Nutrition for Eye Care Part 2: A supplement regimen for optic health


Whole Foods magazine

May 2000

Nutrition for Eye Care Part 2: A supplement regimen for optic health

An interview with Robert Able, Jr., M.D.

by Richard A. Passwater, Ph.D.

As more and more baby boomers turn 50 and a greater-than-ever percentage of the population survives into the golden years, eye diseases are becoming epidemic. Cataract is already rampant, and age-related macular degeneration may be our next major scourge. Glaucoma and dry eye also are on the rise.

Last month, Robert Abel, Jr., M.D., discussed what an ophthalmologist can learn by looking into one's eyes and the importance of a holistic approach to eye health. In this column, Dr. Abel will chat with us about specific nutrient protocols for cataract, glaucoma, dry eye, and age-related macular degeneration.

Dr. Abel is a graduate of Wesleyan University and Jefferson Medical College. He performed his ophthalmology residency at the Mount Sinai Medical Center in New York City and a cornea transplant fellowship at the University of Florida. He co-founded the alternative medicine curriculum at Thomas Jefferson University, where he is a clinical professor of ophthalmology. A board-certified ophthalmologist, he is on the staff of the Christiana Care Health System and St. Francis Hospital. He also has helped found eye banks, including the Medical Eye Bank of Delaware where he has been medical director since 1981. Dr. Abel instructs the Cornea Microsurgery Workshops at the Academy of Ophthalmology meetings annually and has been on the Academy's Committee of International Ophthalmology. He is an advisory board member of the Lutein Information Bureau.

Passwater: Dr. Abel, let's move on to other examples of what we can learn from nutrition in the treatment of eye disorders. How about glaucoma? Is there some special nutritional advice you can give our readers about either the prevention or treatment of glaucoma?

Abel: Glaucoma results in the loss of vision due to optic nerve damage. Americans are more likely to be blinded by glaucoma than by cataract, although cataract is more prevalent- Glaucoma no longer means elevated intraocular pressure (IOP). As many as 50% of people with high IOP never have optic nerve damage. At least 25% of elderly people with damaged optic nerves never have had elevated IOP In two large studies-the Beaver Dam Eye Study and the East Baltimore Eye Survey-it was found that about 40% of the persons having glaucoma had normal IOP So glaucoma now is defined simply as disorders that can damage the optic nerve.

One common feature to all types of glaucoma is lack of blood flow to the retina and optic nerve. When we speak of glaucoma, we usually are talking about simple or chronic open angle glaucoma. I tend to think of it as a disease of stress. Almost all of the problems have something to do with adrenaline (epinephrine), which is the neurotransmitter for the sympathetic nervous system. We have two involuntary nervous systems: the sympathetic and the parasympathetic. The sympathetic nervous systems controls the fight or flee responses, including anxiety response and increases in heart and breathing rates. The parasympathetic nervous system controls the relaxation response such as slowing of the heart rate. When we constantly disturb the balance between the two systems, we develop the diseases of stress such as glaucoma and heart disease. What we need to do is relax.

When I was in Nepal in 1996, I learned that physicians there treated glaucoma with an herbal remedy called trifolia, which is a blend of three herbs. It's a laxative or a parasympathetic stimulant that relaxes the body.

Robert Abel, Jr., M.D.

Passwater: What is the easiest way to relax?

Abel: Periodically taking deep breaths. If you teach people to take 10 deep breaths three times a day you will get them to slow what they are doing, break their anxiety, lower their blood pressure, increase oxygen to the brain, reduce carbon dioxide and improve eye blood flow. Periodic relaxation, deep breathing, trifolia, magnesium and gingko biloba are all vasodilators.

Other nutrients for preventing or treating glaucoma include vitamin B-12 (1,000 mcg per day) and lipoic acid. They are neuro protectors.

In my book, I suggest 10 tips to avoid vision loss due to glaucoma. They are: 1. Reduce stress. 2. Exercise. 3. Stop smoking. 4. Avoid artificial sweeteners. 5. Take magnesium supplements (400-500 mg at bedtime). Make certain that if you are on high blood pressure medication, your pressure is not below 100/60 mm at night. 6. Improve bowel function. 7. Take 100200 mg of lipoic acid daily. 8. Take sublingual vitamin B-12. 9. Develop an interactive relationship with your physicians. 10. Develop a positive attitude. The mind can heal, as well as harm. You might as well harness the placebo effect-which is a natural positive effect, whenever possible.

