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“Count your age by friends, not years. Count your life by smiles, not tears.”
― John Lennon
NAMASTE AND WELCOME TO THE WAY UP FREE HEALTH NEWSLETTER
TO WHICH YOU HAVE SUBSCRIBED
PART II. NUTRIENTS TO HELP PREVENT
MACULAR DEGENERATION & DIABETIC RETINOPATHY
There are no guarantees in life, but we can change probabilities. We who are health conscious can certainly decrease our risk of developing the various diseases of aging. The major eye disorders are all related to the aging/degenerative processes which are accelerated by an unhealthy lifestyle.
Age-Related Macular Degeneration (AMD or ARMD) is the leading cause of vision loss and blindness among Americans over 65 years old. About 1.75 million U.S. residents currently have advanced age-related macular degeneration with associated vision loss. That number is expected to grow to almost 3 million by 2020.
The retina is composed of a light sensitive layer of cells at the back of the eye which covers about 65% of the interior surface of the eye. The macula is a cluster of light sensitive cells in the center of the retina which are needed for sharp central vision. AMD is a disease which gradually destroys the macula so it destroys central vision. This impairs everyday activities such as reading, driving, and anything requiring central vision. Individuals with AMD may notice straight lines begin to look wavy, reading material becomes blurred, and there may be dark or empty spaces in the center of their visual field. These visual changes are understandably debilitating and distressing.
Early detection of AMD is critical because there are nutrients & treatments which can both delay the progression of and reduce the severity of the disease.
All adults over 40 need a baseline screening exam & those over 65 need an eye exam every 1-2 years.
TYPES OF MACULAR DEGENERATION
Dry AMD is the more common and milder form of AMD and accounts for 85% to 90% of all cases. It develops gradually over time and usually causes only mild loss of vision. AMD is identified during a comprehensive dilated eye exam when the Dr sees a collection of small, round, white-yellow, fatty deposits called drusen in the central part of the retina. Free radical damage causes oxidized drusen to build up in the retina & to form vision blocking clumps. Drusen causes the macula to break down & the tissue supporting the photoreceptors to thin and lose pigment thus causing cloudy central vision and distorted color perception.
Dry AMD can occur in one or both eyes. The occurrence of dry AMD in one eye dramatically increases your risk of developing it in the other eye.
There are three stages of dry AMD:
- In early stage dry AMD there are either several small drusen or a few medium-sized drusen deposits in the the retina. At this stage, there are no symptoms or vision loss so you cannot know you have a problem without getting an eye exam.
- In intermediate dry AMD there are either many medium-sized drusen or one or more large drusen. Some see a blurred spot in the center of their vision. They may require more light for reading and other tasks.
Ten to twenty percent of those with early or intermediate stage dry AMD progress to advanced dry AMD.
- In advanced dry AMD there is drusen plus a breakdown of light-sensitive cells and supporting tissue in the macula. It is characterized by a round, well-defined, nearly transparent spot etched into the macula. This spot is called an area of geographic atrophy.
Although dry AMD can advance and cause vision loss without turning into the wet form, it does evolve into wet AMD in 1 out of 7 people with the disease. There is no way to tell if or when the dry form will turn into the wet form.
Wet AMD will affect 15% of those with AMD. It is also known as advanced AMD & it does not have stages like the dry form. All people who have wet AMD had dry AMD first. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid, which leads to more rapid progression of the disease. The blood and fluid raise the macula from its normal place at the back of the eye. Wet AMD requires more aggressive treatment to seal off the leaking blood vessels & prevent them from growing back. A drug called Lucentis is injected into the eye monthly (about 5-7 times yearly). 95% of those treated stopped disease progression in phase III clinical trials & 40% had improved vision. Other eye injectables which are used are Avastatin or Macugen. There are also various laser treatments available.
Wet AMD damages the retina in one of two ways:
- Retinal Pigment Epithelial (RPE) Detachment The RPE is a thin layer of cells that lies just below the rod cells of the retina. The RPE gets nutrients and oxygen from the choroids (the middle, vascular coat of the eye, between the sclera and the retina).When fluid from leaking choroid vessels accumulates between the choroid and the RPE, the epithelial layer can detach.
