Nutrition

Investigate nutrients for better eye health

What AREDS2 can teach us about nutrition.

BY RUTH FRECHMAN, MA, RDN, CPT

Of the five senses, vision is the sense most affected by diet and nutrition. The key nutrients for eye health are lutein, zeaxanthin, vitamin C, beta-carotene, vitamin E, zinc, and omega-3 fatty acids. Many of these nutrients are antioxidants and may protect eyes by reducing oxidative stress. Proper nutrition, along with dietary supplements, can play a role in protecting and preserving vision.

Supplements for AMD, cataract, and dry eye patients are readily available, and you need to know which are most effective and evaluate the research before making proper recommendations, answering questions, and addressing potential concerns.

In particular, the National Eye Institute’s (NEI’s) Age-Related Eye Disease Study (AREDS and AREDS2) found that taking the AREDS formulation reduced the rate of developing advanced AMD by about 25% in patients at high risk.¹ It appears that the benefits of high levels of antioxidants and zinc are safe and long-lasting. If taking an eye vitamin slows vision loss, more patients may convert.

Diet comes first

There’s no substitute for a healthy diet. Most people don’t eat enough fruits and vegetables (especially dark green leafy vegetables). In addition, a balanced diet includes a variety of whole grains, beans and legumes, eggs, lean sources of protein, low-fat sources of calcium, and fatty fish. For older adults who cannot afford healthy food, don’t have access to a variety of foods, or can’t prepare meals, recommend additional dietary supplements for general health. This could include a 100% recommended dietary allowance multivitamin, calcium, vitamin D, and fish oil (smokers and past smokers should not take any supplements with beta-carotene to reduce the risk of developing lung cancer).²

Because diet is a risk factor in AMD, it’s particularly vital to address. Of the carotenoids, only lutein and zeaxanthin are found in the lens and retina. In the AREDS2 study, people with low dietary levels of lutein/zeaxanthin who took the L/Z supplement decreased the risk of developing advanced AMD.³ So, encourage foods high in lutein and zeaxanthin, such as kale, spinach, collard greens, egg yolks, pistachios, corn, green peas, summer and winter squash, persimmons, Brussels sprouts, and broccoli.

Even though adding omega-3 fatty acids did not improve the AREDS formulation for reducing the incidence of AMD, vegetarians and other people who don’t eat fatty fish may have low levels of the omega-3 fatty acids DHA and EPA. DHA builds and repairs the retina, and research suggests that DHA and EPA are useful for treating dry eye syndrome.⁴ Therefore, suggest a fish oil supplement for non-fish eaters.

Supplement overview

Many people take supplements hoping to find magic in a bottle. They hope that popping a pill provides an easier solution to staying healthy and maintaining eye health than eating the right foods. Eye supplements can be expensive, so they should have a specific purpose. When suggesting a supplement, all of the nutrients and amounts should match the AREDS2 formula.

AREDS2 formula

 500 mg vitamin C

 400 IU vitamin E

 2 mg copper

 10 mg lutein and 2 mg zeaxanthin

 1000 mg omega-3 fatty acids (350 mg DHA and 650 mg EPA)

 25 mg zinc

It’s impractical to get these amounts of nutrients from food. For example, the dietary equivalent of 500 mg of vitamin C is one orange, one cup of orange juice, 1½ cup of strawberries, one cup of red pepper, one large tomato and one kiwi. Ensuring proper nutrients and amounts helps patients get the same results as the NEI’s study while avoiding possible unintended and undesirable consequences not related to eye health.

This high dose of vitamins and minerals is a great option for many AMD patients. However, since the AREDS study found that the formulations did not offer protection from developing early AMD, the supplement should only be recommended to people with intermediate or advanced AMD.⁵ For other patients, a daily multivitamin, which contains nutrients not in the AREDS formulation, may aid in overall health and lower the risk of cataracts.⁶

Look with a critical eye

Supplements are not approved, tested, or guaranteed for safety by the government. Patients, especially older adults, need to be informed of the benefits as well as the risks, how much to take of them and for how long.

After confirming that the supplement has benefits by researching the AREDS and AREDS2 large, randomized clinical trials, read the label.

The Supplement Facts panel lists the contents, the amount of active ingredients per serving and other added ingredients, such as fillers, binders and flavoring ingredients. The label is useful to spot potential allergies. However, since the supplement industry isn’t regulated, some supplement labels may not contain the listed ingredients. Also, the supplement may contain more or less of the proper nutrient amounts, or they may contain additional and sometimes harmful ingredients.

If you have questions, check the label for the manufacturer’s contact information. Some independent organizations test supplements to guarantee the potency and the lack of contaminants — but not the supplement’s safety or effectiveness. When choosing supplements, look for a seal of approval on the label from one of these organizations:

• US Pharmacopeia. Labeled as USP. (www.usp.org).

• ConsumerLab.com. Labeled as CL.

• NSF International. Labeled as NSF (www.nsf.org).

Also, be aware of any claim on the label that might be misunderstood, such as “proven to prevent blindness.” For more on false advertising, visit the Federal Trade Commission’s website (http://www.ftc.gov). When recommending a supplement, be sure that claims are backed by scientific evidence from a reputable source. Don’t make a decision on just one study. (See “Supplement sleuth”.)

Supplement sleuth

The FDA suggests using caution if you see these statements:

 It’s totally “safe” or “all natural” (lead is natural).

 There are personal testimonials with amazing results.

 It will cure a disease.

 It offers a no-risk “money-back guarantee.”

 There’s a limited availability (“buy now”).

Conclusion

Food should always act as the first line of defense for good eye health and preserving vision. But, the general public may not get enough nutrients to maintain ideal eye health, so you should have a thorough knowledge of “eye-friendly” foods.

Also, with eye diseases such as AMD, research shows that patients can benefit from the ARESD2 supplement, and other supplements may fill nutrient gaps. Be equipped to know the most beneficial supplements and how to use them based on the most up-to-date science and facts. OP

REFERENCE:

Ruth Frechman, MA, RDN, CPT, is the owner of On the Weigh in Burbank, CA, and author of the multi-award winning book, “The Food Is My Friend Diet.” Email her at Ruth@RuthFrechman.com.