Vitamin & Mineral Supplements

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Background

Physicians long debated whether taking vitamin and/or mineral supplements could help prevent or slow down age-related macular degeneration (AMD). This debate ended in 2001 with the publication of the results of the Age-Related Eye Disease Study (AREDS). This study evaluated over 4700 patients and proved that a supplement combining zinc and several anti-oxidant vitamins is beneficial for people with macular degeneration. This summary will answer several questions about AMD and supplements.

What is AREDS?

The Age-Related Eye Disease Study (AREDS) was a major study sponsored by the National Eye

Institute (NEI), one of the Federal Government’s National Institutes of Health, and conducted at eleven major medical research facilities around the U.S. In the study, scientists looked at the effects of zinc and antioxidants, and a combination of both, on patients with cataract, and on those with varying stages of age-related macular degeneration (AMD). They also studied patients without evidence of cataract or AMD to determine if the supplements can prevent the development of these conditions.

What were the results?

The study showed a number of important things:

High levels of antioxidants and zinc can reduce the risk of vision loss from advanced AMD by about 19% in high-risk patients (patients with intermediate AMD or advanced AMD in one eye but not the other).
Supplements do not provide significant benefit in patients with no or minimal AMD.
These nutritional supplements do not prevent the initial development of AMD, nor do they improve vision already lost to AMD.
Nutritional supplements do not seem to prevent cataracts, or to keep them from getting worse over time. While most patients in the study experience no serious side effects from the doses of zinc and antioxidants used, a few taking zinc alone had urinary tract problems that required hospitalization. Some patients taking large doses of antioxidants experienced some yellowing of the skin. The long-term effects of taking large doses of these supplements are still unknown.

Should I take nutritional supplements?


click here to go to Focus Macula Pro site

If you have intermediate AMD (or advanced AMD in one eye only) talk to your physician about taking nutritional supplements

. He or she can help you determine if they may be beneficial--and safe--for you, and what types and doses of supplements to take. The doses used in the study were:

Vitamin C 500mg
Vitamin E 400 IU
Beta-carotene 25000 IU
Zinc 80 mg as zinc oxide
Copper 2 mg as cupric oxide (copper should be taken with zinc, because high-dose zinc is associated with copper deficiency).

The vitamin preparation used in the AREDS study is commercially available. "Focus MaculaPro", available through Retina Specialists' offices, adheres closely to the AREDS formula. Other widely available products include Ocuvite-PreserVision, and ICaps. Unfortunately, many vitamin products promoted to the public for AMD depart substantially from the above formulation. It is important to realize that the AREDS formula is the only combination of vitamins and minerals with well-designed scientific proof of effectiveness for AMD.

What if I am a smoker or former smoker?

Smokers and ex-smokers probably should not take beta-carotene, as studies have shown a link between beta-carotene use and lung cancer among smokers. "Smokers formula" versions of AREDS-type vitamins that replace beta-carotene with Lutein are available.

What about Lutein and Omega-3 fatty acids?

The original AREDS study did not investigate whether supplements of lutein and/or omega-3 fatty acids were of any benefit. While some physicians believe that they may be helpful, there is no definitive evidence of benefit at this point. A second study, "AREDS II", is investigating lutein and omega-3 supplements. Results are expected by early 2013.

Are dietary factors important? Dark Green Leafy Vegetables – Disease Fighters

While we do not yet have firm evidence that supplements of Lutein are helpful, diets rich in foods containing lutein may be beneficial. Researchers from Harvard University found that people who eat the most lutein-rich foods are 43% less likely to develop age-related macular degeneration. People most protected from age-related macular degeneration eat 5 or more helpings of spinach or collard greens per week. Lutein, a form of beta-carotene, is most highly concentrated in dark green leafy vegetables: mustard greens, collard greens, spinach and kale. Another benefit of a diet rich in vegetables is a decreased risk of cancer and cardiovascular disease. These greens are available at your local grocery store and each helping must be at least ½ cup cooked or raw.

Patients taking the anticoagulant Coumadin should not increase the amount of green and leafy vegetables without consulting their physician.

Where can I get more information?

More information on AREDS is available from the National Eye Institute, www.nei.nih.gov

You can also get trustworthy information from the American Academy of Ophthalmology's partner Web site: www.geteyesmart.org