Your vision may be stable for months with no apparent blood vessel migration into the retina, but this fluid buildup will eventually cause distorted vision by elevating the macula from its normal position. With no advanced notice this form of wet ARMD can progress to the choridal neovascularization form.
- Choroidal neovascularization (CNV) is a process in which new blood vessels grow in the choroid (the area of the eye containing the most blood vessels) through the Bruch membrane (the innermost layer of the choroid) allowing the development of tiny, abnormal, leaky blood vessels inside the eye to leak beneath and into the retina. This leaking is why it is called wet AMD. CNV can create a sudden deterioration of central vision, noticeable within a few weeks. Other symptoms which can occur include metamorphopsia (a visual disorder in which images appear distorted in various ways) and color disturbances. Hemorrhaging of the new blood vessels can accelerate the onset of symptoms of CNV. CNV is a major cause of visual loss.
Most cases of AMD do not result in complete blindness since side vision is not usually affected. Yet more than I million people worldwide are completely blind from advanced AMD.
Risk Factors for Age-Related Macular Degeneration
- Age is the number one risk factor with 1/3 of those over 75 being affected by AMD.
- Smoking has been shown to affect the rate of oxygen delivery to the retina causing the potential to negatively impact vision. Since the retina requires a high rate of oxygen consumption, smoking also causes oxidative stress. A smoker’s chance of developing AMD is 2-5% greater than a non-smoker.
- Oxidative stress is caused by the production of“free radicals”, a type of reactive oxygen species which can attack and degrade tissue & functioning. Free radicals set off a chain reaction which can damage all cells, including DNA. Oxidative stress is a major cause of all the eye disorders we have discussed.
- A Family history of macular degeneration, especially when an immediate family member has AMD.
- Women live longer & are more likely to be affected by AMD.
- Caucasians are more at risk than those of other races.
- Prolonged sun exposure because ultra-violet (UV) light damages retinal tissue directly, and can also lead to the accumulation of the products which are harmful to the retina. Use sunglasses with UV light protection.
- Light-colored eyes offer less protection from damaging UV light, & are more likely to be affected by dry AMD.
- Poor general nutritional status
- Overweight individuals with a body mass index (BMI is a measure of body fat) higher than 30 are 2 ½ times more likely to be affected by AMD.
- High blood pressure leads to a constriction, or narrowing of the blood vessels that nourish the retina & increases AMD risk.
- Inactivity increases risk because exercise improves cardiovascular health and increases oxygen levels throughout the body including the retina. In dry AMD, the retina does not receive adequate oxygen, leading to the death of cells in the macula.
- Some cases of macular degeneration can be induced from the side effects of drugs such as Aralen (chloroquine, an anti-malarial drug) or phenothiazines (a class of anti-psychotic drugs), including the brand names of Thorazine (chlorpromazine, which also is used to treat nausea, vomiting and persistent hiccups), Mellaril (thioridazine), Prolixin (fluphenazine), Trilafon (perphenazine) and Stelazine (trifluoperazine). Excessive use of Tylenol can contribute to AMD because of glutathione depletion. Other medications can contribute to AMD & need to be used with caution if you are at risk. Check for your medications on this list by scrolling to the bottom of the page.
- Increased levels in the blood of C-Reactive Protein a substance found in the body which increases in response to inflammation in the body.
- High levels of homocysteine in the blood create an increased risk for AMD. It's well-known that taking folic acid , vitamin B6 and vitamin B12 supplements reduce homocysteine levels significantly. A new study found that women (average age of 60 who had cardiovascular disease or several risk factors) who took the B vitamin supplements had a reduced rate of AMD
For more information about these supplements & homocysteine see my newsletter"VITAMIN B12 / FOLIC ACID / HOMOCYSTEINE"
WHAT NUTRIENTS CAN HELP PREVENT AMD?
Various studies have shown nutrients can both prevent the development of AMD or slow the progression to advanced AMD in those with intermediate AMD. For those who like to see the specific studies, some are listed at VITASEARCH.
