The Visionary Diet

Elizabeth Somer, RD10/18/16

Vision loss happens as you age and there is nothing you can do about it, right? Wrong! This long-held myth has been debunked by recent research showing what you eat has a huge impact on whether or not you suffer vision loss as you age.

You are right to be concerned about your eyes. Cataracts and macular degeneration are among the top three causes of vision loss in the world. For example, globally 196 million people have macular degeneration, which is estimated to increase to 288 million by 2040. You are also right to assume that these causes of vision loss increase as we age. For example, cataracts – a clouding of the lens in the eye that affects vision – are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. Macular degeneration is caused by the deterioration of the central portion of the retina, the inside back layer of the eye that records the images we see and sends them by way of the optic nerve from the eye to the brain. Again, it is most common in older people, which explains why it also is called age-related macular degeneration (ARMD or AMD). (1, 2)

Consider this – is it age per se, or is vision loss (at least in part) caused by the choices we make along the way? In general, we know that people who eat the most colorful fruits and vegetables also have the lowest risk for losing macular pigment (MP) associated with ARMD. For example, people who eat diets rich in vegetables, legumes, fruit and seafood have as much as a 41 percent lower risk for ARMD, while those who eat the typical American diet high in fatty dairy products, meat, French fries, added sugars and refined grains have up to a two-fold increased risk. (3)

As research has narrowed the association, a few specific nutrients have come to the forefront. The Age-Related Eye Disease Study or AREDS, a study sponsored by the National Eye Institute, has found that daily consumption of specific antioxidants in these healthful diets, as well as the omega-3 fats in fatty fish, may help to slow the progression of vision loss as we age. (4)

How do these nutrients protect your vision?

1) Antioxidants, such as vitamins C and E, protect the eyes from damage from UV light exposure. This damage is common to eyes because they are exposed to intense light, which generates little oxygen fragments called free radicals that damage membranes. The eye naturally stockpiles vitamin C to levels 20 times and higher than those found in the blood. The high concentration of vitamin C in ocular tissue might be an adaptation that protects against the damaging UV rays in sunlight. Intakes of at least 500 milligrams of vitamin C and 400 IUs of vitamin E a day appear to be most effective at maintaining optimal tissue levels of these vitamins. (5)

2) Lutein and zeaxanthin are antioxidants, but they do much more. These two compounds can cross the blood-brain barrier and the blood-retina barrier to form macular pigment (MP) in the eye. There they act as internal sunglasses by absorbing blue light, which otherwise would damage the macula and lead to ARMD. As little as 10 milligrams of lutein daily and 2 milligrams of zeaxanthin daily (the amount found in 1/2 cup of cooked spinach) raises blood and ocular tissue levels of lutein and reduces the risk for vision loss. (6) Even if vision problems develop, the disease is less likely to progress to advanced stages when lutein and zeaxanthin intakes are high.

3) The omega-3 fat DHA is the main omega-3 found in ocular tissue. This fat improves membrane fluidity and ease with which the cell can regulate what goes in and what comes out. It also has anti-inflammatory and immune-stimulating functions. This important fat may support proper drainage of intra-ocular fluid from the eye, decreasing the risk of high eye pressure and glaucoma. There is preliminary evidence that the omega-3s in seafood, DHA and EPA, might help with a condition called “dry eye syndrome.” (7, 8)

The visionary diet is simple, just follow these guidelines to stack the deck in favor of healthy vision throughout life: 

1. Consume daily at least nine servings of colorful fresh fruits and vegetables (including two servings of lutein-rich dark green leafy vegetables and two servings of vitamin C-rich citrus fruits). 

2. Limit or avoid saturated fat by reducing intake of meat and fatty dairy products; then emphasize the eye-healthy fats in fish, choose foods fortified with an algal-based DHA (life’sDHA), and/or take a supplement of at least 220 milligrams of DHA omega-3.

3. Even if you eat perfectly, it would be difficult to get all the nutrients from diet alone in the amounts found to protect eyes from vision loss. Consider taking a supplement to fill in any nutrient gaps. Look for high-quality supplements, including those that contain FloraGlo lutein and OPTISHARP zeaxanthin.

4. Wear protective sunglasses year-round that filter out 100 percent of the sun’s ultraviolet rays.

5. Catch any signs of vision loss early. Have a doctor check your eyes after dilating them at least once in your 20s, twice in your 30s, and every two to four years between ages 40 and 64, and every one to two years after that.

 

Read more about our expert Elizabeth Somer, RD

 

References

1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. The British Journal of Ophthalmology. 2012 May;96(5):614-8. PubMed PMID: 22133988.

2. Wong W, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global Health. 2014;2(2):e106-e16.

3. Chew E: Nutrition effects on ocular disease in the aging eye. Investigative Ophthalmology & Visual Science 2013;54:(14):ORSF42-7.

4. The AREDS study’s findings: https://nei.nih.gov/amd/summary#1

5. The Age-Related Eye Disease Study 2 Research Group: lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration. Journal of the American Medical Association 2013;309:2005-2015.

6. Chew E, Clemons T, Agron E, et al: Long-term effects of vitamins E and E, beta carotene, and zinc on age-related macular degeneration: AREDS report no. 35. Ophthalmology 2013;120:1604-1611.