Passwater: So instead of worrying so much about elevated IOP, the emphasis should be on blood flow to the back of the eye.

Abel: Exactly. Elevated IOP still is considered a risk factor, but we know now to look for optic nerve damage even in the absence of elevated IOP We look for evidence of reduced blood flow at the back of the eye and at the optic nerve itself. -

A common problem in glaucoma patients is that many are elderly and may have high blood pressure. These patients usually are on anti-hypertensive medicine. A problem that sometimes arises is that when they lie down at night, they relax, and their blood pressure drops naturally. However, their blood pressure drug still is working and their blood pressure drops even more. As a result, they don't have enough blood supply to the eye. This in turn causes or aggravates their glaucoma and insufficient blood (low in the brain can cause problems including death. This is why some people die in their sleep. This is why I tell them about nutrients such as magnesium and gingko biloba at bedtime.

It's rewarding to watch people be able to be weaned from their glaucoma eye drops as their nutritional programs progress. I do this very carefully because I don't want to endanger their eyes during the process. What I tell them to do is to go on a drug vacation on one eye to see if the drug really is having much effect on the other eye.

Passwater: In your 10 tips, you mention that people should avoid artificial sweeteners. Why?

Abel: Artificial sweeteners are neuro toxins. That's why they give you that lingering taste on your tongue at the back of your mouth. Artificial sweeteners stimulate your tongue's nerve endings. They can weaken nerve cells, including the nerve cells in the brain and the eye. Our bodies haven't learned how to detoxify these chemicals yet.

Diabetic patients with neuropathy actually may be worsened by using artificial sweeteners. Instead, I recommend that they use stevia, an Indian herb or D-xylose as sweeteners. The "D" form of xylose is not absorbed, and it is sweet.

Passwater: You mentioned that cataract is the most prevalent eye disorder.

Are cataracts becoming more prevalent?

Abel: Cataracts are pandemic. Around the world, catarrh-acts are the leading cause of blindness. More than 42 million people worldwide have vision so poor they cannot read the big "E" on the eye chart. Earlier, I said that glaucoma was the leading cause of blindness in the U.S., but cataract causes more vision loss. In the U.S., people usually elect cataract surgery before they lose total vision.

However, eye diseases are becoming more prevalent in general. I believe that the three biggest factors that cause eye disease are sunlight, inadequate nutrition and stress. We are a very stressed society, and we are on the run. Everything is faster, faster, faster. We need to relax more.

We also are faced with more ultraviolet energy (UV) penetrating the reduced protective ozone layer. The UV in sunlight can cause the free radicals that damage the proteins in the eye lens. When this happens, the lens becomes less transparent and appears cloudy. A cataract begins to form when the crystalline proteins lose their shape and structure because of damage from free radicals. The crystalline proteins then clump together causing the lens to become opaque rather than remain transparent. It is essential to wear UV-filtering sunglasses while outdoors. Even rabbits in Argentina and Australia are developing cataracts now due to the reduced ozone layer. Tobacco smoking is also a risk factor for cataract.

As for nutrition as a defense against cataract, the main thing is to take at least 2,000 mg of vitamin C daily, and remember to drink lots of water. The lens is a crystalline hard structure inside the eye. It has no blood supply and no nerves. You have to wash the system as much as possible and that alone can improve it. This is more important than people realize. Most people are walking around dehydrated. Some even have cracking fingernails or toenails. If they would just drink more water, their nails and their hair would be healthier. And they also should be supplementing with essential fatty acids.

Passwater: I like the food pyramid in your book. You make water the foundation and most important block in the pyramid. It's too bad everyone else drawing pyramids seems to miss this point. In your view, after water, what is next in importance?

Abel: Selenium and sulfur nutrients also help protect the eye lens as they help form the water-soluble antioxidant, glutathione, which is extremely effective in preventing cataracts. The most efficient way to increase glutathione levels in the eye lens is to eat sulfur- and selenium-containing foods and to take supplements of glutathione precursors such as lipoic acid and N-acetylcysteine (NAC), as well as selenium. Excellent sulfur-containing foods are eggs, capers, onions, and garlic. Topical MSM eye drops also are useful.

