“Why do my oil supplements not work?
In my dry eye specialty practice, I see discouraged patients frequently, coming with the complaint they’ve tried all kinds of supplements, diets and treatments without relief. Most have tried all this at home or on the advice of a general eye doctor or a friend, without seeing dry eye specialists, but some have seen many. When it comes to failed drops (like prescribed Restasis, Xiidra, steroids, etc, or over the counter/non-prescriptive artificial tears) and oral supplements, there are many reasons for this complaint and I’ll list 5 of the most common here:
>> 1) Most cases of dry eye (but certainly not all) are caused by or contributed to by obstruction of the oil producing glands called Meibomian Glands (loosely dubbed MGD for Meibomian Gland Dysfunction). These obstructions vary in type, but commonly involve waxy products caused by stagnation of the oils caused by poor blinks (like as occurs from staring at digital screens like we’re all doing now) and inadequate consumption of the right balance of the “essential” Omega Oils, 3,6&9. If the glands are clogged, then taking good oils (or any other products that don’t unclog), then this is analogous to putting great oil in a bottle with a big, tight cork in it and the supplement “fails.” Unclogging has to be coupled with these supplements to get effective care.
>> 2) Not all oils are well absorbed. If you have lost your gallbladder through surgery or diseases like stone blockages, then you’ve lost the ability to easily digest greasy, oily foods. Gallbladder supplements can help and without them, you may have to take small, frequent doses, so your liver can trickle the enzymes you need into the part of your gut that digests and absorbs the oils.
>> 3) Not all oils are equally “good.” Using olive oil as an example (which is largely Omega 7 and while a good polyunsaturated oil, it isn’t the right oil for your tear glands), we’ve all seen the range of quality and expense we face at the supermarket. Most recognize “Extra Virgin Olive Oil” or EVOO, as the best. The first “pressing” is considered the best - and organic, carefully tended olives take it a step further. They will market this as “organic, extra virgin, cold pressed olive oil.” (also called EVOO & it tends to be the most pricey). This oil is the most like the olive which is well recognized by our gut and is well-absorbed, as well as well-utilized by our body. Once the company pressing those olives has extracted what they can by pressing in a cold vice, they can add more heat and pressure to extract more “olive oil,” but this merits a lower grade and when they add even more heat, pressure and chemicals (like hexane), they can get out the “dregs” which they can sell as “cooking oil” - but isn’t what you’d want on your salad for dressing. The dry eye supplements - and I’ll use flax seed as the next example, are similar but not marked the same way. The “organic, extra virgin, cold pressed flaxseed oil” is sometimes called “organic, cold pressed extra high ligand oil” but flaxseed oil is processed the same way as olives. By the time you get to the dregs, they sell that as linseed oil (better for sealing decks than for dry eye supplements, but some companies can still market grades close to it as flaxseed oil). Needless to say those supplements don’t help the way the EVOO-like flaxseed oil can. In one way or another, the other oils like fish, borage, black current seed, etc, follow the same analogy and unfortunately, you will usually get what you pay for. Cheaper supplements are less likely to be helpful.
>> 4) Not all dry eye disease is caused by MGD. A common cause or contributor behind MGD is Aqueous Tear Deficiency (ATD), or too little water. All the oil supplements in the world won’t fix the ATD part of a dry eye problem. Fortunately, this is we’re anti-inflammatory medications (like Restasis, Xiidra, steroids, etc) can help. OTC artificial tears are only a “BandAid” that temporarily offers some relief but doesn’t deal with the root causes of the dry eye process. Some artificial tears (especially if they come in big, multi-use bottles) contain harsh chemicals called preservatives, which neutralize germs at the expense of neutralizing the tear glands. This can make you increasingly dependent on these products. Other common “co-contributors” like conjunctival chalasis, allergies, blepharitis etc, all require specific treatments and until they are addressed, your symptoms may persist and the supplements “don’t work.”
>> 5) Dry eye disease doesn’t tend to happen overnight. In fact it usually takes decades before it is obvious (that’s another long discussion), so the corollary is that improvement tends to take “a long time.” Depending on how aggressive the treatments are and how bad the disease has progressed, improvement can be slower than watching paint dry. It seems to take forever even when daily (tiny) gains are being made. We all want to get noticeable improvement when we’re shelling out big bucks for our care, but that rarely happens when you’re digging out from bigger problems. Supplements, coupled with appropriate care guided by a dry eye specialist who’s properly diagnosed and addressing your specific problems remains the best way to get better.