Here is a list of those nutrients:
- Lutein and Zeaxanthin are 2 of the most important nutrients for improving & maintaining eye health. They are the most plentiful carotenoids in the America diet and are found in very high concentrations in fruits & vegetables with red, orange & yellow colors. They are especially found in dark green leafy vegetables, broccoli, orange & red peppers, carrots, egg yolk, corn, squash, and Kiwi. The eyes contain more lutein & zeaxanthin than any other part of the body. Together they make up most of the pigment in the center of the retina (the macula which is responsible for sharp and detailed vision) & are also concentrated in the lens of the eye.
Much evidence supports the role of lutein and zeaxanthin in reducing the risk of AMD. Multiple studies have shown Lutein & Zeaxanthin to be important for eye health because of their ability to protect the eyes by filtering out high-energy blue light & ultraviolet radiation from the sun. They also act as antioxidants to neutralize oxidative damage.
The National Eye Institute is conducting a second large human clinical trial, Age-Related Eye Disease Study (AREDS2), to confirm whether supplements containing 10 mg a day of lutein and 2 mg of zeaxanthin per day affect the risk of developing AMD.
Beyond reducing the risk of developing eye disease, separate studies have shown that lutein and zeaxanthin improve visual performance in AMD patients.
A study on those with AMD was reported in the Annals of the New York Academy of Sciences. After 3 months on this supplement vision was kept stable thus appearing to halt the progression of AMD. This result is better then the normal course. Of the 110 patients who continued nightly use of 3 mg melatonin combined with 50 mg zinc orotate & 50 mcg selenium the vast majority had dramatically reduced pathological changes in the eyes. The patients also reported improved vision.
- Resveratrol confers a marked protection against oxidative stress. Resveratrol may specifically help prevent retinal pigment epithelial cell degeneration induced by oxidative stress. Recent studies have shown that resveratrol reduces the incidence of AMD.
- Vitamin C helps the body form and maintain connective tissue, including collagen found in the cornea of the eye. Vitamin C also promotes the integrity of the delicate capillaries in the retina & can help prevent the build up of drusen. Studies suggest long-term use of vitamin C may reduce the risk of vision loss from macular degeneration.
- Vitamin E helps to protect the cells of the eye from damage caused by free radicals, which break down healthy tissue. Based on nutritional studies, many eye doctors recommend that their patients supplement their diet with a daily multivitamin that contains up to 400 IU of vitamin E in combination with other antioxidants as part of their preventative eye care.
- Selenium increases the effectiveness of Vitamin E in the body. Adequate Selenium plays an important role in the prevention of macular degeneration.
- Beta-carotene - 15 mg (equivalent of 25,000 IU of vitamin A) by mouth along with 500 mg of vitamin C, 400 IU of vitamin E, and 80 mg of elemental zinc daily, seems to help prevent vision loss and worsening of AMD in people with advanced AMD.
- Vitamin B3 (NIACIN) increases blood flow to the eyes & brain by dilating tiny capillaries and can help those with AMD. Vitamin B deficiency can cause macular degeneration.
- Glutathione is critical to the prevention of AMD. A powerful antioxidant, it plays a significant role in the protection of the eyes from oxidative stress, which can lead to unclear eyesight and eventual blindness.
Many studies have shown that low levels of glutathione in the eye are associated with a greater risk for Macular Degeneration. Oral glutathione is not well absorbed in the body, except for lipoceutical glutathione preparations. Supplementing with NAC ( N-Acetyl-Cysteine) may also help to achieve optimal glutathione levels because NAC can convert to glutathione in the body. Your body can also make glutathione from the precursor amino acids: L-Gycine , L-Glutamine , & L-Cysteine together with the B vitamins: B2 , B3 , B6, & B12.
Daily use of acetaminophen (Tylenol) interferes with glutathione levels which can contribute to vision loss in later life.
- N-Acetyl L-Cysteine (NAC) is used as a precursor to increase your body's levels of glutathione. Glutathione concentrations in the eye are much higher than any other body tissues.
- Copper works with Vitamin C to fight oxidative stress & is necessary for proper enzyme functioning. Copper has been used to help reduce the development of advanced AMD and is recommend by Ophthalmologists.