Dr. James Duke said that he learned the following "folk remedy" from an Australian colleague: noting that dogs frequently develop cataracts, the folks down under put eucalyptus honey in the dogs' eyes, one drop twice a day. I have my first three patients on it just to see. It is intriguing that old remedies like this still must be considered. Honey is a very beneficial compound.

On the other hand, we also must be aware of the unhealthful substances people take into their bodies. 1n this society, people use too much sugar, alcohol and tobacco.

Passwater: Can you give us a specific protocol to reduce the risk of cataracts?

Abel: Let's start with a mixed and balanced diet having lots of fresh fruits and vegetables. In addition, I recommend the following supplements:

A multivitamin, preferably having at least 10,000 I.U. of vitamin A. If not, then take a vitamin A supplement to bring the total to 10,000 I.U.

An additional B-complex vitamin

Vitamin C, 1000 three times daily.

Vitamin E, 4000-800 I.U.



MSM ( Methysulfonylmethane),

Magnesium, 500 mg

Selenium, 50-100 mcg

Zinc, 30 mg or less

Copper, 2mg

Manganese, 2-5 mg

In addition, wear UV- and blue-light protection sunglasses while outdoors, and preferably a wide-brim hat. If you are a smoker B STOP! If you take medications, check to see if they are associated with possible side effects such as increased risk of cataract or photosensitivity.

Passwater: In the 1980s, I used to correspond with Dr. Ben C. Lane, an optometrist who correlated sugar intake and chromium deficiency with the loss of visual acuity. He noted that supplementation with chromium and reduction of dietary sugar improved eyesight in many people. He also correlated elevated IOP with low chromium and low vitamin C levels. Two of his publications include "Calcium, Chromium, Protein, Sugar and Accommodation in Myopia" in Documenta Ophthalmologica Proceedings 28:141-148 (1981) and "Elevation of Intraocular Pressure with Daily Sustained Close work Stimulus to Accommodation Lowered Tissue Chromium and Dietary Deficiency of Ascorbic Acid (vitamin C)" in Documenta Ophthalmologica Proceedings 28:149-154 (1981). In their book Save Your Sight, ophthalmologist Mare Rose, M.D., and his brother Michael Rose, M.1)., correlate hyperinsulinemia causal by too much dietary sugar with cataracts, glaucoma and macular degeneration, its well as diabetes, high blood pressure and cancer.

Abel: That's interesting. There also is a great book written by Dr. Weston Price, a dentist who traveled among many indigenous peoples in the mid-1930s. Although his primary interest was in teeth and dental decay, Dr. Price learned that there was almost no tuberculosis, arthritis, or cancer where these indigenous people used no refined sugar.

Four hundred years ago, the only sweet things people put on their tables were fruit and, on rare occasions, maple syrup and honey. We did not have to contend with so much simple sugar in the diet. Now, the diet of almost everyone on earth has changed because of the ease of obtaining refined sugar.

I am reminded of a study that dealt with dogs and diabetes. Those dogs on high sugar diets had elevated blood sugar levels and would go on to develop retinopathy. Those dogs that were not on high sugar diets had norma1 blood sugar levels. Also of interest is the fact that among the dogs that did develop retinopathy, it was possible to control the disease by giving the animals a normal low-sugar diet.

Regarding the research of Dr. Ben Lane, I can see a possible relationship. I would presume that the spikes in blood sugar levels, caused by the increased amount of sugar in the diet, often are followed by an overproduction of insulin. This could then drive the blood sugar level down, which affects the mural cells in the capillary. And as soon as you lose enough of these cells, you start to leak from your capillaries into your eye and other places.

Passwater: What can we do about age-related macular degeneration (AMD)?

Abel: AMD is the leading cause of blindness in the U. S. among persons 65 years of age and older. Macular degeneration develops after a lifetime of damage to the delicate center of the retina called the macula. At least 14 million Americans have macular degeneration. The macula is where most detailed vision occurs. As AMD develops, people lose their ability to drive, read, and even to recognize faces. They can see things on the periphery, but not so well in the center. After a lifetime of looking directly at something to see it, they now look to the side so that the object appears on the periphery.

