February is AMD Awareness Month

… a good time to think about nutrition in eyecare

By: Larry A. Hookway

I tend to spend time speaking to my patients about nutrition.   I think nutrition education is a major failing of our health care education and is often either, at best, ignored by most health care providers or, at worst, bad advice is given.   In addition, the media constantly often reports sensational results of new studies that are often contradictory which makes it hard for our patients to know what to do.

The supplements that I discuss with patients are in the following list:

AMD

• Eat spinach, kale, collard greens, orange bell peppers, egg yolks and cold water fish. These provide lutein, zeaxanthin, and omega 3 from whole foods (always the best way).
• Mild Dry AMD
  • Good   Lutein 10mg   Zeaxanthin 2mg
  • Better    One of the supplements sold only in doctors’ offices (MacuHealth, Restore, MaxiVision, etc)

Explanation to patient:   These supplements build up the macular pigment level to an optimal level.  The macular pigment is a yellow filter that filters out high energy blue light and not only helps protect the delicate photoreceptors but also improves vision by reducing the glare caused by the blue light.  (Like having yellow sunglasses built right into the retina).

• Moderate to Severe AMD AREDS 2 formula

Explanation to patient: The largest study shows that people with moderate to severe have 25% less vision loss if they take this supplement.  There is a controversy now about whether zinc is good for all patients.  The jury is still out on this with some experts saying that we need to do genetic testing to determine if it is safe.

Dry Eye

• Good: 1000 to 2000mg of Omega 3 in Fish Oil

Explanation to patient:  Dry eye is a chronic inflammatory process in the eyelids.  Fish oil is anti-inflammatory and also helps the eye produce its normal oil layer. As a bonus fish oil lowers bad LDL cholesterol and triglycerides and increases HDL (good) cholesterol.  (do not use if taking Coumadin).

• Better: Supplements like BioTears, MaxiTears and EZ Tears. These have Omega 3, some have black currant seed oil which is an anti-inflammatory Omega 6 (GLA ) and some have turmeric, Vitamin E and green tea leaf extract.  BioTears also has lactoferrin which helps prevent infections by viruses and bacteria.

Diabetes

• High Fiber Diet: A study by the University of Texas Southwestern Medical Center showed that people who increased their fiber to 24 to 50mg daily dramatically improved blood sugar levels. This was as effective as some diabetic medications.  (13 servings per day of a mixture of fruits, vegetables, beans, brown rice, and whole grain bread or pasta)
• Cinnamon: A study by the Human Research Center in Bettsville, Maryland showed that one-half teaspoon of cinnamon daily makes cells more sensitive to insulin. After 40 days the patients experienced lower sugar spikes.
• EyePromise DVS: This elatively new supplement for diabetics was designed by Paul Chous, O.D., a leading speaker and researcher on ocular nutrition. It is designed to maintain healthy blood vessels.  To see the complete ingredient list go to eyepromise.com.

Vitamin D

• In Ohio we should be remind our patients to supplement with Vitamin D in the winter. Vitamin D has large role in immune health, bone and muscle health and is involved in preventing cancer formation.  Some studies estimate that over 50% of adults are deficient.   The minimum daily requirement is 400 IU but this is expected to be increased.   2000 to 4000 IU is considered safe.  The body makes 10,000 units in 30 minutes in the summer around noon with a lot of skin exposed and no sunscreen.   In the winter in Ohio even if you had skin exposed the body would not make Vitamin D.

Future:

We are on the verge of big changes in medicine.  The human genome will enable us to personalize our treatment of our patients. It is also likely that the epidemic of diabetes will lead to research on how to prevent or delay onset of diabetes.

If you are interested in nutrition I recommend ONS (Ocular Nutrition Society) web site:  www.ocularnutritionsociety.org