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Current Thoughts on Nutrition With Emphasis on Treating the Cause of Degenerative Eye Disease, Safety Issues, B Vitamins and Essential Fatty Acids and Dry Eyes
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Current Thoughts on Nutrition With Emphasis on Treating the Cause of Degenerative Eye Disease, Safety Issues, B Vitamins and Essential Fatty Acids and Dry Eyes


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Current Thoughts on Nutrition …

Current Thoughts on Nutrition
With Emphasis on Treating the Cause of Degenerative Eye Disease, Safety Issues, B Vitamins and Essential Fatty Acids and Dry Eyes

Ellen Troyer, MT MA

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  • 70% Nutrition and Exercise
  • Vitamin B-1 is a big player in type-2 diabetes, B-2 in crosslinking and B-3 in cholesterol control.
  • Mention that this information has been in the literature for almost ten years, yet some folks act like it is just being discovered.
  • Improves Mood. We recommend getting 10 minutes of sun (sans sunscreen) every day on as much skin as you can expose without getting arrested.
  • Superoxide Dismutase (SOD) protein enzymes are mostly extracellular. One wonders why anyone would ignore manganese mn(SOD) since it’s necessary for intracellular (mitochondrial) antioxidant defense, which is critical for eye and brain health.
  • JA
  • PURPOSE:To investigate the potential effect of dietary supplementation with omega-3 fatty acid on lipid composition of meibum, aqueous tear evaporation, and tear volume in patients with dry eye.METHODS:In a pilot, prospective, randomized, double-masked study, patients with dry eye received a daily dose of fish oil, containing 450 mg of eicosapentaenoic acid, 300 mg of docosahexaenoic acid, and 1000 mg of flaxseed oil (TheraTears Nutrition; Advanced Vision Research, Woburn, MA) for 90 days. There were 2 patient visits: baseline and final. At these visits, patients completed the ocular surface disease index to score subjective symptoms, and slit-lamp examinations, breakup time, corneal staining, Schirmer type I, fluorophotometry, evaporometry, and collection of meibomian gland secretion samples for lipid composition analysis were performed.RESULTS:A total of 36 patients with dry eye completed the study. At the end of the study, 70% of the patients became asymptomatic, whereas for the placebo group, 37% [corrected] of the symptomatic patients became asymptomatic. Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretion. The lipid composition of the samples collected from the omega-3 group was found to be very similar to that from the placebo group. No trends between groups were seen for other objective parameters.CONCLUSIONS:Dietary supplementation with omega-3 fatty acids in dry eye showed no significant effect in meibum lipid composition or aqueous tear evaporation rate. On the other hand, the average tear production and tear volume was increased in the omega-3 group as indicated by both Schirmer testing and fluorophotometry.
  • Lactoferrin is suggested in peer-reviewed literature to increase the level of iron binding proteins to better inhibit viral and bacterial infections and to balance other tear lipocalins (family of proteins that transport small hydrophobic molecules), which modulate the surface tension of the tear film and affect the comfort of the contact lens wearer. Lactoferrin taken orally appears to survive absorption in the stomach by converting to a very small molecule called lactoferricin which can easily find its way into secretory tissue including the eyes. (17-24)Background: Lactoferrin is produced in the tear film by neutrophils that constitute the "first line of defense" against infection. Neutrophil apoptosis (programmed cell death) signals the macrophage to clean up debris from wound sites, including surgically induced wounds (LASIK).
  • Flaxseed oil increases stool bulk and frequency of defecation, it is not recommended for those with bowel obstruction, irritable bowel syndrome or diverticular disease. (Hydrate Essentials)
  • Transcript

    • 1. Current Thoughts on Nutrition With Emphasis on Treating the Cause of Degenerative Eye Disease, Safety Issues, B Vitamins and Essential Fatty Acids and Dry Eyes Presented by: Ellen Troyer, MT MA
    • 2. Course Learning Objectives: • To Review Current Science • To Separate Fact From Marketing Fiction • To Identify Safety Issues and Possible Complications
    • 3. Financial Disclosure & Other Info • Biosyntrx CEO / Chief Research Officer • Founding Board Member, Ocular Nutrition Society • Board Member, Ophthalmic Women Leaders • Scientific Advisory Board – • ARVO Member • Board Member – Falls & Fractures Alliance • Voting Member – Council for Responsible Nutrition
    • 4. U.S. Visual Impairment and Disease • • • • • Dry Eyes: 20+ million Macular Degeneration: 10.6 million Cataracts: 20.5 million Diabetic Retinopathy: 5.3 million Glaucoma: 2.2 million (2 million undiagnosed) • These numbers are projected to double in 20 years!