- ZINC helps reduce the number of free radicals in the human body. Zinc is also essential for oxidation & metabolism. It makes it possible for the liver to release vitamin A so it can be used in eye tissues. This important mineral is essential in aiding the activity of dozens of enzymes, including the antioxidant enzymes involved in protecting the lens from cataracts and the macula from macular degeneration. Zinc concentrations in the eyes are higher than in any other part of the body, and they are especially high in the retina.
Zinc deficiency causes deterioration of the macula & can prevent the photoreceptors from functioning. Zinc deficiency may cause night blindness, poor vision, Macular Degeneration, and ultimate blindness. Medications that interfere with zinc include, acid blockers, antacids, anti TB meds, antivirals, arimidex (for breast cancer), blood pressure meds, cholesterol agents, steroids, oral contraceptives & HRT, selective estrogen receptor modulators used to treat breast cancer. In an Age- Related Eye Disease Study (AREDS), a supplement of zinc with copper reduced the risk of advanced AMD by 21%.
Harvard University conducted a study reported 3/15/11 on the effects of omega 3 fats on AMD. The study performed a dietary analysis on more than 38,000 women. No men were included in the study. All of the participants were in their 40's at the time of enrollment in 1993, and none had AMD at the study’s start. Eye health was tracked over the course of a decade, during which time 235 women developed AMD. This study found that women with the highest intake of EPA and DHA, had a 38% lower risk of AMD.
In a 2009 National Eye Institute (NEI) study using data from the Age-Related Eye Disease Study (AREDS), participants reporting high levels of omega-3 fatty acids in their diet were 30% less likely than their peers to develop macular degeneration during a 12-year period.
- Lycopene helps to protect the retina from oxidative damage initiated by absorption of light, a major factor in macular degeneration. According to in vitro and animal research published in the September issue of Nutrition (19, 9:794-9, 2003), lycopene seems to protect against AMD development due to its antioxidant properties.
- Astaxanthin is the ultimate supplement for eye health and the prevention of blindness according to recent studies. This is because Astaxanthin is one of the few antioxidants able to cross the blood-retinal barrier, which has huge implications for the health of your eyes. Astaxanthin has been found to have protective benefits against a number of vision-related problems. It has been scientifically proven to be highly effective in relieving symptoms of eye fatigue & weakness, irritated eyes, sensitivity to glare, poor depth perception, and difficulty focusing on objects at different distances, as when you shift from distance to close work and back again. A 2002 study looked at the effect of astaxanthin on the degree of eyestrain in computer users. The study showed that those who took 5mg of astaxanthin daily had significantly improved visual function compared to those taking the placebo, whose vision was unchanged. Another study involving healthy volunteers over 40 showed that after 28 days on doses of astaxanthin somewhere between 4mg & 12mg daily, the sharpness of their vision at 20 feet & beyond had been greatly improved. This evidence shows that astaxanthin can both reduce eyestrain in computer work & improve eyesight.
- Hydroxytyrosol is a polyphenol derived from olive oil & is the most potent antioxidant found in nature up to this time. It has 10x the free radical quenching effects of green Tea and 2x the free radical quenching effects of Co-Enzyme Q10. In May 2010 it was patented for the prevention of AMD. For more information see "Hydroxytyrosol protects against oxidative damage by simultaneous activation of mitochondrial biogenesis and phase II detoxifying enzyme systems in retinal pigment epithelial cells."
- EGCG from green tea has been found to inhibit UVA induced damage & enhance retinal pigment epithelial survival after UVA exposure. It may be suitable for the prevention of early AMD.
- Bilberry has powerful antioxidant & anti-inflammatory properties. It helps strengthen the structural integrity of blood vessels throughout the body. Bilberry promotes healthy circulation to the small capillaries that deliver oxygen & nutrients to the eyes. It may also aid in making activities such as reading & computer use easier on your eyes. Bilberry may help your night vision and adaptation to the dark, and promote visual acuity and capillary integrity. During World War II before their nighttime flights British pilots found that eating a bilberry spread, helped them see more clearly even on the darkest of nights. Scientific studies have shown bilberry improves visual acuity in healthy individuals, as well as improving vision in patients who have glaucoma, cataracts and age-related macular degeneration.
