Q: I’ve read that supplements containing lutein are good for macular degeneration and that the main source of lutein is from dark green leafy vegetables. Are supplements with lutein better than real food?

A: This is one of the most important and insightful questions I’ve ever received. It’s true that macular degeneration is increasing in the population. It’s become a leading cause of visual disability in the western, industrialized world. It’s also true that lutein supplements are recommended by many eye doctors. The interesting part is how lutein was identified as being important in the disease. Researchers looked to see why certain groups did not develop the disease and found that these groups had a much higher intake of dark green leafy vegetables (kale, spinach, chard, collards) than groups that did develop the disease. The increase in the disease also was found to parallel the fact that fewer people in western society eat these vegetables, eating processed foods instead. The researchers then looked at what it was in these vegetables that was protective and came up with lutein and a related compound. So why don’t doctors recommend more kale or spinach for macular degeneration? Great question. Most research is funded by companies with something to sell. It doesn’t help them if you simply buy more vegetables. A large study comparing vegetables to lutein supplements needs to be done, but hasn’t been. To be on the safe side, increase your vegetable intake even if you take lutein supplements. Remember, it isn’t nice to fool Mother Nature.

Q: I was recently diagnosed with macular degeneration. My doctor told me to take lutein tablets. Is this enough?

A: Unfortunately there is not yet an answer to your question. Some of the best published studies on the topic were done at Massachusetts Eye and Ear Hospital, and they showed reduced risk of macular degeneration (ARMD) when patients ate a diet rich in whole spinach. They did not use lutein tablets. Many doctors have assumed that the lutein tablets will give the same protection as whole spinach, but the studies have not yet been done. The truth is we don’t know if they will work as well. Until the answer is in, all patients with ARMD should eat lots of spinach, kale, Swiss Chard, collards and beet greens. Lettuce does NOT count. If you have questions about other ways to reduce the risk of vision loss from ARMD, call our office for free information.

Q: A new large study suggested zinc is important in treating macular degeneration. How much should I take?

A: The Age-Related Eye Disease Study (AREDS) did indeed show that patients taking both antioxidants and zinc did not develop vision loss as severe as those without the supplements. However, the levels of zinc used in the study were very high, and the group taking the zinc had a hospitalization rate 50% higher than the group who didn’t take the zinc. The National Academies maximum safe upper limit (UL) for zinc is 40mg/day. The AREDS study used 80mg/day.

Zinc in high doses is potentially dangerous. It can cause anemia as well as different types of immune system problems. Our office always suggests blood tests to monitor patients who take zinc. It’s also a good idea to monitor copper levels, since zinc can cause copper deficiency. Your doctor should be checking these levels so he or she can adjust your zinc intake accordingly.

Q: How do fats in the diet effect macular degeneration?

A: Research has shown that eating a diet high in Omega-6 fatty acids, such as canola oil, corn oil, safflower oil and other common vegetable oils, increases your risk for heart disease, cancer, auto-immune disease and macular degeneration. This is especially true when the diet is simultaneously low in beneficial Omega-3 fatty acids such as are found in flaxseeds, sardines and wild salmon. “Farmed” or pen-raised salmon does not have the same beneficial fats as wild salmon. Omega-3 oils are lost in even minimal processing of food, but are essential (the body can’t make them) in thousands of biochemical reactions in our bodies.

Trans-fatty acids are also harmful fats, and are commonly found in margarine, snack foods such as crackers and cookies, frozen foods and in foods fried in oils. “Partially hydrogenated soybean oil” is the most common type of trans-fatty acid and should not be eaten.

Q: Do you advise eye supplements such as the commonly advertised brands to prevent macular degeneration (ARMD) for families with a history of it?

A: This is an excellent question, because it cuts to the heart of our current “treatment” of ARMD. First though, it’s important to specify which type of ARMD. Ninety percent of cases are the “dry” form. The remaining “wet” form cases are essentially a different disease, more related to poor circulation in the retina and vascular problems such as poorly controlled hypertension

We don’t know if supplements will prevent ARMD, though the LAST Study at the Chicago VA Hospital suggested that possibility. However, we do know from numerous studies that there are a number of risk factors for the disease. These include low intake of dark green leafy vegetables, low intake of omega-3 fatty acids, exposure to dietary trans-fats, exposure to blue wavelength light, high body fat index, sex (male/female, not how much), smoking and genetics.

Taking a supplement is, in my estimation, inadequate and unproven to protect you if you have a strong family history. Our office has an ARMD Protocol which is discussed with at-risk patients. If you call we will be happy to send it to you.

Q: You recently wrote about a recent study which showed zinc to be important for the treatment of macular degeneration. How do I know how much to take?

A: The Age-Related Eye Disease Study (AREDS) did indeed show that patients taking both antioxidants and zinc did not develop vision loss as severe as those without the supplements. However, neither you nor your doctor knows how much you should take unless he or she sends you in for blood testing.

I recently taught a course to eye doctors at NOVA Southeastern University in Florida. The essence of the class was this; 1) too little zinc means worse macular degeneration and too much zinc means poor absorption of iron, copper and magnesium (anemia). The group in AREDS that took high zinc levels had 50% higher hospitalizations. 2) one and a half years of testing in our office has shown that a high number of macular degeneration patients are very low in blood levels of zinc, but some are normal. So how much is enough? Only blood tests will tell. If your eye doctor isn’t sending macular degeneration patients in for zinc blood tests you need to ask them why not.

Q: Is it true that a study recently reported an improvement in macular degeneration by taking certain nutritional supplements?

A: It is true. For the first time, patients with macular degeneration showed an actual improvement in several important measures following special nutritional supplements. The study, known as the Veterans LAST Study, used special supplements with a form of lutein identical to the lutein found in certain green leafy vegetables. This is important because many if not most of the popular lutein supplements use a different, artificial type of lutein that is suspected by many of being far less effective that the type of lutein used in the study. The study, published in April of this year, was conducted in a large Veterans hospital in the Chicago area. Prior studies have only demonstrated a reduced risk of developing the disease. The LAST Study is the first to show actual improvement in the disease. For more information, call our office.

Q: What is the latest research on lutein supplements for macular degeneration?

A: A study called VETS was just published last month. It used a natural form of lutein called purified lutein crystal as well as a very broad array of antioxidants similar to those found in high quality green leafy vegetables. The study was significant in that it actually showed a slight improvement in the thickness of the macular pigment layer and improvement in several visual functions. Past studies have shown the severity of macular degeneration is directly related to the amount of macular pigment. This was the first study I’ve reviewed that actually showed a reversal, albeit slight, of some of the deterioration caused by macular degeneration.

Purified lutein crystal is an expensive form of lutein. It’s patented under the trade name, “FloraGlo”. Most lutein supplements, and virtually all the inexpensive ones, use a cheaper form called lutein ester that is somewhat different from the form found in real food. There are some studies indicating lutein ester is not as effective as the natural form, but more research needs to be done in this area. Supplement labeling laws do not require manufacturers to specify what form of lutein they use, so most simply list it as “lutein”.

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