    • 5. The Cost of Visual Impairment • Total financial burden of major adult visual disorders is $35.4 billion • $6.8 billion for cataracts • $5.5 billion for refractive error • $2.9 billion for glaucoma • $575 million for AMD • $493 million for diabetic retinopathy
    • 6. Lifestyle Matters Most Where Eye, Body and Mental Health is Concerned • • • • • • • • • Nutrient-dense Quality Food Intake Protection From Sun Weight Control Adequate Exercise Nutritional Supplementation to Prevent Deficiencies Supportive Relationships Passion for Life and Causes Sense of Belonging Concern for Society
    • 7. Nutrient Deficiencies • Most people are micronutrient deficient. • Bruce Ames, PhD. (one of the most published nutrition scientists in the world) triage theory posits that the slightest deficiency of any of the essential vitamins and minerals, over time, increases the risk of degenerative disease, including eye disease.
    • 8. Why Eye Care Professional Care • HHS data collected from phone interviews found that most people over-estimate fruit and vegetable consumption during phone interviews. • The CDC released data in 2007 suggesting that fewer than 15% of the population consume 5 servings of fruits and vegetables a day. • The current HHS recommendation is 9-13 servings a day.
    • 9. Multiple Vitamin / Mineral Safety • According to the latest research published in the Feb. 2013 American Journal of Clinical Nutrition, multi-vitamin /mineral / antioxidant supplements at levels that do not exceed the Academy of Medicine Safe Upper Level (UL) does not increase mortality risk, in spite of the poorly-designed studies or meta-analysis that suggest it does.
    • 10. US National Poison Data System • Data collected by NPDS and published by the American Association of Poison Control Centers in Clinical Toxicology reported NO deaths from multiple vitamins; zero deaths from any of the B vitamins; zero deaths from vitamins A, C D, or E.
    • 11. Nutritional Genomics Views • The Reductionist Approach-tries to identify THE ONE gene that causes a particular disease, or THE ONE dietary chemical or supplement that will prevent it. • The Systems Approach-uses methods from genetics, molecular biology, physiology and nutrition to study how diets affect an individual person: instead of analyzing only genes, it analyzes blood chemistries, enzymes, and metabolites, etc.; instead of looking at one gene, it considers many.
    • 12. Genetic Role in Aging
    • 13. Why our cells respond to our nutritional status  Our body’s cellular response to RNA decoded messages is dependent on our environmental status, including nutritional status.  Nutritional deficiencies cause cells to respond to degenerative or toxic genetic messages that may be ignored when the body is properly nourished.
    • 14. B- Vitamins • B vitamins are water soluble and our needs change on a daily basis based on environmental conditions. Our bodies remove any extra without risk of overdose. • B1 is a big player in type-2 diabetes • B-2 in crosslinking • B3 in cholesterol control • Vitamins B6, B12, and folic acid are suggested to protect women against age-related macular degeneration, as well as required to prevent the body from producing excessive amounts of homocysteine, a marker for disease including eye disease.
    • 15. Folate, B6, B12 and Methionine Metabolism
    • 16. Water Soluble B Vitamin FACTS Adequate B Vitamin intake is critical for those who are at risk of gene-related degenerative diseases like AMD and Alzheimer’s.