Diabetic Retinopathy
Diabetic retinopathy (DR) is a microvascular ( the portion of the circulatory system composed of the smallest vessels, such as the capillaries, arterioles, and venules) complication of diabetes mellitus that can lead to substantial visual loss and blindness. Diabetic retinopathy can manifest either by the swelling of blood vessels in the eye causing them to leak fluid or by new abnormal blood vessels growing on the surface of the retina causing damage.
You may not notice any changes to your vision in the beginning, but over time it can worsen leading to vision loss. Diabetic retinopathy usually affects both eyes. It is the leading cause of blindness among working-age Americans, according to the U.S. National Institutes of Health (NIH).
The stages of Diabetic retinopathy are:
- Mild Nonproliferative Retinopathy: The earliest stage in which small areas of balloon-like swelling in the retina's tiny blood vessels called “microaneurysms” occur.
- Moderate Nonproliferative Retinopathy: In stage 2, some of the blood vessels that nourish the retina become blocked.
- Severe Nonproliferative Retinopathy: In this stage more blood vessels become blocked cutting off the necessary blood supply to the retina.
- Proliferative Retinopathy: This is the advanced stage of the disease which causes the signals sent by the retina for nourishment to trigger the growth of new abnormal & fragile blood vessels. They begin to grow along both the retina & the surface of the clear, vitreous gel that fills the inside of the eye. Because these blood vessels have thin & fragile walls, they can leak blood causing severe vision loss or even blindness.
The more poorly regulated your diabetes, the higher your risk for diabetic retinopathy, or for any other complications of diabetes.
- Alpha Lipoic Acid (Thioctic acid) is considered one of the most versatile antioxidants because it is soluble in both fat & water. Lipoic acid has the ability to regenerate & thus increase levels of vitamins C, E & glutathione. Lester Packer, a leading scientist who has researched free radicals states “Alpha lipoic acid could have far-reaching consequences in the search for prevention and therapy of chronic degenerative diseases”. Lipoic acid has also been shown to inhibit the activity of aldose reductase (an enzyme normally present in the eye and elsewhere, which converts excess glucose into sorbitol in diabetic patients). Excess sorbitol in the eyes, nerves, and kidneys can lead to retinopathy, neuropathy, and nephropathy. Lipoic Acid has also been shown in a recent study to improve vision in glaucoma patients,
- Inositol is found in high concentrations in the lens and enhances the growth of cell membranes in the eyes. The cell membranes main function is to regulate the contents of the cells, which allows them to function effectively. Inositol can help to counter the effects of high blood sugar levels in the lens of the eye. High blood sugar levels can cause inflammation, vision changes and eventually diabetic cataracts.
- Bilberry preliminary clinical studies suggest that bilberry's ability to stabilize connective tissue in the eye helps to reduce the occurrence of diabetic retinopathy.
- Other studies have shown that combining 160mg of bilberry extract with 8 oz. blueberries in combination with gingko biloba and zinc can help to halt vision loss.
- Thiamine vitamin B1 can help prevent diabetic retinopathy & blurry vision. Please also see Benfotiamine, a fat-soluble form of vitamin B1.
- Magnesium lower serum levels have been associated with increased likelihood or progression of retinopathy in type 1 and type 2 diabetes, For more see "Association of Hypomagnesemia With Diabetic Retinopathy" and "Magnesium deficiency and other risk factors for diabetic retinopathy"
- Vitamin B12 Some studies suggest low B12 levels are a risk factor for DR.
- Oral Antioxidants. A 5 year study suggested antioxidant supplements "could be a useful adjunctive therapy in the treatment of nonproliferative DR."
- Taurine supplementation improved DR in rats.
Studies conducted by both the Diabetes Complications and Control Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that tighter control of blood sugar significantly reduces the chances of developing or worsening diabetic retinopathy in patients with type 1 and type 2 diabetes.
For more information on supplements to help control blood sugar see Diabetes.
Also see "Diabetes and vitamin levels"
Please see our last newsletter on cataracts and glaucoma for more information.
Again, be sure to get regular eye exams & appropriate follow ups as your ophthalmologist suggests. Only use nutritional supplements as an adjunct to whatever your Dr suggests.
Until our next newsletter, wishing you peace, health,
and all of your heart’s desires.
Priscilla Slagle M.D.
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