Chapter 6 - Nutritional Assistance Options
Nutritional Assistance Options in CITY 1
Patients expect and appreciate suggestions from their eyecare providers on how to best care for their eyes, especially in the case of vision loss. Minimizing or preventing further vision loss is an extremely important issue in the minds of those with vision loss. Fortunately, over the past decade scientists have demonstrated that a good diet combined with nutritional supplementation is the best opportunity for slowing down, stopping and in some cases, even improving vision loss. This chapter gives the macular degeneration patient the information needed to keep the macula as healthy as possible.
Why Nutrition Is Important For Eye Health
Researchers have demonstrated that proper nutrition can slow down or stop the progression of macular degeneration by maintaining the healthier parts of the macula. “The Age-Related Eye Disease Study” (AREDS), conducted by The National Eye Institute and published in 2001, demonstrated that certain antioxidants slowed down the progression of macular degeneration in certain patients. AREDS 1 was the first study on nutritional supplements to be accepted by The American Medical Association, and many eye doctors immediately began recommending those ingredients to patients.
The Age-Related Eye Disease Study 1
AREDS 1 also inspired many other scientists to identify exactly which nutrients help the macular and which may cause harm. The “Lutein Antioxidant Supplementation Trial” (LAST) demonstrated significant improvement in visual function with the addition of Lutein and Zeaxanthin to the AREDS ingredients.
The Age-Related Eye Disease Study 2
The Age-Related Eye Disease Study 2, (AREDS 2) was later conducted to test various other combinations of ingredients on macular function.
Nutrition From Diet: Foods Beneficial To Consume
Try to choose foods or take supplements that contain vitamin C, vitamin E and lutein, as well as zinc. Vitamin C-rich foods include citrus fruits, melons, tomatoes, potatoes and broccoli. You can get vitamin E from soybeans, greens, fish, wheat germ, nuts and seeds. Dietary sources of zinc are legumes (peas, dried beans, garbanzos, chickpeas, black-eyed peas, lentils and soy products) and whole grains. The carotenoid pigment lutein is found naturally in spinach, kale, collard greens, romaine lettuce and peas. Other protective compounds are the red and purple pigments found in berries and other fruit. Eat berries, especially blueberries, often.
The Website AMD.org States The Following
- People who eat a diet high in vegetables and fruit have a lower incidence of age-related macular degeneration. Dark green, leafy vegetables are particularly helpful.
- People who eat quality fish, such as wild caught Salmon, three times a week have a lower incidence of macular degeneration.
- People who eat a lot of saturated fats have a higher risk of AMD.
Eat Lots Of Vegetables And Fruits
Antioxidants protect against oxidation, which is a part of the process of ARMD. Dark green leafy vegetables like spinach, kale, mustard greens and collard greens contain high levels of lutein, a critical antioxidant. Antioxidants are also present in fruits and vegetables with bright color, including red grapes, peppers, corn, oranges, cantaloupe and mango.
Look for fresh produce in a variety of colors to get a wide range of vitamins in your diet. We don’t have all the answers, so eating a varied diet is wise. Eat 5-9 servings a day. While this may sound like a lot, a serving is really only ½ cup of most foods or one cup of leafy greens.
People who eat quality fish, such as wild caught Salmon, 2-3 times a week have a lower risk for ARMD. Wild caught is better because the fish are eating algae from the sea. They contain more omega-3 fatty acids which seem to be a critical nutrient for the heart and eyes. The best fish are either wild salmon or small fish like sardines. If you cannot tolerate fish or obtain it easily, an omega-3 supplement is another option. Fish oil capsules are widely available, but your best option is a health food store and not a chain drug or department store.
Recent evidence suggests that of the two types of omega-3 available, the triglyceride form is more effective than the ethyl-ester form. It’s complicated to explain, but the type will be listed on the label.
Limit Your Fat Intake
In reviewing studies on fat, researchers found that while the amount of fat consumed makes a difference, the real issue for ARMD is the amount of saturated fats in the diet. The biggest source of saturated fat is animal products – beef, lamb, pork, lard, butter, cream, whole milk and high-fat cheese. Plant oils also have saturated fat, including coconut oil, cocoa butter, palm oil and palm kernel oil.
Read the labels on processed foods and baked goods, as they often have high amounts of saturated fats. Instead, consume healthy fats like olive oil or avocado.
