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ARMD and Nutrition

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Vitamins and nutritional supplements typically work as antioxidants – they fight oxidation. Oxidation is a process where energy such as sunlight or chemicals, from sources like cigarette smoking, produces free radicals. These free radicals injure cells and cause damage to the DNA. Antioxidants help to prevent or meliorate this damage. Enzymes in our bodies can also help to neutralize these dangerous elements. Some nutrients, such as zinc, also work by helping these enzymes perform their work. Oxidation and free radical damage is thought to contribute to ARMD.

Our Summary Recommendations:

  1. PATIENTS WITH EARLY ARMD or with strong family history or risk factors should take an antioxidant vitamin supplement with a B-complex, and with a diet of 3 servings of fruit per day, 5-7 servings of vegetables high in Lutein and Zeaxanthin, and at least 1 meal of fish or supplements to increase Omega-3 fatty acids.
  2. PATIENTS WITH INTERMEDIATE TO ADVANCED ARMD should take an AREDS vitamin supplement (taking the dose at breakfast and dinner), with a B-complex, and with a diet of 3 servings of fruit per day, 5-7 servings of vegetables high in Lutein and Zeaxanthin, and at least 1 meal of fish or supplements to increase Omega-3 fatty acids. 

Common Recommended Supplements:

AREDS Vitamins: The ARED Study / The Age-Related Eye Disease Study
In this national study patients were given one of four treatments:

  1. zinc alone
  2. antioxidants alone
  3. a combination of antioxidants and zinc or
  4. a placebo

 Antioxidants Plus Zinc   Zinc Alone  Antioxidants
  • Reduced risk of developing advanced AMD by about 25 percent
  • Reduced risk of vision loss by about 19 percent
  • Reduced risk of developing advanced AMD by about 21 percent
  • Reduced risk of vision loss by about 11 percent
  • Reduced risk of developing advanced AMD by about 17 percent
  • Reduced risk of vision loss by about 10 percent

 
The specific daily amounts of antioxidants and zinc used by the AREDS researchers were:

AREDS vitamins are available as Ocuvite Preservision, ICaps AREDS Formula, and Macular Complete. These are NOT prescription medicines and are available over-the-counter at most pharmacies and supermarkets. They are probably not covered by most prescription drug plans. These are usually taken with breakfast and dinner, as directed on the label of your specific chosen supplement. You should stop taking other multivitamins that contain Vitamins A, E and Zinc when taking AREDS supplements. Patients may consider taking a B complex supplement if not contained in the chosen supplement.

All patients should consult with their medical doctors before taking these large doses of supplements to reduce potential harmful side effects. For example, beta-carotene has been shown to increase the risk of lung cancer among smokers. Smokers should not take high doses of vitamin A or Beta-carotene due to this risk. Taking supplements with zinc may cause a copper deficiency. The study also found high zinc levels were associated with genitourinary tract problems. Patients should discuss the best combination of supplements to take with their primary care physician. The impact of taking antioxidant-zinc combination supplements for decades is not known.

Carotenoids: (lutein & zeaxanthin & beta-carotene)

The NIH Eye Disease Case-Control Study found carotenoids reduced risk of the "wet" form of macular degeneration. The ARED study included beta-carotene as part of its "antioxidant" regimen. Lutein & zeaxanthin, both carotenoids, most markedly reduced the risk. Cigarette smoking "canceled" the benefits of this supplementation. Beta-carotene and lycopene, two other carotenoids which are in many supplements, are virtually absent in the macula, the center of the retina where macular degeneration occurs. There is no recommended daily allowance.

Retinol (a form of vitamin A)

The NIH Eye Disease Case-Control Study found retinol had no effect in ARMD. Vitamin A palmitate, at 15,000 IU per day, was reported to diminish loss of side vision in retinitis pigmentosa patients. These patients lose side and then central vision due to a genetic defect that cause their retina to degenerate prematurely. The RDA of Vitamin A is 5,000 IU per day, equivalent to the 15mg in the ARED study. Excessive doses can lead to blindness and liver damage.

