacterial properties that work well to
kill off microorganisms on the skin around the eyelids. Tea tree oil is a
known killer of demodex and it's imperative to keep your facial and eyelid
skin clean while treating demodex, because more bacteria will only
exacerbate the issue.

We have made a tea tree oil soap bar to use for your hair, face, and
eyelash area. We recommend using it once or twice per day. To use,
simply lather the soap between wet hands and apply in circular motions
to your wet face, taking care to close the eyes tightly and rinse them well
afterward. You can even use this soap in the shower as a shampoo for
scalp demodex and dandruff. There are a few other commercially
prepared tea tree eyelid cleansers, such as Cliradex and We Love Eyes,
that are also beneficial.

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Chapter 14 - What is Ocular Rosacea?

Ocular Rosacea Overview

Everyone has probably heard the term ‘rosacea' at least once or twice in
his or her lifetime. Rosacea, in this case, is one that deals with the face;
however, most people don't know the term can also apply to a condition
which targets the eyes. Burning, itching, and redness could sometimes
be symptoms of ocular rosacea.

This condition is a type of inflammation which typically corresponds with

chronic skin rosacea. In certain instances itchy, red eyes are the initial
sign that an individual has ocular rosacea. Whilst there isn’t a cure
available for rosacea, great eye care and eyelid hygiene practices could
help manage it and reduce the symptoms.

What Causes Ocular Rosacea?

Ocular rosacea is typically caused by environmental and genetic factors.
The majority of the causes below could also exacerbate ocular rosacea.

Ocular Rosacea Triggers:

- Spicy foods
- Hot caffeinated drinks
- Extremely cold or hot temperatures
- Anger and stress
- UV sunlight
- Vigorous exercise
- Saunas or hot baths
- Corticosteroids
- Poor eating habits (processed foods, low vegetable intake)
- Poor hygiene

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Ocular Rosacea Symptoms and Signs
A glaring redness around the eye is the initial symptom associated with
ocular rosacea. People with ocular rosacea might notice a dilation of
blood vessels in their eyes and on the surface of their eyelids, causing
them to become extremely visible. This condition could also make the
eyes itchy and dry.

Burning and stinging of the eyes are common. Whilst discomfort, dry
eyes, and cosmetic defects are some of the ocular rosacea’s most
widespread symptoms, the condition sometimes affects vision due to dry
eyes. Sufferers might have blurred vision or increased sensitivity to light.
Ocular rosacea is also capable of causing the eyelids to swell, and it can
lead to meibomian gland dysfunction due to insufficient oil glands.

Ocular Rosacea Treatment

Ocular rosacea can be managed by keeping to a strict eye care routine.
This routine should be kept up even when the condition seems to clear
up. This aids in the prevention of flare-ups.

The tips below can also be used to help manage the condition:
- Wash face and eyelid area with an all natural, tea tree oil based
soap.
- Ensure eyelids are cleaned twice in a day: a cotton round/ball
should be sprayed with a hypochlorous acid eyelid cleanser, such
as Heyedrate Lid and Lash Cleanser, and then moved across the
eyelid to eradicate oil and debris from the area. Also, spray this
hypochlorous acid eyelid cleanser on areas of rosacea on the skin
to help alleviate symptoms.
- A warm compress should be applied: blocked glands can be
loosened by applying a warm compress eye mask that has been

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 microwaved for 20 seconds. Allow it to sit on closed eyes for 10 to
20 minutes, reheating as needed.
- Makeup should be avoided: the moment a flare-up happens,
makeup should be avoided, as well as any facial products which
consist of skin irritants like fragrances.
- Stick to glasses instead of contact lenses: the moment the eyes get
irritated, contact lenses should be avoided. Once the episode
subsides you can return to wearing contact lenses.
- Sun exposure should be limited: sunglasses, sunscreen and a hat
should be used to limit exposure to sunlight. UV rays are a
common rosacea trigger.
- Consume omega-3 fatty acids: various studies have shown that
flaxseed oil and fish oil consumption could help lower rosacea
flare-ups.