    • 17. Hydro Carbon Beta Carotene – Not So Much • Not an appropriate source of Vitamin A where eye health is concerned. • Does not as readily covert to pre-formed Vitamin A (retinol) in the older population as it does in younger people • Does not quench the singlet oxygen associated with AMD if other singlet oxygen quencher antioxidants like Bilberry are available through diet or other supplementation • Inhibits the absorption of the two xanthophyll carotenoids, lutein and zeaxanthin, which are vital for optimal macula pigment density and UV lens protection • Synthetic beta carotene associated with increased cancer risk
    • 18. Vitamin E • A 2005 study in the JAMA suggested that excessive (400 IU) synthetic Vitamin E can be dangerous. • A closer look shows that the isolated finding applied only to an older group of patients (over the age of 70) with a long history of heart disease, stroke or diabetes, who were also taking a combination of medications, including ACE inhibitors, calcium channel blockers, anti-platelet agents and lipid-lowering agents during the course of the study. • A significant percentage of study participants were also cigarette smokers, further clouding the issue. • Always look for nutrition products that include only natural vitamin E tocopherols and tocotrienols – the d-form is natural, the dl-form is synthetic. • Vitamin C regenerates Vitamin E so 200-300 mg of daily natural vitamin E including all 8 forms of the Vitamin E molecule is adequate.
    • 19. Vitamin D – The Sunshine Vitamin • Lowers the risk of many cancers • Improves bone calcium absorption • Reduces blood pressure in hypertensive patients • Helps prevent chronic renal failure • Reduces risk of multiple sclerosis • Lowers risk of skin infections
    • 20. Zinc, Copper, & Manganese Magic • Zinc can biochemically shut down the nuclear factor kappa-B (NFk-B) pathway, which shuts off production of inflammation and paincausing compounds (cytokines). It becomes even more efficient when presented with a balanced amount of copper and manganese, which creates mn(SOD) enzymes that create antioxidant defense in cells exposed to oxygen.
    • 21. Why we must include nutritional antioxidants in our diets?  Specific plant-based antioxidants scavenge free radical damaged molecules from inside cells, thereby protecting DNA.  Vitamins C and E help to prevent intraand extra-cellular oxidative damage to oxidized lipid molecules.
    • 22. Macula Pigment Nutrients Lutein, Zeaxanthin, Meso-zeaxanthin Lutein and Zeaxanthin also possess antioxidant properties
    • 23. Bilberry: Fact or Fiction? • Anecdotal evidence of improved night vision of pilots in WWII. • Since the structure of anthocyanins is consistent with an ability to donate hydrogen atoms, it has been concluded that these compounds have powerful antioxidant capability. • Accordingly, anthocyanins have been shown to scavenge chemically-generated superoxide and nitric oxide radicals, as well as quench destructive singlet oxygen.
    • 24. N-Acetyl Cysteine  Precursor to glutathione- an amino acid complex  Glutathione is the “master” antioxidant  Glutathione is destroyed by digestive process, therefore must be created internally.  Glutathione is depleted in cataractous lenses
    • 25. NFk-B, Antioxidants & Inflammation  The generation of reactive oxygen species (ROS) by phagocytic leukocytes is one of the most important hallmarks of the inflammatory process.  In addition to promoting general cytotoxicity, ROS may also act to up-regulate pro-inflammatory gene expression by activating nuclear factor kappa b (NFkB).  A variety of antioxidant molecules, such as N-acetylcysteine (NAC) glutathione and vitamin E can inhibit NFk-B activation associated with eye disease.
    • 26. ↑ Mitochondrial Function Mitochondria are dependent on water based amino acids, particularly • acetyl-l-carnitine • lipoic acid, •COQ-10 • small amounts of Omega-3 DHA …for ATP energy and mitochondrial housekeeping. Small amounts of DHA is vital for membrane permeability that allows nutrients in and waste material out.
    • 27. A powerful antioxidant that has been proven in new clinical studies to improve brain function, alter mood, and increase cellular energy when taken with a balanced amount of Lipoic Acid. This is particularly important to the AMD patient because most suffer from low to medium grade depression.
    • 28. Lipoic Acid • Lipoic Acid is the nutrient that intracellularly regenerates most all other nutrients. • Along with acetyl-L-carnitine, it increases ATP cellular energy. • Both fat and water soluble antioxidant.
