Recommending ocular supplements blindly: more harm than good?

By Dr. Renee Rambeau,

The media is full of mixed messages, bombarding consumers (our patients) with unbelievable amounts of advertising including hundreds of messages about health, wellness and nutritional supplements.

As doctors, our patients look to us for sound advice regarding the addition of vitamins as prevention and treatment for ocular conditions including blinding eye disease like age-related macular degeneration. With the recent publication of the AREDS 2 study, the picture seems to be even more muddled than before. This post will help to clarify this controversial topic.

Research

– AREDS (NEI sponsored study) and other research published in the last several years have consistently produced statistically significant results that highlight the importance of recommending lutein & zeaxanthin to slow the progress of AMD. Few ODs would argue these results.  These studies show a minimum of 10mg/day of lutein and 2mg/day of zeaxanthin. So where is the controversy?

Supplements: empty promises?

Supplements are a dime a dozen but which products really contain the quality ingredients the labels promote?

-Just recently, major headlines were made by the New York Attorney General Eric Schneiderman requesting that hundreds of supplements be pulled from the shelves after a study by Clarkson University demonstrated that 4 of 5 supplements contained none of the ingredients listed on the label.

– Another study published online in the American Academy of Ophthalmology Journal in the fall of 2014 concludes that the “majority of top selling ocular nutritional supplements did not contain identical ingredient dosages of the AREDS or AREDS 2 formulation”.

Prescribing supplements

With all this conflicting information, what do we prescribe for our patients? And yes, I did say prescribe…after all we don’t hesitate to choose the proper antibiotic or intraocular pressure lowering drop if indicated by exam findings. Why should we hesitate to prescribe a product that research has proven to help slow the progression of a blinding eye condition?

The first recommendation is always whole foods; incorporating a variety of fruits and vegetables into a daily diet and aiming for 7-10 servings of these nutrient rich foods every day and a goal of 10mg of lutein and 2mg of zeaxanthin.  Here are just a few examples of dietary sources of these powerful antioxidants.

Good Food Sources of Lutein and Zeaxanthin (mg/serving)

Food/Serving
(1 cup)
Lutein and
Zeaxanthin
Lutein Zeaxanthin
Kale 20.5 – 26.5* 1.1 – 2.2*
Collard greens 15.3 5.1
Spinach 3.6 – 12.6* 1.7 – 13.3* 0.5 – 5.9*
Turnip greens 12.1 0.4
Broccoli 2.1 – 3.5* 1.4 – 1.6*
Corn, yellow 1.4 – 3.0 0.6 0.9
Peas, green 2.3 2.2
Orange pepper 1.7
Persimmons 1.4 0.8
Tangerine 0.5 0.2

*depending on variety and preparation

Source: USDA-NCC Carotenoid Database, 1998                                                                                                                        USDA Food Nutrient Database for Standard Release 13                                                                                          Hart and Scott, 199 HHN-1550B/0502

What happens if the patient in my chair is unwilling to try whole foods?  If the patient in my chair is hesitant to change his/her diet (or limited by other health conditions), my second recommendation is Juice Plus. Juice Plus is whole food nutrition in a capsule. The product is produced by dehydrating whole foods (fruits, berries and vegetables), utilizes a nutrition label instead of a supplement label and is backed by a significant amount of clinical research.

 

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