Ocular rosacea diet

- Be sure to stay hydrated!
- Consume fatty acids such as omega-3 and healthy omega-6 fatty
acids, which have unique anti-inflammatory properties.
- Avoid spicy, hot foods: for numerous people, consuming spicy, hot
food is capable of triggering ocular rosacea.
- Alcohol consumption should be limited, especially as it can be a
potential ocular rosacea trigger. It is best to limit consumption to a
couple drinks each week (or less).

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Chapter 15 - One Key to Successful Dry Eye
Management
Clean eyelids are key to dry eye management. As we discussed above,
the outermost layer of your tears, the lipid layer, helps prevent the tears
from evaporating and keeps them stable on the eye. Keeping your
eyelids free of debris, bacteria, excess makeup, and clogged glands will
help prevent blepharitis, MGD, demodex, ocular rosacea, and more,
which will lead to reduced dry eye symptoms. Cleaner eyelids means
fewer dry eye symptoms. Therefore an eyelid hygiene regimen that is
performed twice daily is recommended (think brushing your teeth to
prevent cavities and keep teeth healthy).

Let’s go over both Dr. Jenna’s and my routine that we do morning and
night. You can also check out the accompanying video, by going to
www.RethinkingDryEye.com under the Dry Eye Routine tab.

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Dr. Jenna Zigler’s Eyelid Hygiene Regimen
● Morning Routine
○ Upon awakening, apply two sprays of Heyedrate Lid & Lash
Cleanser to a cotton ball/round
○ Wipe in a horizontal motion across both upper and lower
eyelid five times
○ Allow Heyedrate Lid & Lash Cleanser to dry, no need to rinse
off
● Shower
○ Wash entire body, hair, and face with Heyedrate Tea Tree Oil
Soap
● Evening Routine
○ Remove any makeup with oil-based makeup remover, like
Heyedrate Eye Makeup Remover
○ Wash face with tea tree oil soap, like Heyedrate Tea Tree Oil
Soap, and pat dry
○ Apply a warm compress, like Heyedrate Warm Compress, to
the eyes for ten minutes
○ Lid massage and meibomian gland expression
○ Apply two to four sprays of a hypochlorous acid eyelid
cleanser, like Heyedrate Lid & Lash Cleanser, to a cotton
ball/round
○ Wipe in a horizontal motion across both upper and lower
eyelid five times
○ Allow Heyedrate Lid & Lash Cleanser to dry, no need to rinse
off

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Dr. Travis Zigler’s Eyelid Hygiene Regimen
● Morning Routine
○ Upon awakening, apply two sprays of hypochlorous acid
eyelid cleanser, like Heyedrate Lid & Lash Cleanser directly
to eyelids
○ Allow Heyedrate Lid & Lash Cleanser to dry, no need to rinse
off
● Shower
○ Wash entire body, hair, and face with tea tree soap, like
Heyedrate Tea Tree Oil Soap
● Evening Routine
○ Apply a warm compress, like Heyedrate Warm Compress, to
the eyes for ten minutes
○ Lid massage and meibomian gland expression
○ Wash face with a tea tree soap, like Heyedrate Tea Tree Oil
Soap
○ Two to four sprays of a hypochlorous acid eyelid cleanser,
like Heyedrate Lid & Lash Cleanser, directly to closed eyelids
○ Gently rub into eyelid area
○ Allow Heyedrate Lid & Lash Cleanser to dry, no need to rinse
off

ACTION ITEM
1. Start an eyelid cleansing routine morning and night. Head to
www.RethinkingDryEye.com under the Dry Eye Routine tab,
watch our demonstration video, and download the checklist.

177
 Sick of Dry Eye?

Join our 7-Day Dry Eye Bootcamp Challenge, which is a great

adjunct to this book, and start rethinking your dry eye treatment
today.

www.DryEyeBootcampChallenge.com

178
Wrapping Up - YOU CAN DO THIS
I hope you enjoyed reading this book as much as I enjoyed writing it. We
have seen drastic changes in our patients and customers around the
world that have adopted these changes to their lifestyle. We often don’t
realize the fuel (food) that we are putting in our body is what is really the
problem, because we are educated otherwise by the government, big
business, and factory farms who have all the money.