The macula is one of where most metabolically active tissues in the body. Although the macula occupies some 2% of the visual field, it is represented in about half the brain's visual areas. The macula contains most of the eye's cone cells (daytime vision), which are tightly packed together. Each cone cell in the macula has its own nerve fiber that communicates directly to the brain. In contrast, in the peripheral areas of the retina, several rod cells share a single nerve fiber.

In addition to having the greatest concentration of cone cells, the macula has a very high density of yellow pigments derived primarily from two carotenoids-lutein and zeaxanthin. Thus, the macula appears as a yellow dot in the center of the retina.

Occurrences of macular degeneration are 90% of the dry type and 10% of the wet type.

The wet type is the result of new blood vessels coming into the retina. There is a factor in the retinal pigment epithelium, a pigment layer underneath the retina that nourishes and removes waste from the macula, that will prevent angiogenesis (new blood vessel formation). Only when the eye is starved of antioxidant nutrients, or the blood supply is reduced, does this factor not get produced and new vessels grow. That means if you breathe enough and if you do a little exercise and you try to have good cardiopulmonary health you may in fact not get the wet type of macular degeneration.

Passwater: But the dry type is more common than the wet type of AMD. What can be done here?

Abel: Yes, it is true that 90% of AMD cases are the dry type. We have to work with those people. Macular degeneration is like starvation of the retina. The eye is a bag of water with two lenses. The first is in the cornea is in the front of the eye, and the next is the crystalline lens that forms cataracts. In between are aqueous fluids anti vitreous humor and, in the back of the eye, the retina. In fact, the blood vessels are separated and designed so that light impacts directly on the macula without having to go through blood vessels.

All Clay. light hits the retina, and your cells break down, build up, break down, build up, break down, etc. Imagine if you will, a camera going off and on all the time. Think about the level of photo-stress you are under.

Now, let's shift the focus for a minute. Nutrition for the retina is centered in the liver. That is where we store our fat-soluble vitamins, activate our B-complex vitamins and make and release glutathione. All food goes through the portal veins into the liver, so if the liver is not in good shape the eye is going to suffer. Macular degeneration patients who are on medications frequently suffer from poor digestion and other conditions that may interfere with the body's antioxidant levels.

Let me tell you about one 60-year-old gentleman who consulted me. My partner had been seeing him for five years concerning his developing macular degeneration and cataracts. I traced his case back and found out he had begun taking a certain medication two and a half years ago. I think that may have helped trigger his macular degeneration. Then, eight months ago, he started on cholesterol lowering drugs, and at his most recent examination we noted an early cataract. Those kinds of things we can stop, and intervention may stop both processes.

As a matter of principle, patients should be in charge of their bodies. They should work interactively with their doctors. It no longer is acceptable for the doctor simply to tell the patient what the course of action will be. Today's patients have many care givers: physicians, nutritionists, acupuncturists, specialists, etc. We all must work together as a team and figure out the best options for our patient. If option A isn't working, then we should move to the next. But the patient must be part of the decision-making process.

Patients with macular degeneration can be stabilized. Early AMD usually can be prevented from progressing, while there may be no nutritional treatment for advanced AMD. AMD patients need to have a positive attitude. They usually are older patients who already are taking several medications. They say, " 1 can't take another pill, 1 take six already." 1 tell them nutrition isn't necessarily a pill, and, besides, we do have to supplement to catch up--at least initially.

Passwater: What supplements would you recommend to slow or prevent AMD?

Abel: First, multivitamins with meals, plus plenty of antioxidants, especially lutein. Be sure to get about 10,000 IU of vitamin A daily plus 5,000 to 10,000 IU of beta carotene. To begin with, I would recommend between 6 and 20 mg of lutein daily. Any regimen should include at least 1,000 mg of vitamin C daily, and, if you tolerate it, as much as 3,000 mg. In addition, there should be vitamin E (400 IU); magnesium (500 mg unless you have kidney disease); bilberry (100 mg daily); ginkgo biloba extract (15 drops, once or twice daily); garlic (one odorless capsule daily with between 100 mg and 1,000 mg, depending on tolerance); essential fatty acids (one tablespoon of flaxseed oil daily); DHA (500mg daily); selenium (50-200 mcg daily); taurine (200 mg daily); chromium (200 mg daily); zinc (30 mg or less daily); and digestive enzymes as needed.