Nutritional supplements are recommended to patients with Age-Related Macular Degeneration in hopes of preventing further damage, slowing down the progression and sometimes actually improving vision. In addition, family members of patients with ARMD are urged to take supplements as well.
The family members at the highest genetic risk of developing ARMD are the siblings of the person with the condition. The next highest at risk, at about 30 percent, are the children of the patient. For those reasons, nutritional supplementation at the same level of the patient is recommended for siblings and children of the patient.
There are varying opinions on what ingredients belong in a macular degeneration nutritional supplement. The reason for the wide disparity of professional opinions is that there have been innumerable studies that have been published on macular degeneration and nutrition. Many of the studies contradict each other. Some studies have excellent scientific protocols and some do not. Some scientists have even criticized the National Eye Institute’s AREDS 2 study protocol.
Ingredients And Consummation Limits
Based on a wide range of scientific studies, the following ingredients have been identified as beneficial to the health of the macula. Of course, due to significant possible health issues, always check with your primary care physician before taking nutritional supplements. In addition, you must understand that more of an ingredient is not always better! For example, excess zinc can cause urinary issues.
The two most important ingredients are Lutein and Zeaxanthin.
Lutein and Zeaxanthin are classified as a carotenoids and are synthesized only by plants. It is found in high quantities in green leafy vegetables such as spinach, kale and yellow carrots. It is also found in egg yolks. Lutein is obtained by humans by eating plants.
The macula of the retina is where lutein and zeaxanthin are found. Zeaxanthin is found at the macula lutea while lutein predominates elsewhere in the retina. Both absorb ultraviolet and blue light thereby protecting the retina from the damaging effects of free radicals produced by those harmful rays of light.
Other ingredients that help the macula are: Zinc (the picolinate form), Vitamins A, B6, C, D3 and E, Folic Acid. Copper is necessary because Zinc reduces the amount of copper in the body. And, as mentioned before, Omega 3 is very important.
Advice And Brands To Trust
Your low vision doctor is the best source of recommendation for nutritional supplements. Most medical doctors (retinal doctors, general ophthalmologists, primary care doctors) are better versed in pharmaceutical medicine, rather than nutritional medicine. In addition, retail vitamin store clerks do not have the background or training to properly recommend nutritional supplements for macular degeneration.
Additional Healtful Recommendations
Stop Smoking: Smoking causes macular degeneration.
The capillaries behind the macula, named the choriocapillaris, are only one red blood cell wide. Each red blood cell carries oxygen and nutrition to the photoreceptors in the macula. Those photoreceptors require intense amounts of oxygen and nutrition to keep functioning.
Smoking causes extra ingredients to enter the red blood cell, thickening the blood and reducing the amount of oxygen and nutrients the cell can carry to the macula. Ingredients like sulfur dioxide, carbon monoxide, nicotine and other by-products squeeze out the oxygen and nutrients, causing slow death to the photoreceptors.
Do not allow yourself to think that struggling with depression is a sign of weakness. Your frustrations, anger and other emotions are not a sign of failure, but rather can be seen as an opportunity to grow. Communicate with the loved ones in your life and do not be afraid to ask them to listen to you. Listen to sound advice and know when it is time to seek further help.
Ultraviolet light from the sun damages the macula photoreceptors. The damage to the macula from the absorption of UV radiation is cumulative over your lifetime. Scientific studies have confirmed the relationship of UV radiation and macular degeneration.
To provide adequate protection for your eyes, sunglasses should:
- Block out 99 to 100 percent of both UV-A and UV-B radiation
- Screen out 75 to 90 percent of visible light; especially blue light
- Be perfectly matched in color and free of distortion and imperfections
Altering one’s diet is a lifestyle change that requires commitment, motivation and support. Your fear of losing more vision can be used to motivate yourself and your family to make these changes.
I Highly Recommend You Do The Following
- Eat a healthier diet
- Take nutritional supplements daily
- Avoid direct sunlight
- Wear UV blocking sunglasses
- Do not smoke
- See your eye doctors regularly
- Keep researching new medical, visual and nutritional information
“AMD is a disease largely driven by genetics and aging, and those are two things we can't do anything about. Vitamin supplementation is something patients can do to slow the progress and put the brakes on the train. Also, eating a well-balanced diet with plenty of leafy green vegetables and fish and limiting carbohydrates will work in your favor. A diet that is good for your heart is a diet that is healthy for your eyes.”
Edward L. Paul, Jr., OD, Ph.D. FIALVS
Low Vision Optometrist, Wilmington, N.C.