Robert Abel, Jr., MD
Robert Abel, Jr., MD, ophthalmologist, Christiana Care Health System, Wilmington, Delaware, and former professor of ophthalmology at Thomas Jefferson University, Philadelphia. He is author of The Eye Care Revolution.
Nutrition is a widely accepted ally in the fight against macular degeneration, the leading cause of vision loss in the US. But you can do more to protect your eyes than follow the standard recommendations, according to Robert Abel, Jr., MD, author of The Eye Care Revolution.
Current recommendations emphasize a few key nutrients once you have the disease. According to the National Eye Institute, a specific daily nutritional formula called AREDS—500 mg of vitamin C, 400 IU of vitamin E, 10 mg of lutein, 2 mg of zeaxanthin, 80 mg of zinc and 2 mg of copper—can slow the progression of existing macular degeneration from early stage to its advanced stage.
But Dr. Abel argues that certain foods and supplements are not only effective at slowing the progression of the eye disease but can prevent the disease as well. To be sure, there is no large-scale study proving that any one nutrition formula definitively prevents this sometimes devastating eye disease. But there is a substantial body of evidence that a variety of nutrients, including many that are not currently in the AREDS formulation, are important for prevention, according to Dr. Abel. We also talked to Health Insider’s naturopathic advisor, Andrew Rubman, ND, for his recommendations on nutrient dosages that can protect your vision.
Here’s the plan…
Age-related macular degeneration (AMD) is a condition that causes progressive damage to the delicate center of the retina called the macula. The macula is composed of light-sensing cells that allow us to see objects clearly. If you have AMD, over time you develop a blurry, distorted or dark area near the center of vision that interferes with the ability to see. People with advanced macular degeneration lose the ability to drive, read and recognize faces and, in some cases, they go blind.
The nutrition connection: Because the macula is so sensitive to light, it needs protection against the oxidation caused by exposure to UV radiation as well as environmental toxins and smoking. Many antioxidant nutrients work together to protect the eye and, in particular, the macula from this damage. When the eye isn’t properly “fed,” metabolic waste accumulates in tiny deposits called drusen, leading to AMD.
In short, according to Dr. Abel, AMD develops because our eyes are starved of the nutrients they need to protect themselves.
Docosahexaenoic Acid (DHA)
Why you need it: DHA is an omega-3 fatty acid found in high levels in algae and cold-water fish. Even though the AREDS 2 study didn’t find that omega-3 supplementation slowed progression of AMD, Dr. Abel believes it is key for prevention. DHA is a major component of retina receptors and cell membranes.
Benefit by: Including cold-water fish such as tuna, salmon and mackerel in your diet two to three times a week. Supplement with DHA (500 mg) twice a day. It doesn’t matter whether it’s derived from fish oil or microalgae. Consult your doctor if you are taking a blood thinner such as coumadin (Warfarin)—even aspirin—since DHA also has blood-thinning effects. Dr. Rubman points out that because tuna is likely to contain high levels of mercury, it’s best to limit consumption to no more than twice a week for people who are age 18 and older…and to no more than once a week for people who are younger.
Lutein and Zeaxanthin
Why you need them: The cone cells in the macula have a very high density of yellow pigments, derived primarily from two carotenoids—lutein and zeaxanthin—that neutralize ultraviolet light damage to the retina, filter dangerous wave-lengths of blue light (from TVs, computers, tablets and smartphones) and stabilize the pigment layer beneath the retina.
Benefit by: Eating green leafy vegetables such as spinach, kale, mustard and turnip greens. Supplement with lutein (10 mg) and zeaxanthin (2 mg) daily. According to Dr. Rubman, even higher amounts of these two nutrients might be more beneficial. Check with a doctor who is knowledgeable about supplements for what would be best for you.
Vitamin D
Why you need it: Vitamin D reduces inflammation in the retina by clearing amyloid beta, a waste product that can impair vision. Many studies have found that people who have a normal blood level of vitamin D (30 mg/dL to 60 mg/dL) are much less likely to develop AMD.
Benefit by: Getting your doctor to test your vitamin D level and, depending on the results, taking 2,000 IU to 5,000 IU daily of vitamin D-3.
B-12 and Folic Acid
Why you need them: These B vitamins protect the macula and the optic nerve. A 10-year study published in American Journal of Clinical Nutrition (2013) showed that deficiencies of folic acid and B-12 substantially increased the risk for macular degeneration.
Benefit by: Eating plenty of leafy green vegetables for folic acid. Animal foods (seafood, red meat, poultry) are good sources of vitamin B-12. Supplement with sublingual (under-the-tongue) B-12 (100 micrograms to 500 mcg) and take a folic acid pill or capsule (500 mcg to 1,000 mcg) daily. Dr. Rubman also recommends periodic testing to make sure blood levels of B-12 are adequate.
Vitamin C
Why you need it: Vitamin C protects against free-radical damage from exposure to UV light.
Benefit by: Eating fruits (oranges, grapefruit, strawberries, kiwi, mango, pineapple) and vegetables (broccoli, kale, peppers). Supplement with vitamin C (at least 1,000 mg) daily in a split dose twice a day between meals.
Vitamin E
Why you need it: Highly concentrated in the retina, vitamin E prevents lipid per-oxidation (deterioration of fats) and protects against free-radical damage from UV light.
Benefit by: Taking 400 IU daily with DHA to support the cell membrane function.
Flavonoids
Why you need them: Flavonoids are powerful antioxidants found in a wide variety of plants (especially blueberries and grapes) that improve the eye’s adaptation to darkness (night vision) and improve or retard progression of macular degeneration. Studies find that moderate consumption of wine, which contains not only flavonoids but also other antioxidants, is associated with a lower risk of developing macular degeneration.
Benefit by: Drinking wine in moderation—one glass a day for women and up to two glasses a day for men—if you can drink alcohol safely. Flavonoids, such as bilberry, are widely available in supplement form as well. Dr. Rubman recommends 750 mcg to 1,000 mcg daily of a mixed flavonoid formula.
Taurine
Why you need it: This amino acid, found in high levels in the retina, is thought to protect against both ultraviolet light and toxic substances.
Benefit by: Taking 500 mg daily.
Glutathione
Why you need it: A super antioxidant, glutathione squashes free radicals that can damage vision. If you have macular degeneration, it’s likely that you already have a significantly diminished level of glutathione.
Benefit by: Eating avocados, asparagus, eggs and garlic. And supplement with 500 mg daily, taken between meals with a small amount of fruit.
Garlic
Why you need it: In food or as a supplement, garlic improves circulation, including in the eye. Improved blood flow through the tiny capillaries in the eyes brings in needed nutrients and helps eliminate waste products.
Benefit by: Including garlic in your meals and taking one odorless capsule (100 mg to 1,000 mg, depending on tolerance) daily. You may want to choose an “odorless” garlic supplement, such as Kyolic aged garlic extract.
Magnesium
Why you need it: Magnesium helps improve the function of the small blood vessels such as those found in the eye, which helps to bring in nutrients and eliminate waste products.
Benefit by: Taking 500 mg daily.
Selenium
Why you need it: Selenium, present in very high levels in the eye, protects against free-radical damage from UV light and is needed for the body to take full advantage of both vitamin E and glutathione.
Benefit by: Taking 50 mcg to 200 mcg daily.
Zinc
Why you need it: Zinc, found in high concentrations in the eye (especially in the retina and its underlying tissues), helps bind the protective pigment layer of the retina to the underlying tissue. Zinc also helps to form connections between nerve cells.
Benefit by: Taking 80 mg zinc as zinc oxide daily.