    • 29.         An enzyme that is required for electron transport in ATP synthesis (facilitates energy production at the cellular level) Immune system support Provides antioxidative-bioenergetic balance Useful in maintaining energy levels Oxidative protection for cellular membranes and plasma lipoproteins Neuro-protective Low level linked to decreased cardiovascular function DECREASED WITH STATIN USE
    • 30. RESVERATROL for Eye & Body Health • Resveratrol regulates protective sirtuin protein (SIRT1) gene expression in a dose dependent manner. • SIRT1 is also referred to as the rescue gene, longevity gene, or skinny gene. • A combination of SIRT1 and resveratrol are suggested to be the regulators needed to protect our eyes against UVB damage and our bodies against heart attack, stroke, diabetes, arthritis, osteoporosis and obesity.
    • 31. Systemic Treatments for Dry Eyes Orals  Essential Fatty Acids • • • • • • • HydroEye BioTears Hydrate Essential TheraTears Nutrition Fish Oil Dry Eye Formula EyePromise EZ Tears
    • 32. Possible Effects of Omega EFA on Dry Eyes • Provide overall anti-inflammatory effect • Increase fluidity of meibomian gland secretions • Alter polar characteristics of lipid layer and decrease evaporative loss • Optimize function of goblet cells • Improve epithelial cells microvilli expression and adhesion
    • 33. What’s So Great About Fish? Protein, Iron, Vitamins / Minerals and Omega-3 Fatty Acids Every patient does not require the same amount of fish or fish oil. The American Heart Association recommendation is still two servings of fish per week for disease prevention, which is about 3,500 mg of Omega-3 fatty acids EPA / DHA per week.
    • 34. Omega-3 Omega-3 Omega-3 Omega-3 Omega-3 Omega-3 Omega-3
    • 35. Grade School Logic The most scientifically sound way to properly balance Omega-6 / Omega 3 fatty acid rations is to simply consume fewer empty-calorie processed junk foods and make the following Dietary changes: Consume three or four daily small servings of nutrient-dense foods. Include small servings of cold-water fish two or three times a week. Take one concentrated fish oil capsule a day on the days you don’t eat fish.
    • 36. Anti-Inflammatory Omega-3 Fatty Acids From Fish Oil Excessive Amounts Not Recommended to Compensate for Nutrient-Empty High Omega-6 Junk Food Diets. Too Many Fish Being Removed From the Seas for This Reason. KRILL OIL: Antarctic krill oil may be superior to fish oil because it contains phospholipids, carotenoid antioxidants and omega-3 bonded together in a way that keeps them safe from oxidation and easily absorbed in your body.
    • 37. 7 things to know about Omega-3 EFAs from HHS-2013 1. 2. 3. 4. 5. 6. 7. Results of studies provide moderate evidence that people who eat seafood once a week are less likely to die of hear disease Supplemental EPA / DHA has NOT shown to protect against heart disease. A 2012 review of studies suggest EPA / DHA may be modestly helpful in relieving symptoms of rheumatoid arthritis. The nutritional value of seafood is important during fetal growth and development, particularly DHA. Ongoing research in omega-3 fatty acids and brain and eye disease is not yet conclusive about effectiveness. Conflicting evidence about omega-3 link to prostate disease Bottom line: including seafood in diet is healthful. Omega-3 supplements benefit is still uncertain.
    • 38. Fish Oil & Coagulation Status • CASE REPORT – Omega-3 fatty acids may lower thromboxane A(2) supplies within the platelet as well as decrease factor VII levels. This case report illustrates that fish oil can provide additive anticoagulant effects when given with Warfarin Ann Pharmacother. 2004 Jan;38(1):50-2. • STUDY – Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy….. “Fish oil supplementation in doses of 3-6 grams per day does not seem to create a statistically significant effect on the anticoagulation status of patients receiving chronic Warfarin therapy”. J Thromb Thrombolysis. 1998 Jul;5(3):257-261.
