September 2011




Could fasting cause dry eye?

by Matt Young EyeWorld Contributing Editor


Research suggests fasting has some impact on tear proteins

MuslimThe holy Islamic month of Ramadan makes significant nutritional demands on many Muslims, who abstain from eating and drinking from dawn to sunset during that period. Sustained fasting is believed to be a risk factor for certain diseases, including cardiovascular and gastrointestinal ones, but could it also impact dry eye disease? Researchers recently investigated that possibility, and although there are no concrete answers, they found interesting changes in tear protein patterns in a fasting group, which warrants further investigation. "In the present study, we found alterations in the protein content of tear film during one month fasting," reported Reyhaneh Sariri, Ph.D., biochemistry department, Faculty of Science, University of Guilan, Iran. Dr. Sariri's report was published in 2010, volume 53, number 3, in Acta Medica.

Analyzing tear proteins

Researchers decided to analyze the tear film in fasting participants because certain bodily fluids were shown to be altered under short-term starvation conditions. "Since the biochemistry of some biological fluids (such as blood and urine) has shown slight alterations due to fasting, it is expected that an extended strict fasting may influence tear quality," Dr. Sariri noted. Dr. Sariri and colleagues compared the tear protein content of 35 men and 25 women during their Ramadan fasting periods with their tear proteins 1 month previous to fasting. Specifically, a tear protein sample was collected on the 25th day of Ramadan on the 25th day of fasting. "Electrophoresis pattern of tear samples indicate that some tear proteins are decreased in fasting state," Dr. Sariri reported. "However, total tear proteins showed an increase using Lawry protein assay."

Meanwhile, a separate high-performance liquid chromatography analysis of tear samples found that most proteins were decreased in a fasting state. It appears, therefore, that fasting may induce some type of protein shift in the tear film. But could this shift indicate that fasting is a risk factor for dry eye disease? Researchers could not yet answer that question, but they did stress that tear protein makeup is an important factor in dry eye disease.

"A significant difference in tear protein patterns between patients suffering from dry eye and healthy volunteers has [been] demonstrated by one-dimensional electrophoretic separation of tear proteins," Dr. Sariri reported. If tear proteins are a central factor to the makeup of dry eye disease and a change in tear film protein occurs during fasting, then perhaps there could be some elevated risk for those fasting. However, at this point, any solid link between fasting and dry eye appears to be conjecture. Dr. Sariri is looking to the future, hopeful that an analysis of tear proteins could better manage dry eye disease patients. "It could be demonstrated that analysis of tear proteins, and the multivariate approach including all peaks in the analysis, can be helpful in dry-eye disease diagnosis or follow-up," Dr. Sariri reported. "However, some problems remain before routine clinical use of these methods. Reproducibility must be investigated in further studies, and variation of tear protein patterns even in the same subject must be considered."

In the meantime, Dr. Sariri is certain about the link between fasting and other diseases. "There is no doubt about the influence of fasting on many systemic diseases and even on many eye diseases," Dr. Sariri noted. Although less is known about the impact of fasting on tears, more research is needed because of the importance of the tear film for diagnostic purposes. "Human tear film is an interesting and valuable body fluid in terms of diagnostic purposes," Dr. Sariri noted. "Despite its biochemical similarity to blood plasma, it is easily collectable with minimum trauma to the patient. A tiny drop of tear fluid could be used for diagnosis of certain eye diseases and even systemic diseases."

Bjorn Johansson, M.D., Linkoping University Hospital, Sweden, said he is not aware of any individuals who have fasted and resultantly developed eye problems. "A few people [I know] have gone through fasting for health-related issues, but had no vision related problems," Dr. Johansson said. Still, Dr. Johansson said that fasting does decrease the body's nutritional reserves, which could have some impact on health. "When you are fasting, you are taking from the body's energy reserves," he said.

Editors' note: Dr. Sariri has no financial interests related to this study. Dr. Johansson has no financial interests related to his comments.

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