Age-Related Macular Degeneration: Nutritional Therapies

Question: “I was diagnosed with the beginnings of dry macular im 63, female , could u recomend a supplement for me? im taking for 6 months now a formula that is Ronald Hoffman’s Ocular support. 60veggie caps 2 a day $30.00, i have been using that. What do u recommend?
thx julieann”

Answer: Age-related macular degeneration (AMD) is a leading cause of permanent vision loss in the elderly. It is considered to be irreversible, so prevention is important. Treatment with dietary supplements is accepted medically.

There are two forms, dry AMD and wet AMD. Ninety percent of the time, it is the dry form. The wet form of AMD usually begins as the dry form.

According to the Merck Manual of Diagnosis and Therapy, the treatment for AMD is (1) Dietary supplements (dry or wet), (2) Intravitreal anti-vascular endothelial grow factor drugs or laser treatment for wet AMD, and (3) supportive measures.

The acceptance of dietary supplements by conventional medicine as a treatment for AMD is due in part to a study published in the October 2001 Archives of Ophthalmology, publicized by the National Eye Institute, National Institutes of Health in 2001. The headline read “Antioxidant Vitamins and Zinc Reduce Risk of Vision Loss from Age-Related Macular Degeneration.”

While the study concluded that what they considered “high levels” of antioxidants and zinc significantly reduced the risk of advanced age-related macular degeneration (AMD) and its associated vision lossm, they were unable to demonstrate the same effect on the development or progression of cataract.

“Scientists found that people at high risk of developing advanced stages of AMD, a leading cause of vision loss, lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc. In the same high risk group — which includes people with intermediate AMD, or advanced AMD in one eye but not the other eye — the nutrients reduced the risk of vision loss caused by advanced AMD by about 19 percent. The clinical trial — called the Age-Related Eye Disease Study (AREDS) — was sponsored by the National Eye Institute (NEI), one of the Federal government’s National Institutes of Health.”

Now, before we talk specifically about nutritional supplements and age-related macular degeneration, I want to focus on a common mistake most people make. When a study such as this is published, and a particular combination of nutrients, at a certain dosage level, results in a positive outcome, the tendency is to run out and purchase a product that duplicates that regimen. The thinking is that this must be the optimal combination, the optimal dose, etc. That is not necessarily true.

In most studies of this type, the researchers did not compare different formulations and dosages to determine which combination and/or dosage was optimal. Instead, they sat down beforehand and decided what to use. Sometimes that decision is based upon the fact that a certain product is being provided to them. Oftentimes, the decision is based on previous research. Sometimes it merely a “best guess.” Rarely, if ever, should you conclude that the formula used is necessarily the best, because that type of comparison is not usually part of the study.

In the case of this AREDS study, the antioxidant formulation contained a combination of vitamin C, vitamin E, and beta-carotene. The specific daily amounts of antioxidants and zinc used by the AREDS researchers were 500 milligrams of vitamin C; 400 international units of vitamin E; 15 milligrams of beta-carotene; 80 milligrams of zinc as zinc oxide; and two milligrams of copper as cupric oxide. How did they come up with this combination? “In the study’s planning stages, a panel of nutritionists, ophthalmologists, and biochemists reviewed the basic science and epidemiological data and recommended these vitamins and dosages.”

So when the results were published, everybody ran out to buy formulations that mimicked this exact formula. And this might be a big mistake.

For one thing, in the actual study, they divided the participants into four groups. One group received the antioxidants alone (i.e. no zinc). Their risk of AMD was reduced by 17 percent, and risk of vision loss reduced by 10 percent. Another group received zinc alone (i.e. no antioxidants). Their risk of AMD was reduced by 21 percent and risk of vision loss reduced by 11 percent. The third group received a combination of antioxidants plus zinc. Their risk of AMD was reduced by 25 percent and risk of vision loss reduced by about 19 percent. A fourth group received a placebo.

What, then, is the proper conclusion? Do we look at this and run out to purchase a mixture of Vitamin C 500mg, Vitamin E 400IU, beta-carotene 15 mg, zinc 80 mg, and copper 2 mg? Many people do. Or do we say, “Wow! Antioxidant vitamins and minerals do indeed seem to have a profound effect on preventing AMD. Since I’m at risk, I certainly should make sure I am taking ample amounts of these nutrients as part of my supplement regimen.”

Do we look at this “AREDS” formula, and ask whether it would be better if we took natural vitamine E rather than the synthetic version they used? Even better, should we take a natural mixed tocopherol vitamin E. If the AREDS formula lists “dl-alpha tocopheryl acetate,” that is synthetic vitamin E.

Do we look at this “AREDS” formula and ask whether it would be better if we took natural beta-carotene rather than synthetic beta-carotene? Even better, would there be even more benefit if there was some actual vitamin A in the formula, rather than just beta carotene?

Do we look at this “AREDS” formula and ask whether it would be better if we took chelated zinc and copper rather than the oxide?

Do we look at this “AREDS” formula and ask whether it would be better if we included lutein and zeaxanthin in the regimen? Do we ask “if this collection of basic antioxidants was so helpful, might it not be even better if we included a broader selection of potent antioxidants in the regimen, antioxidants such as alpha-lipoic acid, glutathione and/or glutathione precursors, manganese, and phyto antioxidants such as those found in billberry, ginkgo, grape skin.
The researchers demonstrated that one particular mixture of antioxidants was significantly beneficial in reducing AMD. They did not prove that this was the best mixture. They did not prove that other, similar mixtures might not be even better.