Additionally, no doctor is responsible for your health… YOU ARE. We

are trained in Western medicine, which is mostly about symptom relief by
use of medications, not disease prevention. We believe in a different
approach to medicine and it involves healing your body from the inside
out with natural solutions, hydration, exercise, diet, detox, and more.

Thousands of people have been successful doing this, we did it, and
know you can do it too!

You need to make a move RIGHT NOW in the right direction while this
book is fresh. START TODAY!

Prove to yourself that you can do this!

You are capable of doing anything you set your mind to!

Your health is in jeopardy if you don’t make these changes.

Your life is in jeopardy if you don’t make these changes.

Your future depends on the actions you take today.

Choose to take the right actions!

STOP waiting for someone else to change your life!

STOP waiting for it to magically improve on its own!

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STOP making excuses!

STOP thinking you can’t do it!

STOP abusing your body!

STOP feeling hopeless and start to take the actions in this book ONE
STEP AT A TIME!

STOP medicating!

STOP saying you can’t do it!

STOP putting it off until tomorrow, next week, or next year!

Be honest about what you need to do to change your life.

Get up right now and take that step to change your life forever.

Start Rethinking Dry Eye Treatment!

180
Next Steps
1. All the steps and action items can seem very overwhelming when
you are first getting started. Which is why I put the chapters in the
order that they are in. All the information is important and can help
in your journey to healing your dry eye and other disease. Start
with the smallest and easiest win and move on from there. Make
these habits that stick and aren’t just the latest fad in your life.
2. Visit www.RethinkingDryEye.com for the accompanying action
items and checklists for each chapter. On the website we also
have links to the products we recommend for each step. Some of
these products we sell, our company includes Eye Love and
Heyedrate, but most of the products we recommend are not our
products.
3. Do it with someone to help with accountability. Join the
conversation and find an accountability partner on our Facebook
Group, the Dry Eye Syndrome Support Community. In each
section at www.RethinkingDryEye.com there will be a Facebook
icon to click and join the conversation in regards to that section.
Come join the conversation!
4. Stick to it! YOU CAN DO THIS!! I know I have said it over and
over again, but you can. It takes a belief that you can do it and you
will do it. Write your newly developed habits on your mirror and
look at it daily to remind yourself how far you have come. The list
will start small and grow from there. When you experience a
setback, look at the list to see how much you have accomplished.
Examples would be “Drink 80 ounces of water per day” or “Lose
50 pounds in 12 months” or “Green smoothies for breakfast.” It
doesn’t matter how “small” the win is, it is still a win and moving
your life toward less inflammation and better health.

This will hopefully inspire you to take action and educate yourself even
more!

Visit www.RethinkingDryEye.com for your bonuses, videos, and printouts

to help you throughout this book.

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182
We Want To Hear About It
Nothing fulfills us more than seeing patients succeed with a plan that we
have set out for them. Please share your successes with any of our
programs or products! You can always email me at
travis@eyelovellc.com and Dr. Jenna at jenna@eyelovellc.com.

Please don’t be afraid to reach out to myself, Dr. Travis Zigler, or my

wife, Dr. Jenna Zigler, in the Dry Eye Syndrome Support Community on
Facebook to learn more.

Make sure to include pictures.

Also if you know anyone that can benefit from our products or program, a
referral is one of the biggest compliments you can give us! :)

Side Note on ALL Natural Treatments

EVERYONE SHOULD BE DOING THE FIRST LINE OF TREATMENT
(Natural)… EVERYONE!!! Persevere with this first line of action items. It
may take up to 6-8 weeks for the symptoms of dry eye to be managed.
Some of these will have to be continued for life, but you will notice other
ailments disappearing as you begin to implement these habits.

