Pick up a gray saucer and hold it in front of you, about a foot in front of your face. Now, if you could make everything surrounding that saucer appear slightly blurry, you’d have an approximation of what the world looks like for someone who has advancedstage macular degeneration.
The grayed-out blob in the center of the field of vision hovers right where the face would be if you were conversing with a family member across the breakfast table. It squats right where the printed page would be if you were reading a newspaper or a book. So, someone with advanced-stage macular degeneration in both eyes would not be reading this chapter. And, unfortunately, there is nothing in this chapter that could help restore their vision.
If, however, you have advanced-stage macular degeneration in just one eye, or if you’ve been diagnosed with the disease and are in the early or middle stage, you might benefit greatly from the nutritional approaches described in this chapter. There’s even a good chance that these nutrients will help preserve your vision over the long haul.
Macular degeneration, or age-related macular degeneration (AMD), as it is sometimes called, is related to the generation of free radicals, explains Robert Anderson, MD, founding member and past president of the American Holistic Medical Association and author of The Clinician’s Guide to Holistic Medicine. Free radicals are naturally occurring molecules that damage the body’s tissues, including the sensitive tissues of the eyes.
Scientists are not yet clear about the exact causes of macular degeneration, says Dr. Anderson, but they certainly know what it looks like.
The macula is composed of light-sensitive cells in the center of the retina, which lines the back inside surface of the eyeball. When ophthalmologists (eye doctors) and optometrists use their special instruments to peer through the iris, they can see through the clear fluid inside the eyeball and look directly at the retina and the macula. While the whole retina is sensitive to light and participates in vision, the macula is the most sensitive part and also the part that provides the clarity in the center of our field of vision. The rest of the retina provides the soft-focused peripheral vision around the edges.
One of the early indications of possible problems in the macula is the appearance of yellowish deposits known as lipofuscin on the macula, says Dr. Anderson. Lipofuscin is a “degenerative compound” that gets deposited in many places in the body, including the eyes, as we age, he explains.
Does free radical damage actually cause or contribute to these deposits? That’s not clear. However, in the eyes, lipofuscin causes lumpy extrusions known as drusen that can distort the vision. For many people with macular degeneration, the first hint of the disease comes when they notice visual distortions, such as a blurry spot or straight lines that seem wavy in places. (Both symptoms should trigger a visit to an ophthalmologist for an eye exam.)
Many people, however, learn that they have the beginnings of AMD when they go in for a new set of glasses. The eye-care professional notices the yellow deposits and lets them know that they have AMD.
AMD is not a diagnosis that you want to hear, because if the disease progresses unchecked, it can lead to partial blindness—that hovering gray spot that takes away the ability to read, to see faces, and to drive. However, if you have AMD, you for sure want to know that you have it. That’s because there’s a lot you can do to keep the disease from progressing.
Remember that mention of free radicals? What mops up free radicals? Antioxidants! Antioxidants, of course, are nutrients, including many of the essential vitamins and minerals found in an ordinary, everyday multivitamin, things like vitamins A, C, and E. Whether the lipofuscin disappears or not, scientific studies have shown that in many cases, taking high doses of antioxidants can hold back the progression of the disease and in some few lucky individuals even reverse it, says Dr. Anderson.
There’s a good chance that you can postpone further damage for “several decades,” says Dr. Anderson. For most of us, that’s quite enough to last us for the duration.
Before we get to Dr. Anderson’s dietary recommendations, let’s take a look at a major, government-sponsored scientific study on the role that nutrients can play in treating macular degeneration. Not surprisingly, that study also points to the power of antioxidants.
The National Eye Institute’s Age-Related Eye Disease Study (AREDS) lasted 10 years and involved some 3,600 participants. Results, which were released in 2001, showed that high doses of antioxidants do indeed “hold back the progression” of macular degeneration for many people.
What does holding back the progression mean for people in real terms? It means that if you have mid-stage macular degeneration, if you take these nutrients, you may never, ever get the advanced stage of the disease and lose your vision. It means that if you have advanced-stage macular degeneration in just one eye, and take these nutrients, you may never get the advanced stage of the disease in the second eye. You preserve the vision in that healthy eye.