My advice–probably obvious by now–is to looks at the bigger picture. You don’t need an “AREDS” formula. Instead, you need to make sure your total supplement regimen includes those nutrients–and more. You are probably already getting those nutrients, at those levels, in the various nutritional supplements you already take. The lesson you should be taking away from this research is that antioxidants are a key to the prevention and treatment of AMD.

You certainly do not want to limit yourself to an “AREDS” formula alone. There are other nutrients (lutein, omega-3 oils, vitamin A, ginkgo biloba, bilberry, goji, selenium, n-acetyl cysteine, alpha-lipoic acid, coenzyme Q10 or ubiquinol, acetyl-l-carnitine, etc) that are important. And tying all of this together with a good broad spectrum multivitamin multimineral is essential.

On a personal note, my primary area of health vulnerability is my eyes. I have had cataract surgery. I am already suffering partial visual field loss due to glaucoma. I have a family history of glaucoma. I was extremely myopic, which increases my potential for various retinal damage. Adjusting my supplement protocol to accommodate this problem is of the highest importance to me. I do not take an “AREDS” formula. Instead, I apply the lesson learned from that research by including the following products in my daily supplement regimen:

* Antiox Phyto Complex (Willner Chemists, Code: 57091)
This is a powerful blend of antioxidants from plant extracts (Acai Berry, Mangosteen, Goji, Pomegranate, Green Tea, Grape Skin and Grape Seed). Dose: One capsule twice a day.

* Blackcurrant with Lutein (Jarrow Formulas, Code: 55410)
Each capsule contains 200 mg of black currant extract, along with 10 mg lutein and 400 mcg Zeaxanthin. Dose: One capsule twice a day.

* Omega Vision (Nordic Naturals, Code: 55601)
A blend of omega-3 fish oil (High DHA to EPA ratio) with extra lutein (10 mg per softgel) and zeaxanthin. Dose: One or two softgels, twice a day.

* Willvite Multivitamin Multimineral (Willner Chemists, Code: 30439)
A full spectrum, balanced multivitamin multimineral, with calcium and magnesium. It provides 30 mg of zinc, as an amino acid chelate and 2 mg copper, as the gluconate. It also provides 300 IU of natural vitamin E and a total of 20,000 IU of vitamin A. That 20,000 IU of vitamin A is divided as follows: 15,000 IU as natural beta-carotein and 5,000 IU as actual, preformed vitamin A. This is a bonus when it comes to various conditions, including AMD prevention. And finally, it also includes 1000 mg of vitamin C, as ascorbic acid and calcium ascorbate along with all the other B-vitamins, trace minerals, etc. Dose: 2 tablets, two times a day.

* Alpha Lipoic Sustain 300 with Biotin (Jarrow Formulas, Code 59190, 32968)
A powerful, fat soluble antioxidant. It has been shown to have special value in glaucoma and diabetes. Dose: One tablet twice a day.

* Ubiquinol 100 mg (various brands, Jarrow Formula QH-Absorb Code: 59922)
Powerful antioxidant. Look for “Kaneka” trademark symbol. Dose: One softgel, two times a day.

* Antiox Phyto Blend (Willner Chemists, Code: 57551)
This is optional. It is similar to the Antiox Phyto Complex, above, but is a liquid (dropper bottler) rather than a liquid-filled capsule. I add a dropper ful of Antiox Phyto Blend to my bottled water, my evening Margarita, as a way to get additional phyto antioxidants. It contains Acai, Mangosteen, Pomegranate and Goji. It has a mild, berry flavor and easily blends in with water, etc.

Now, this is not my total supplement regimen. I also take extra vitamin D3, GPLC (Glycine Propionyl-L-Carnitine, Probiotics, etc). But these are those products I count on to provide the specific nutrients shown to be protective (and perhaps therapeutic) for AMD prevention and other eye problems.

Getting back to the original question, no one product is going to be the answer. You need a broad spectrum multivitamin multimineral. You need extra antioxidants, both regular (vitamins such as lutein, vitamin A, vitamin C, etc) and plant derived (phyto antioxidants such as ginkgo, billberry, goji, grape skin, etc). You need fish oil omega-3’s, in therapeutic quantity. You need a comprehensive supplement regimen, not a single “eye,” “vision,” or “AREDS” formula.

If you need help deciding on a supplement program for this problem, or others, you are welcome to consult with the pharmacists and nutritionists at Willner Chemists. We will evaluate your current supplement regimen, and offer suggestions for improvement or optimization. Stop by any of our stores, or call 1-800-633-1106. An in-person visit is always best, but we will do our best to help you over the telephone if you cannot come to the store.

Don Goldberg, R.Ph.
Willner Chemists

About Don Goldberg

Hello. I am what you might call a Nutritional Pharmacist. After college, I worked in the Pharmaceutical and Nutritional Industry, first in Quality Control, and then in Manufacturing and Product Development. Increasingly, as the years passed, I became more involved with nutritional supplements. I spent many years detailing physicians, herbalists, and homeopaths about nutritional and herbal therapies and products. In 1992, along with my friend Arnie Gitomer, I bought Willner Chemists, a well-established nutritionally oriented pharmacy. For the first time, I had an opportunity to communicate directly with the consumer, the patient, and the customer. I love it. This blog is an additional way for me to extend my personal views and opinions directly to you. You can also hear me on the radio, every Sunday, from 2 to 4 pm on WOR radio in NY (710 AM), or WGKA in Atlanta (920 AM). Or check our website, www.willner.com.
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One Response to Age-Related Macular Degeneration: Nutritional Therapies

  1. superior says:

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