Useful links
- Facebook: Dry Eye Syndrome Support Community
- Facebook: The Dry Eye Show
- YouTube: The Dry Eye Show

183
An Aside...
As a thank you for purchasing this book and reading it, I would like
to give you 20% off your first order on our store, Eye Love. Visit
www.eyelovethesun.com and use the code SWITCHNOW

Join the Dry Eye Syndrome Support Community on Facebook

USE THE CODE SWITCHNOW TO GET 20% OFF YOUR 1st HEYEDRATE

ORDER AT

184
 EYELOVETHESUN.COM

Sources & Reference Materials

● Blind Faith by John Crittenden.
● The Kind Mama by Alicia Silverstone - We had the opportunity to meet Alicia in December 2016 and while we were
already vegetarian, she completely shifted and rattled our beliefs even more. Her mission with her company, My Kind
Organics, is incredible.
● Campbell and Campbell, China Study, 7, 89, 93, 184, 205, 230
● Gann et al., “Effects of a Low-Fat/High-Fiber Diet.”
● Chavarro, Willett, and Skerrett, Fertility Diet, 44.
● “Position of the American Dietetic Association: Vegetarian Diets,” Journal of the American Dietetic Association 109,
no. 7 (July 2009); 1266-82
● “Doctors Endorse Vegan and Vegetarian Diets for Healthy Pregnancies,” Physicians Committee for Responsible
Medicine, https://scienceblog.com/19099/doctors-endorse-vegan-and-vegetarian-diets-for-healthy-pregnancies/
● R. L. Blaylock, “A Possible Central Mechanism in Autism Spectrum Disorders, Part 3,” Alternative Therapies In Health
and Medicine 15, no. 2 (March-April 2009): 56-60, http://www.ncbi.nlm.nih.gov/pubmed/19284184 .
● “Organic Authority.com: 5 Food Labels That Mean Nothing,” HuffPost Food, January 12, 2012,
https://www.huffpost.com/entry/5-food-labels-that-mean-n_b_1202681?guccounter=1&guce_referrer=aHR0cHM6Ly91
cy5zZWFyY2gueWFob28uY29tLw&guce_referrer_sig=AQAAALYC8eav0ZS9JIsKgz4RBngw8rMj6SafTS2JKPeiWbps
AVshBQeK4acEFvVZEgvR0u3uOC0eDH4ixnoQvx0a__Y7idnIoNdHIXIM4AUeivowbtLKGyYUjBAYP-9NXZse7vmPhJ
9qWb3qEMl7BbNVcsMyZ86uGhQpzNKL4fuv9oQa
● Karl Weber, ed., Food, Inc. (New York: Public Affairs, 2009), 23. Robert W. Sears, MD, FAAP, and Amy Marlow, MPH,
RD, CDN, HappyBaby: The Organic Guide to Baby’s First 24 Months (New York: William Morrow Paperbacks, 2009),
24.
● M. Hansen et al., “Potential Public Health Impacts of the Use of Recombinant Bovine Somatotropin in Dairy
Production,” Prepared for a Scientific Review by the Joint Expert Committee on Food Additives, Consumers Union,
September 1997,
https://advocacy.consumerreports.org/press_release/potential-public-health-impacts-of-the-use-of-recombinant-bovine
-somatotropin-in-dairy-production-part-1/
● “Meat on Drugs,” Consumer Reports, June 2012, https://www.youtube.com/watch?v=pgTkzoCd7Sc
● “A Cesspool of Pollutants, Now Is the Time to Clean Up Your Body,” McDougall Newsletter, August 17, 2004,
https://www.drmcdougall.com/misc/2004nl/040800pucesspool.htm
● “Dioxin & Furans: The Most Toxic Chemicals Known to Science, “Energy Justice Network,
https://www.ejnet.org/dioxin.
● Arnold Schecter et al., “Intake of Dioxins and Related Compounds from Food in the US Population, “Journal of
Toxicology and Environmental Health 63, no. 1 (May 11, 2001): 1-18, https://www.ejnet.org/dioxin/dioxininfood.pdf.
● Mark Hyman, MD, “Diary: 6 Reasons You Should Avoid It at All Costs Or Why Following the USDA Food Pyramid
Guidelines is Bad for Your Health,” Huffpost Healthy Living,
https://www.huffpost.com/entry/dairy-free-dairy-6-reason_b_558876
● Mark Bittman, “Got Milk? You Don’t Need it,” New York Times, July 7,
2012,https://opinionator.blogs.nytimes.com/2012/07/07/got-milk-you-dont-need-it/
● “Lead Contamination of Chicken Eggs and Tissues from a Small Farm Flock,” Journal of Veterinary Diagnostic
Investigation 15, no. 5 (September 2003): 418-22,
https://journals.sagepub.com/doi/abs/10.1177/104063870301500503
● “Consumer Reports Investigation: Talking Turkey,” Consumer Reports, http://www.consumerreports.org/turkey0613.
● “The Natural Human Diet,” PETA,https://nutritionfacts.org/2016/11/15/the-natural-human-diet/
● “Ask Dr. Sears: Artificial Sweeteners For Kids?,” Parenting,
https://www.parenting.com/child/ask-dr-sears-artificial-sweeteners-for-kids/
● “Trans Fats,” American Heart
Association,https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/trans-fat
● “Trans Fat Is Double Trouble for Your Heart Health,” Mayo Clinic,
https://newsnetwork.mayoclinic.org/discussion/transfat-is-double-trouble-for-your-heart-health/
● National Toxicology Program, CERHR Expert Panel Report for Bisphenol A, US Department of Health and Human
Services, November 26, 2007. Breast Cancer Fund, Disrupted Development: The Dangers of Prenatal BPA Exposure,
September 2013, https://www.webmd.com/parenting/baby/news/20080903/bisphenol-a-some-concerns-remain#1
● Disrupting Chemicals: From Basic Research To Clinical Practice (New York: Humana Press, 2007)
● Authority Nutrition, 5 Toxic Chemicals Hiding in Your Deodorant.