Vitamin C

Vitamin C is an antioxidant and an essential cofactor (helper) in many metabolic processes including but not limited to connective tissue production. The NIH Eye Disease Case-Control Study found Vitamin C reduced the risk of visual loss in ARMD to a small degree. The ARED study found it beneficial. Excessive doses can cause kidney problems. The RDA of Vitamin C is 60 mg per day, although 500mg is recommended in the ARED study.

Vitamin E

Vitamin E is an antioxidant and an essential cofactor (helper) in many metabolic processes. Research has shown that 400-800 IU of vitamin E per day can markedly reduced the risk of heart disease. Recent studies have shown that Vitamin E may have a role in preventing stroke. The NIH Eye Disease Case-Control Study found Vitamin E did not reduce the risk of visual loss and may actually increase risk in macular degeneration. The ARED study found it reduced risk of visual loss and progression of ARMD. The RDA of Vitamin E is 30 units per day, although 400IU is recommended in the ARED study.

Zinc

Zinc is a common trace mineral in humans that is highly concentrated in the retina. It is essential for metabolism in the retina and in the rest of our body. Lower levels are found in our bodies as we age due to poor diet or poor absorption of zinc. Some studies have shown a benefit of zinc in preserving vision in ARMD. The ARED study found it reduced risk of visual loss and progression of ARMD. Too much zinc can prevent other essential minerals from being absorbed, causing anemia, and can cause severe intestinal problems. The ARED study used copper to help prevent this. Zinc must be taken on an empty stomach as food interferes with its absorption in the intestine. The RDA is 15 milligrams of zinc per day, although 80mg as Zinc Oxide with 2 mg of Copper Oxide is recommended in the ARED study.

Omega-3 Fatty Acids, Fish and Flax seed

Recent studies found that patients with higher vegetable fat consumption had elevated risk (2.22) for ARMD, than those who consumed monounsaturated fats (OR, 1.71) and polyunsaturated fats (OR, 1.86). Patients with higher intake of omega-3 fatty acids or certain types of fish had a lower risk for ARMD. Patients eating at least one and preferably two fish meals a week had a lower chance of having ARMD and heart disease. Certain "fatty" fish such as mackerel, lake trout, herring, sardines, albacore tuna and salmon contain two omega-3 fatty acids – eicosapentaenoic and docosahexaenoic acids (EPA and DHA). Alpha-linolenic acid is less potent and is found in soybeans, canola, walnut and flaxseed oils. Supplemental omega-3 fatty acids are available in pill form as "Fish Oil Supplement," or can be taken as Flax seed oil or Flax seed supplement. There is no RDA or study to show their benefit. A starting dose of 5 grams of omega-3 per day is currently recommended by many alternative and herbal specialists. About 2 teaspoons of flax seed oil contains 5 grams of Omega-3 fatty acid.

Fruit

Research shows that 3 or more servings per day of fruits lowers the risk of ARMD by 36% compared to eating less than 1½ servings per day.

Lutein and Zeaxanthin

These carotenoids are commonly found in dark green, leafy vegetables such as spinach and collard greens, kale, mustard greens, and turnip. Marigold petals contain a more concentrated source of potential lutein. The NIH Eye Disease Case-Control Study found eating green leafy vegetables five or more times a week markedly reduced the risk of visual loss from macular degeneration. Lutein and zeaxanthin are antioxidants. They also comprise the two dominant yellow pigments in the macula, the center of our vision and the site where macular degeneration occurs. Lutein and zeaxanthin filter out visible blue light. The lens and cornea filter out most ultraviolet light, but allow through the visible blue light which can cause photodamage, damage from excessive light interacting with the retina. There is no recommended daily allowance. Patients typically take 6-15mg a day of marigold derived form.