    • 39. Fish Oil Safety & Prostate Cancer • Blood level omega-3 fatty acids as risk determinant molecular biomarker for prostate cancer. Sorongon-Leqaspi MK, Chua M, et al. Prostate Cancer. 2013;: 8756 [abstract] Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. Brasky TM, Darke AK, et al. J Natl Cancer Inst. 2013 Aug 7;105(15): 1132-41 [abstract] The relevance of serum levels of long chair omega-3 polyunsaturated fatty acids and prostate cancer risk: A meta-analysis. Chua ME, Sio MC. et al. Can Urol Assoc J. 2013 May-June;7(5-6): E33343 [abstract] Consumption of fish products across the lifespan and prostate cancer risk. Torfadottri JE, Valdimarsdotti UA, et al. Plos One 2012 Apr 17;8(4): e59799 [abstract] Fatty acid patterns and risk of prostate cancer in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition. Dahm CC, Gorst-Rasmussen A, et al. Am J Clin Nutr. 2012 Dec; 96(6): 1354-61 Omega-3 fatty acids and cancers: a systemic update review of epidemiological studies. Gerber M. Br J Nutr 2012 Jun; 107 [abstract]
    • 40. Another Fish Oil Safety Big Concern • Immunomodulation by dietary long chain omega-3 fatty acids and the potential for adverse health outcomes. Denton JL, Hord NG, Ghosh S, Gurzell EA. Prostaglandins Leukot Essential Fatty Acids. 2013 – Nov-Dec: 89(6): 379-90 • This study demonstrated that excessive Omega-3 long chain fatty acids EPA / DHA dampens immunity and alters cellular membrane pathogen clearance during acute infection resulting in adverse health outcomes and reduced survival. • This calls for biomarker development and validation as rational first steps towards setting recommended dietary intake levels.
    • 41. Dry Eye Fish Oil Studies May be Too Short for Long Term Therapy Consideration Short-term consumption of oral omega-3 and dry eye syndrome. Kangari H. Efekhari MH, et al. Ophthalmology 2012 Nov (30 days) Effects of dietary supplementation with fish oil on dry eye syndrome subjects: randomized controlled trial. Kawakita T, Dawabata F, et al. Biomed Res 2013 (90 days) Polyunsaturated fatty acids induce modification in the lipid composition and the prostaglandin production of the conjunctival epithelium cells. Vial S, Leclere L, et al. Graefes Arch Clin Exp Ophthalmol 2012 Feb. (Omega 6 GLA affected PGE1 and 2, Omega-3 showed no effect).
    • 42. Oil Omega-3 Omega-6 GammaLinolenic Acid 85% 15% (GLA) NONE NONE 75% 9% Borage 75% NONE 23% Black Currant Seed Oil 15% 65% 18% FLAX EPO
    • 43. Omega-6 vs. Omega-3 “Omega-6 administration increases the PGE1 levels in tears of patients with Sjögren’s Syndrome and improves ocular surface signs and symptoms of ocular discomfort.” Systemic Omega-6 EFA Treatment and PGE1 Tear Content in Sjögren’s Syndrome Patients. Aragona, P., Bucolo,C., et al IOVS 2005; 46:4474-4479
    • 44. Omega-6 vs. Omega-3 “This study provides evidence for a beneficial effect of particular orally administered omega-6 fatty acids in alleviating dry eye symptoms and improving overall lens comfort in patients suffering from contact lens associated dry eye.” Oral omega-6 essential fatty acid treatment in contact lens associated dry eye, Kokke KH, et al., Contact Lens Anterior Eye (2008), doi:10.1016/j.clae.2007.12.001
    • 45. Metabolic Pathways of Omega-3 and Omega-6 Fatty Acids Omega-6 Omega -3 Linoleic Acid (LA) Polyunsaturated oils, including flax, corn and safflower Delta--6-desaturase Alpha-Linolenic-Acid (ALA) Black Currant (15%) Flax (85%) Delta 6 enzymes impaired by aging, alcohol and nutrient deficiencies, trans fatty acids and elevated cholesterol. Gamma-Linolenic Acid (GLA) Delta--6-desaturase Steridonic Acid (SDA) Black Currant, EPO, Borage (18-24% GLA) Eicosatetiaenoic Acid (ETA) Dihomo-Gamma-Linolenic Acid (DGLA) Delta-5-desaturase Delta-5-desaturase PGE1 Series One Prostaglandin Anti-inflammatory Fish Oil &Cod Liver Oil Arachidonic Acid (AA) Lipoxgenase LBT--4 Pro--inflammatory Cylooxygenase Cylooxygenase (COX2) PGE-2 Pro- inflammatory EPA/DHA EPA appropriately blocks Omega 6 delta-5-desaturase downstream conversion PGE3 Anti-inflammatory Lipoxgenase LBT-5 Anti-inflammatory
    • 46. Natural Anti-Inflammatories • • • • Quercetin- bioflavonoids Ginger- gingerols (anti-inflammatory) White Willow Bark- extracted as salicin Curcumin- Tumeric
    • 47. Vitamin A • Vital for the health of epithelial cells of the cornea and conjunctiva, as well as the function of the immune system. • It is also necessary for goblet cell and lacrimal gland production of the large variety of mucins now associated with the base layer of the tear film.