Passwater: Is dry eye becoming more of a problem?

Abel: Dry eye not only is an increasing problem in the elderly, but is increasing among computer users of all ages. People who use computers are susceptible to two side effects-red eye and myopia. They get red eye because they stare and do not blink. And because they do not blink, their eyes dry out. Well, we should be able to remedy this situation with a rather simple recommendation: just remind them that they need to blink more often. Perhaps we also could put a bottle of artificial tears by their computers. And we should instruct them to avoid eye drops that use a vasoconstrictor to reduce red eyes.

The other kind of dry eye occurs as we increase in years. As we age, our bodies make less aqueous fluid. We should be drinking more water, but many of us do not. We should avoid caffeinated products that actually dehydrate us.

When we are older, we don't have as much DHA (an essential fatty acid) in our bodies. If we start on a program of borage, flaxseed, primrose or some other oil, say 200 mg a day, this will lubricate our tear glands tremendously-and within just five days. People will feel the improvement in their eyes.

Even g1ucosamine can benefit the eyes; it's not only for the joints. My book has a chapter on the relationship between dry eye and arthritis. They are not such an odd couple because the affected membranes are very similar. DHA will improve your skin and hair, and even thin the blood a little bit, a very little bit. Eicosapentaenoic acid (EPA), another essential fatty acid, does more, improving the digestion and increasing bone density.

Also, we must look at the medications a patient is taking. Someone on an antihistamine, or medication for a bowel problem, or taking a nerve drug is likely to find it has a drying effect. Again, it comes back to looking at the whole person.

Passwater: You have mentioned medications several times during this interview. In your book, you provide a list of medications and their interaction with nutrients. You also provide a table of natural alternatives to several drugs. Most people don't associate their eye problems-cataracts or otherwise-with their long-term medication. How much of a problem is this?

Abel: There are more than 300 medications that will increase cataracts because they are water-soluble and get into the lens. UV light facilitates their interactions with the crystalline proteins in the lens. There are hundreds of drugs that cause dry eye. There are many drugs that cause disturbances in color perception. Viagra decreases blue vision for up to five hours after ingestion. There is even a book called Eye Complications of Medications.

Passwater: There's another feature of your book that I like: you use a lot of anecdotes. They are interesting and help bring home the messages.

Abel: Thank you. I like to relate case histories. As an example, I explain that when my father started having cataracts 21 years ago I started him on nutritional supplements. Now, he is 86 and still has 20/20 vision in each eye. For his 80th birthday I gave him a copy of the Physicians' Desk Reference (PDR), and he said, "It was about time you gave me that." In a sense he was saying, "We should know what is available."

Over and over in the book I tell people to consult their pharmacists. The pharmacist is in the best position to know about drug interactions. Doctors rarely have the time, or perhaps the interest, to learn all this. Fortunately, there are other people in the community who will.

I like to tell stories about people, and I've put some of them into the book. One interesting tidbit tells how bilberry was credited with winning the Battle of Britain.

That's right: one of the secret weapons employed by the Royal Air Force to gain supremacy in the night skies above war-torn Britain came from a jam jar. Although the German Luftwaffe had more planes and pilots than the British, they didn't have jars of bilberry jam on the tables in every flight mess. The purple bioflavonoids in bilberry fed the rod cells in the eyes of the British flyers-the ones that we depend upon for night vision. Because they could see better in the night sky, the English prevailed.

By the way, for day vision, we need the yellow, orange and red fruits and vegetables.

Passwater: Well, let's leave the other stories for our readers to enjoy when they read your book. There, they also will find your specific supplement recommendations for preventing and reversing cataracts, glaucoma and other eye disorders. In this chat, you have taught us:

that eye disease often is related to other problems or diseases in the body;

that drugs that lower cholesterol can reduce vision;

that an unhealthy liver will inevitably cause eye disease;

that poor digestion often underlies macular degeneration;

that hundreds of prescription and over-the-counter drugs can be harmful to the eyes.

Thank you for sharing your experience with us, and we'll look for updated information on your website at WF

2000 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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