Lutein Content of certain Fruits and Vegetables

Vegetable/Fruit mcg/100g * grams/oz =20 mg
Beet greens 7,700 260 / 10
Broccoli 1,800 1111 / 40
Brussels sprouts 1,300 1538 / 55
Celery 3,600 555 / 20
Chicory leaf, raw 10,300 194 / 7
Corn, yellow 780 2564 / 92
Cress leaf, raw 12,500 160 / 6
Endive 4,000 500 / 18
Green beans 740 2702 / 97
Greens, collard 16,300 123 / 5
Greens, mustard 9,900 202 / 8
Kale 21,900 91 / 3.25
Leek, raw 1,900 1052 / 38
Lettuce, iceberg 1,400 1428 / 51
Lettuce, leaf 1,800 1111 / 40
Lettuce, romaine 1,900 1052 / 38
Okra, raw 6,800 294 / 11
Peas, green 1,700 1176 / 42
Pepper, red 6,800 294 / 10.5
Pepper, yellow 770 2597 / 93
Pumpkin 1,500 1333 / 48
Spinach, cooked 12,600 158 / 7
Squash, summer 1,200 1666 / 60
Squash, winter 38 55555 / 1984
Swiss chard 11,000 181 / 6.5

*SOURCE-mcg/100g-Carotenoid Content of Fruits and Vegetables: An Evaluation of Analytical Data. Mangles AR, et al. JADA 93:284-296 (1993)

Bilberry (Vaccinium myrtillus)

Bilberry gained notoriety during World War II. British Air Force pilots who ate Bilberry preserves before night missions reported improved night vision. It was used as a medicinal herb since the 16th century. Bilberry is the fruit of a perennial shrub that is commonly found in various climates in damp woodlands and moors in England and Scotland. It is known as huckleberries in the USA, whortleberries in England and blaeberries in Scotland. The fruit contains flavonoids and anthocyanin, which can help to prevent capillary fragility, thin the blood, and stimulate the release of vasodilators. Anthocyanin, a natural antioxidant, also lowers blood pressure and reduces clotting. It also contains glucoquinine that has the ability to lower blood pressure. Bilberry has long been a homeopathic remedy for poor vision and "night blindness." Small clinical tests confirm that given orally, it improves visual accuracy in healthy people, and can help those with eye diseases such as pigmentosa, retinitis, glaucoma, and myopia. Key Dried Bilberry fruit and Bilberry tea has been used as a treatment for diarrhea and as a relief for nausea and indigestion. There is no recommended daily allowance. No side effects have been reported. Patients typically take 100mg up to 3 times a day.

Pycnogenol, Proanthocyanidin, & Oligomeric Proanthocyanidin Complexes (OPCs): (Grape seed extract & Pine Bark extract)

Pycnogenol is a scientific name for this class of bioflavonoids derived from pine bark, lemon tree bark, grape seeds, grape skins, or cranberries. They are also called Oligomeric Proanthocyanidin Complexes (OPCs). Proanthocyanidin is an OPC extracted from both pine bark and grape seeds. They are supposedly strong antioxidant with intense free radical scavenging effect on free radicals. They are advertised as an anti-aging supplement, although no data exists on effects in ARMD or other diseases associated with aging. There is no recommended daily allowance. Patients typically take 1mg/kg per day.

Ginkgo Biloba

The medicinal part of Ginkgo is derived from the ginkgo, and it is still widely prescribed in Chinese herbal medicine practice. In Europe, ginkgo is a commonly prescribed "drug." Ginkgo can inhibit a naturally occurring blood protein causing relaxation of contracted blood vessels. Contraction of blood vessels underneath the retina may contribute to ARMD. Ginkgo can cause platelet function abnormalities and may cause easy bruising and bleeding. It should be used with caution in patients on anticoagulants such as Coumadin. Ginkgo also contains antioxidants. A single French study on 20 patients over age 55 with macular degeneration conducted over 6 months showed "significant improvement" in visual acuity distance vision. There is no recommended daily allowance. Patients typically take 50-100mg up to 2 times a day. You must consult your doctor before beginning this drug.

Lycopene

Lycopene is a carotenoid found in tomato. Compared with beta-carotene, alpha-carotene and other carotenoids, lycopene is the most potent antioxidant. It is touted to prevent cancer and heart disease. There is no RDA, but one study in 1995 suggested it lessens the risk of ARMD. Researchers have placed the lowest protective lycopene dosage at 6.5 mg per day.