Beta-carotene |
15 milligrams |
Vitamin C |
500 milligrams |
Vitamin E |
400 IU |
Zinc (in the form of zinc oxide) |
80 milligrams |
Copper (in the form of cupric oxide) |
2 milligrams |
Should you take the AREDS formula? The researchers who conducted the study suggest that you discuss the formula with your doctor because these amounts are higher than government experts typically recommend for these nutrients.
We’re going to look at each of these nutrients individually, and in some cases raise the possibility that you might want to consider taking even more than the amounts recommended in the formula. It’s always a good idea, when you’re dealing with a serious disease such as macular degeneration, to discuss all supplements that you wish to take with your doctor.
A second study, known as AREDS2, is currently under way. It involves even more study participants and is looking at a couple of additional nutrients: lutein, zeaxanthin, and omega-3 fatty acids, particularly the essential fatty acids EPA and DHA. We’ll look at all of these nutrients individually as well.
The one thing that stands out about the AREDS study is that, with the exception of copper, all of the other nutrients in the winning formula are included because they are antioxidants. Copper is in the formula because you need it in order for the zinc to do its job.
Supplements can be a good thing when you need extra nutrients in order to heal, but don’t let supplements overshadow the importance of food. Your regular, everyday diet needs to be full of foods that are rich in antioxidants, says Dr. Anderson. This means that you need to be eating lots of colorful fruits and vegetables. You should also include nuts, seeds, and whole grains in your diet, he says.
People with macular degeneration should concentrate especially on leafy greens, says Dr. Anderson. Make big, colorful salads a part of your regular menu. Enjoy things like spinach and kale. There are many, many kinds of antioxidants that were not specifically tested in the AREDS study. But this doesn’t mean that they don’t play a role in protecting your eyes.
Now let’s look at individual nutrients that can be helpful.
Bioflavonoids are phytonutrients that are helpful to the eyes, says Dr. Anderson. You get a variety of bioflavonoids from fruits and vegetables. Pay special attention to blueberries, he says.
You might also take a supplement such as grape seed extract, bilberry extract, or mixed bioflavonoids. Follow the directions on the package.
Carotenoids are orange and yellow pigments found in many foods. Yep. When Grandmother said that carrots are good for the eyes, she apparently knew what she was talking about. Two carotenoids—lutein and zeaxanthin—are not just important for the macula; they are actually a part of its composition. That’s why the macula looks yellow when you peer into the eye.
You’ll find rich supplies of lutein, zeaxanthin, and other carotenoids in many foods, says Dr. Anderson. Especially good choices include kale, collard greens, spinach, Swiss chard, red peppers, okra, parsley, dill, celery, blueberries, carrots, tomatoes, corn, egg yolks, and paprika. Obviously, not all of these foods are yellow and orange, but the pigments are still there. They’re just masked over by other healthful pigments.
One small study done at Tufts University and published in 2008 found that taking a lutein supplement apparently even offers some protective effects against the development of macular degeneration in the first place.
Lycopene, found in tomatoes, is another carotenoid that’s helpful for macular degeneration, says Dr. Anderson. It’s not quite in the category of lutein and zeaxanthin, but it’s still worth paying attention to, he notes.
Besides getting more carotenoids in foods, it’s also possible to take a mixed carotenoid supplement. Dr. Anderson recommends getting at least 7,000 to 9,000 milligrams of mixed carotenoids per day.
Beta-carotene, a precursor to vitamin A and included in the AREDS formula, is another of the carotenoids. The formula calls for 15 milligrams, which is a fairly hefty amount, given that one study found that amounts far less than this apparently can increase the possibility of smokers getting lung cancer. Of course, if you smoke, you should do everything you can to quit, as smoking contributes to the progression of macular degeneration. But even if you’re a former smoker, you should discuss the 15-milligram dose with your doctor and let him or her know that you used to smoke. Your doctor will evaluate your risks and may well advise you to take the supplement anyway.
Whenever you take a zinc supplement, you also need to get a little copper in order for the zinc to do its job. If you take zinc as recommended in the AREDS formula, make sure you include copper in your daily supplement regimen.
