Nutrition and Macular Degeneration (MD)

Your eye health
Eating a healthy well-balanced diet should be a part of the management of your health. Eye health is an important part of your overall health program.
The following messages are a guide to eye health. Please consult your health care professional or a qualified nutritionist before making major changes to your diet.

Be aware that some foods may interact with prescription drugs and may not suit your medical conditions.

A summary of the ways to reduce your risk
The risk of developing MD and losing vision to this disease can be reduced if you take the following steps:

• Eat fish two to three times a week.
• Eat dark green leafy vegetables and fresh fruit daily.
• Eat a handful of nuts a week.
• Limit your intake of fats and oils.
• Keep a healthy lifestyle – don’t smoke, control your weight and exercise regularly.
  

Other lifestyle factors to consider are:

• Having your macula checked at least every five years.
• Provide adequate protection from sunlight exposure, particularly when young.
  

The role of Antioxidants
Antioxidants are important to our health. They are found in the foods we eat.

What are antioxidants?
When your cells turn food and oxygen into energy they also produce ‘free radicals.’ These are thought to be a contributing factor in the cause of MD and other diseases.

If your system is operating at peak health the free radicals are neutralised by antioxidants before they can cause damage.

Antioxidants for eye health

Lutein and Zeaxanthin	Lutein is a particularly important antioxidant for eye health. It is present in high concentrations in the macula and needs to be frequently replenished. It is found in dark green leafy vegetables including spinach, silver beet and turnip greens. Also found in sweet corn and egg yolks. For example, half a cup of cooked spinach provides 6mg of lutein, 1 cup of sweet corn provides 2.5mg of lutein and 0.8mg of zeaxanthin.
Vitamin C	It is found in citrus fruit, broccoli, potatoes, capsicum and tomato. For example, 1 cup of red capsicum provides 280mg of Vitamin C.
Vitamin E	It is found in nuts, wheat germ, whole grains and green leafy vegetables. For example, 25 almonds provide 7mg of Vitamin E.
Zinc	It is found in meat, seafood (especially oysters), seeds, nuts and whole grains. For example, 250g of oysters provides approximately 40mg of zinc.

Note: Other antioxidants include bioflavonoids found in bilberry juice.
Their relationship to MD as yet has not been studied in Australia.

Frequently Asked Questions
What sort of fish is best?
Fish is good for you fresh, frozen or tinned. Salmon, sardines and tuna are especially good sources of Omega 3.

Which nuts are best?
Studies have not determined which nut is best. Un-roasted brazil nuts, walnuts, pine nuts and almonds are high in essential fatty acids and are good for your heart and your eyes.

I have trouble eating nuts whole. What can I do?
Consider crushing or grinding nuts and using them raw, for example sprinkled on your cereal.

What about seeds?
Seeds such as flax seeds (linseeds) are often recommended by nutritionists for their health benefit high essential fatty acids content. However their relationship to MD as yet has not been studied.

Should I cook vegetables or eat them raw?
Shredding your vegetables and cooking with a small amount of olive oil improves your body’s ability to absorb the nutrients.

My GP has recommended I don’t eat spinach due to my medications.
How can I get lutein?
A lutein supplement should be safe but always consult your doctor.

Which oils might be harmful to eye health?
American studies have shown that patients eating a lot of vegetable oil, margarine, processed and baked foods containing more oil developed MD and lost vision more rapidly. There is disagreement as to whether this relates to the Australian public. At present, cold pressed olive oil appears to be the safest.
Further research is needed to determine what effect oils have on eye health.
Contact your attending doctor for further advice.

Supplements and Macular Degeneration (MD)

What are supplements?
Supplements are vitamins, minerals or other substances taken in addition to the diet.

What research has been done in relation to supplements and MD?
The Age Related Eye Disease Study No. 8 (AREDS) was a major clinical trial conducted by the National Eye Institute in the U.S.A. The results were published in October 2001 in the journal, “Archives of Ophthalmology.”