    • 48. Vitamin B6 • One of the nutrient co-factors required to push the metabolic pathway conversion of GLA to DGLA. • Required for the neuronal blink response.
    • 49. Vitamin C • Absorbyl palmitate (fat-soluble) modulates PGE1 synthesis due to the extended half-life of the fatsoluble vitamin C over ascorbic acid. • This vitamin C combination also enhances the production of IgE concentrates in tears, the first line of basophil and mast cell defense against invading pathogens and allergens that frequently cause dry eye symptoms.
    • 50. Vitamin D It should be included in all nutraceutical formulations that include Vitamin A due to an increased risk of fractures in older patients taking large amounts of supplemental Vitamin A.
    • 51. Vitamin E • Vitamin E should be included in all fatty acidbased nutraceutical formulations to help prevent or slow lipid oxidation. • This particularly includes any formulation that includes flax seed oil or any type of fish oil.
    • 52. Lactoferrin • The replication and biofilm formation of fungi, bacteria and viruses in mucosal tissues are irondependent. Growth of these pathogens becomes almost impossible if adequate amounts of ironbinding proteins, particularly lactoferrin, are concentrated in these fluids. • Adequate levels of tear lactoferrin, naturally produced by the lacrimal gland and neutrophils, are particularly important for the eye surgery or contact lens patient with an increased risk of infection.
    • 53. Additional Tear Support • Minerals – Zinc and Magnesium- important in immune functions • Mucin Enhancers – Aloe Vera Oil – Hyaluronic Acid
    • 54. Flax Seed Oil • Does contain a large amount of Omega-3 EFA • Highly unstable, must be refrigerated • Contains NONE of the nutrient co-factors necessary to ensure conversion to PGE1 antiinflammatory • Does not enhance production of lactoferrin • Excess now linked to cortical opacities and prostate cancer. • May cause intestinal blockage, thyroid problems and reduce platelet aggregation.
    • 55. Metabolic Pathways of Omega-3 and Omega-6 Fatty Acids Omega-6 Omega -3 Linoleic Acid (LA) Polyunsaturated oils, including flax, corn and safflower Delta--6-desaturase Alpha-Linolenic-Acid (ALA) Black Currant (15%) Flax (85%) Delta 6 enzymes impaired by aging, alcohol and nutrient deficiencies, trans fatty acids and elevated cholesterol. Gamma-Linolenic Acid (GLA) Delta--6-desaturase Steridonic Acid (SDA) Black Currant, EPO, Borage (18-24% GLA) Eicosatetiaenoic Acid (ETA) Dihomo-Gamma-Linolenic Acid (DGLA) Delta-5-desaturase Delta-5-desaturase PGE1 Series One Prostaglandin Anti-inflammatory Fish Oil &Cod Liver Oil Arachidonic Acid (AA) Lipoxgenase LBT--4 Pro--inflammatory Cylooxygenase Cylooxygenase (COX2) PGE-2 Pro- inflammatory EPA/DHA EPA appropriately blocks Omega 6 delta-5-desaturase downstream conversion PGE3 Anti-inflammatory Lipoxgenase LBT-5 Anti-inflammatory
    • 56. Supplements $28.7 Billion spent annually just in dietary supplements, vitamins and minerals Common Misconceptions They are “natural”, so completely safe They are ineffective They are all the same More is better
    • 57. Summary • Multi-pronged approach recommended • Minimize adverse environmental conditions, anticholinergic medications, visual strain • Nonpreserved artificial tears • Use topical corticosteroids only for short periods because of side effects • Topical cyclosporine- for severe cases • Treatment should not cause disruption in patient’s lifestyle • Many patients prefer the “natural” approach