Copper also plays another role, says Dr. Anderson. It helps the body manufacture a powerful antioxidant—superoxide dismutase (SOD). Dr. Anderson suggests getting 2 milligrams, the amount called for in the AREDS formula.
Minerals are essential for a number of reasons. Among other things, says Dr. Anderson, several of them help the body manufacture a couple of antioxidants such as SOD and glutathione. He recommends taking 2 milligrams of manganese.
A review of nine major studies published in 2008 found that the omega-3 fatty acids contained in fish oil reduced the risk of developing AMD by 38 percent. These oils also somewhat reduced the risk of developing AMD early in life. (Typically, the disease shows up after age 60, but can appear much earlier in some individuals.)
Does that mean you should take fish oil? Not necessarily. However, it’s worth noting that omega-3s are being studied as part of AREDS2.
It certainly can’t hurt to add more fish to your diet; fatty types such as wild-caught salmon, tuna, anchovies, and sardines are particularly good sources of omega-3s. And if you do choose to try fish oil, for many other conditions in this book, experts have recommended taking 1 to 2 grams of fish oil daily in order to get more of the essential omega-3 fatty acids EPA and DHA.
The mineral selenium helps the body manufacture glutathione, its own powerful antioxidant, says Dr. Anderson. He recommends taking 200 micrograms.
Vitamin C is an antioxidant that can “help slow the progression of all degenerative diseases,” says Dr. Anderson.
Although the government’s Reference Daily Intake is low—just 60 milligrams—vitamin C is safe in much higher amounts. Health experts often recommend amounts far higher than the 500 milligrams called for in the AREDS formula. Many naturopaths and holistic physicians routinely suggest that their patients take thousands of milligrams daily for a variety of conditions, including for the prevention of colds and flu.
Dr. Anderson suggests taking 2,000 milligrams daily for macular degeneration.
If you take more vitamin C than your body can handle, it can trigger diarrhea. In the unlikely event that 2,000 milligrams triggers this side effect, you can divide the dose and space it throughout the day or back off on the amount until you find a dose that doesn’t cause discomfort.
Most studies show that the benefits of vitamins C and E are enhanced when the two are taken together, says Dr. Anderson. He recommends taking 400 IU of vitamin E daily, the amount suggested in the AREDS formula.
Most people simply don’t get enough zinc, says Dr. Anderson. The Reference Daily Intake is just 15 milligrams, and that’s the amount that Dr. Anderson suggests taking for macular degeneration.
Interestingly enough, the AREDS formula calls for a much higher amount—80 milligrams in the form of zinc oxide. In the AREDS study, researchers looked at the effects of antioxidants alone, zinc alone, or a combination of antioxidants and zinc. They found that antioxidants and zinc each had some beneficial effect when taken alone, but that the combination had a more powerful therapeutic effect.
In the AREDS study, people taking zinc at this high dose experienced a slight increase in urinary tract problems. So this is another supplement to discuss with your doctor. Your doctor will consider your personal risk factors and may suggest that you take a lower dose.
If you take a multivitamin, remember to factor in the amount of zinc that’s in the multi.
If you have macular degeneration, you should be under the care of a doctor. Please discuss any supplements you wish to take with your doctor before proceeding. You might want to take a multivitamin to make sure that you’re covering all your nutritional bases.
Beta-carotene* |
15 milligrams |
Copper |
2 milligrams |
Manganese |
2 milligrams |
Mixed bioflavonoids |
Follow package directions. |
Mixed carotenoids |
7,000 to 9,000 milligrams |
Omega-3 fatty acids |
1 to 2 grams of fish oil† |
Selenium |
200 micrograms |
Vitamin C |
2,000 milligrams |
Vitamin E† |
400 IU |
Zinc‡ |
15 to 80 milligrams |
*This is an extremely high dose of beta-carotene. If you smoke or are a former smoker, make sure you let your doctor know that when you discuss this particular supplement.
† Fish oil has a blood-thinning effect. So does vitamin E. If you’re taking any kind of blood-thinning drug, talk to your doctor before taking these supplements.
‡ In the AREDS study, a small percentage of people taking 80 milligrams of zinc oxide experienced urinary tract problems. Make doubly sure that you discuss this supplement with your doctor.