What were they researching?
The purpose of the trial was to assess the clinical course, prognosis and risk factors of age related MD. In addition, to evaluate in randomised clinical trials, the effects of antioxidants and zinc on the progression of Age-Related MD.

Who was studied?
A total of 4,757 people were enrolled in the trial. The people studied were categorised into four groups, from those with minimal signs of MD in either eye to relatively severe disease (vision loss in one eye but good vision in the fellow eye.)
People on the trial were followed up on average 6.3 years later.

What were the results?
The study showed that taking supplements containing high levels of antioxidants plus zinc, significantly reduced the risk of developing late stage MD and delayed visual loss.

The study concluded that those in the intermediate stages of MD, i.e. the group most likely to progress to late stages of the disease and experience severe visual loss, reduced their risk by approximately 25% when taking the high dose zinc and antioxidant formula.

In this same group of people, the study found a 20% reduction in the risk of vision loss caused by late stage MD. Positive results were also found in those who took only zinc and those who took only antioxidants; but neither was as effective as the combined formula.

The study was not designed to answer whether high dose antioxidants and zinc are of benefit for those with NO signs of MD or those with advanced disease in both eyes.

Important Information
It is very important for you to discuss any supplementation with your health care professional. They can help you determine which formulation and dosages are best. This is especially important if you are already taking daily vitamin and mineral supplements or are on any other medications. In addition to the study formulation most people also took a daily multi-vitamin. The impact of taking a high dose, long term antioxidant - zinc combination supplements for greater than eight years is not known.

What is the formula?
The specific daily amounts of antioxidants and minerals used by the AREDS study researchers were:
Vitamin C 500mg
Vitamin E 400iu
ß-carotene 15mg
Zinc 80mg
Copper 2mg

Special medical conditions
If you have a medical condition please discuss with your health care professional before making changes to your diet.

Beta-carotene Important Information
People who smoke, suffer from lung cancer or asbestosis should not take a supplement that includes Beta-carotene. This is the reason it has been left out of some products.

It is important to remember that supplements are not a cure for MD. The study shows they slow the rate of degeneration not stop or reverse it.

Disclaimer
Information contained in this fact sheet is considered by the Macular Degeneration Foundation to be accurate at the time of publication. While every care has been taken in its preparation, medical advice should be sought from a doctor. The Macular Degeneration Foundation cannot be liable for any error or omission in this publication or for damages arising from its supply, performance or use, and makes no warranty of any kind, either expressed or implied in relation to this publication.

Frequently Asked Questions
Who should take a zinc and antioxidant formula?
The research at this point tells us that people with intermediate MD taking the AREDS formula benefit the most. Do not prescribe supplements for yourself.

Why take the AREDS formula as a supplement and not through diet?
In general, eating a balanced diet is the best way to obtain your nutrients.
However, where high dose antioxidants are used to treat disease, supplements may be the only way to get the right amounts. For example, to get the same quantities as the AREDS formula you would need to eat 500g of oysters, 2 cups of red capsicum, and 1400 almonds daily.
Discuss your diet and supplements with your health care provider.

Are there reasons people should be cautious when considering the AREDS formula?
Yes. There are reasons to be cautious in using high-dose vitamins and minerals. For example they can interfere with medications and other nutrients. It is important to follow the advice of your doctor and for more information see the National Eye Institute’s website: www.nei.nih.gov/amd/index.asp

Why take a lutein supplement?
If your diet is low in lutein-rich foods such as dark green leafy vegetables you can ask your doctor if a lutein supplement may be appropriate.

For those who do not have MD but are over 50 with a family history of MD a lutein supplement is more suitable than a zinc and antioxidant supplement (AREDS formula).

Can bilberry or fish oil supplements prevent MD?
At this stage, they have not been studied.

MD Foundation
Helpline 1800 111 709 or visit
www.mdfoundation.com.au