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186
Medical Disclaimer
The attorneys made us do it.

MEDICAL DISCLAIMER: THIS BOOK DOES NOT PROVIDE MEDICAL ADVICE

Eye Love LLC ("we" or "our"), a South Carolina Limited Liability Company, maintains this
book for purposes of information, education, and communication. Nothing in this book
should be construed as a promotion or solicitation for any products, or for the use of any
product in a particular way that is not authorized by the laws and regulations of the country
where the user is located.

The information, including but not limited to, text, graphics, images and other material
contained in this book are for informational purposes only. The purpose of this book is to
promote broad consumer understanding and knowledge of various health topics. It is not
intended to be a substitute for professional medical advice, diagnosis or treatment.

Although practicing physicians, Doctors Travis and Jenna Zigler are not responsible for any
actions taken by you, the consumer, after reading the information in this book. Always seek
the advice of your physician or other qualified healthcare provider with any questions you
may have regarding a medical condition or treatment and before undertaking a new health
care regimen, and never disregard professional medical advice or delay in seeking it
because of something you have read in this book.

We shall not be liable for any damage or injury that may arise from the use of or reliance
upon any information provided in this book or from your inability to access the book. We
assume no responsibility and shall not be liable for any damage or injury to you, your
computer or other personal property including, but not limited to, damages caused by viruses
that infect your computer equipment or other property on account of your access to our book
or from your downloading of any materials, data, text, images, video or audio or other items
from the book.

Eye Love, LLC, Dr. Travis Zigler, and/or Dr. Jenna Zigler do not recommend or endorse any
specific tests, physicians, products, procedures, opinions or other information that may be
mentioned in this book. Reliance on any information appearing in this is solely at your own
risk.

YOU FULLY AGREE AND UNDERSTAND THAT EYE LOVE, LLC IS NOT RESPONSIBLE
FOR YOUR SUCCESS OR FAILURE AND MAKES NO REPRESENTATIONS OR
WARRANTIES OF ANY KIND WHATSOEVER THAT OUR PRODUCTS OR SERVICES
WILL PRODUCE ANY PARTICULAR RESULT FOR YOU.

AFFILIATE INFORMATION
Eye Love, LLC is a participant in the Amazon Services LLC Associates Program, an affiliate
advertising program designed to provide a means for sites to earn advertising fees by
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logo are trademarks of Amazon.com, Inc. or its affiliates.

187
Just like if you purchase from us, if you click an affiliate link and purchase something from
Amazon, you help with our mission to end preventable blindness!

188