7. Gatell-Tortajada J: Oral supplementation with a nutraceutical formulation containing omega-3 fatty acids, vitamins, minerals, and antioxidants in a large series of patients with dry eye symptoms. Clinical Intervention in Aging 2016;11:571-578.             

8. McCusker M, Durrani K, Payette M, et al: The role of vitamins, essential fatty acids, and antioxidants in age-related macular degeneration, dry eye syndrome, and cataracts. Clinical Dermatology 2016; 34:276-285.

Selected References

Alassane S, Binquet C, Cottet V, et al: Relationships of macular pigment optical density with plasma lutein, zeaxanthin, and diet in an elderly population. Investigative Ophthalmology and Vision Science 2016;57:1160-1167.

Arnold C, Winter L, Frohlich K, et al: Macular xanthophylls and omega-3 long-chain polyunsaturated fatty acids in age-related macular degeneration. Journal of the American Medical Association: Ophthalmology 2013;March 21:1-9.

Aslam T, Delcourt C, Silva R, et al: Micronutrients in age-related macular degeneration. Ophthalmologica 2013;229:75-79.

Bovier E, Lewis R, Hammond B: The relationship between lutein and zeaxanthin status and body fat. Nutrients 2013;5:750-575.

Chiu C, Change M, Zhang F, et al: The relationship of major American dietary patterns to age-related macular degeneration. American Journal of Ophthalmology 2014;158:118-127.

Cohen S, Mauget-Faysse M, Oubraham H, et al: Impact of eating habits on macular pathology assessed by macular pigment optical density measure. Journal of French Ophthalmology 2010;33:234-240.

Cui Y, Jing C, Pan H: Association of blood antioxidants and vitamins with risk of age-related cataract. American Journal of Clinical Nutrition 2013;July 10th.

Dawczynski J, Jentsch S, Schweitzer D, et al: Long term effects of lutein, zeaxanthin and omega-3-LCPUFAs supplementation on optical density of macular pigment in AMD patients: The LUTEGA study. Archives of Clinical and Experimental Ophthalmology 2013;251:2711-2723. (Excellent reference list as well!)

Garcia-Layana A, Recalde S, Alaman A, et al: Effects of lutein and docosahexaenoic acid supplementation on macular pigment optical density in a randomized controlled trial. Nutrients 2013;5:543-551.                                          

Gopinath B, Flood V, Wang J, et al: Lower dairy products and calcium intake is associated with adverse retinal vascular changes in older adults. Nutrition, Metabolism, and Cardiovascular Disease 2014;24:155-161.

Johnson E: A possible role of lutein and zeaxanthin in cognitive function in the elderly. American Journal of Clinical Nutrition 2012;96:1161S-1165S.

Johnson E, Maras J, Rasmussen H, et al: Intake of lutein and zeaxanthin differ with age, sex, and ethnicity. Journal of the American Dietetic Association 2010;110:1357-1362.

Johnson E, McDonald K, Caldarella S, et al: Cognitive findings of an exploratory trial of docosahexaenoic acid and lutein supplementation in older women. Nutritional Neuroscience 2008;11:75-83.

Johnson E, Vishwanathan R, Johnson M, et al: Relationship between serum and brain carotenoids, alpha tocopherol, and retinol concentrations and cognitive performance in the oldest old from the Georgia Centenarian Study. Journal of Aging Research 2013;2013:951786.

Loskutova E, Nolan J, Howard A, et al: Macular pigment and its contribution to vision. Nutrients 2013;5:1962-1969.

Marshall L, Roach J: Prevention and treatment of age-related macular degeneration. The Consultant Pharmacists 2013;28:723-737.

Liu R, Wang T, Zhang B, et al: Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration. Investigative Ophthalmology and Visual Science 2014; December 16.

Murray I, Makridaki M, van der Veen R, et al: Lutein supplementation over a one-year period in early AMD might have a mild beneficial effect on visual acuity. Investigative Ophthalmology and Visual Science 2013;54:1781-1788.

Nebeling L, Forman M, Graubard B, et al: Changes in carotenoid intake in the United States: The 1987 and 1992 National Health Interview Surveys. Journal of the American Dietetic Association 1997;97:991-996.

Pastor-Valero M: Fruit and vegetable intake and vitamins C and E are associated with a reduced prevalence of cataracts in a Spanish Mediterranean population. BMC Ophthalmology 2013;13:52. http://www.ncbi.nlm.nih.gov/pubmed/24106773

Pinazo-Duran M, Gomex-Ulla F, Arias L, et al: Do nutritional supplements have a role in age macular degeneration prevention? Journal of Ophthalmology 2014;2014:901686.

Rasmussen H, Johnson E: Nutrients for the aging eye. Clinical Interventions in Aging 2013;8:741-748.

Silvan J, Requero M, de Pascual-Teresa S: A protective effect of anthocyanins and xanthophylls on UVB-induced damage in retinal pigment epithelial cells. Food & Function 2016; 7:1067-1076.

Vishwanathan R, Chung M, Johnson E: A systematic review on zinc for the prevention and treatment of age-related macular degeneration. Investigative Ophthalmology & Visual Science 2013;54:3985-3998.

Vishwanathan R, Iannaccone A, Scott T, et al: Macular pigment optimal density is related to cognitive function in older people. Age and Ageing 2014; January 15.

Zhang Y, Jiang W, Xie Z, et al: Vitamin E and risk of age-related cataract. Public Health Nutrition 2015; January 16: 1-11. 

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