OSD: Scratching the surface

Nutrients hold the key to eye health

What you need to know to educate your patients and answer their questions.

By Ruth Frechman, MA, RDN, CPT

Do you know which eye supplements are most effective for your patients? Supplements for AMD, cataract and dry eye patients are readily available, and you must be able to make proper recommendations, answer questions and address potential concerns.

The nutritional supplement industry produced more than $30 billion in revenue in 2012, a number that is expected to approximately double by 2021, according to Forbes. Everyone seems to have an opinion about supplements and their benefits. Many people take supplements because they want to find magic in a bottle and hope that popping a pill may provide an easier solution to staying healthy than eating the right foods.

Before recommending dietary supplements, it’s important for you to evaluate the research. Make your decisions based on the latest scientific evidence, and have a thorough understanding of supplements in order to best serve your patients.

FINDING GUIDANCE IN AREDS

Overview

The National Eye Institute’s Age-Related Eye Disease Study (AREDS and AREDS2) found that taking the AREDS formulation reduced the rate of developing advanced AMD by about 25% in high-risk people (See AREDS2 comparison, page 56).¹ It appears that the benefits of high levels of antioxidants and zinc are safe and long-lasting. If taking an eye vitamin slows vision loss, more patients may convert.

What to look for

Before suggesting an AREDS supplement, make sure that all of the nutrients and amounts match the AREDS formula. Eye supplements can be expensive, so they should have a specific purpose. Ensuring proper nutrients and amounts help your patients get the same results as the National Eye Institute’s study while avoiding unintended and undesirable consequences not related to eye health.

Since the AREDS study found that the formulation did not offer protection from developing early AMD, the supplement should only be recommended to people with intermediate or advanced AMD.² For other patients, you can recommend a daily multivitamin, which contains nutrients not in the AREDS formulation but may aid in overall health — research supports that multivitamin supplements lower the risk of cataracts.³

Don’t forget diet

There’s no substitute for a healthy diet. Most people don’t eat enough fruits and vegetables, which gives ophthalmologists an opportunity to talk to their patients about eating a variety of both (including dark green leafy vegetables), as well as whole grains, beans and legumes, eggs, lean sources of protein, low-fat sources of calcium and fatty fish. For older adults who may not be able to afford healthy food, have access to a variety of foods or be able to prepare meals, recommend additional dietary supplements for general health. This could include a 100% RDA multivitamin, calcium, vitamin D and fish oil. Also, remind smokers and past smokers to not take any supplements with beta-carotene to reduce the risk of developing lung cancer.⁴

Because diet is a risk factor in AMD, it’s particularly important to address it with patients. Of the carotenoids, only lutein and zeaxanthin are found in the lens and retina. In the AREDS2 study, people with low dietary levels of lutein/zeaxanthin who took the L/Z supplement decreased the risk of developing advanced AMD.⁵ So encourage foods high in lutein and zeaxanthin, such as kale, spinach, collard greens, egg yolks, pistachios, corn, green peas, summer and winter squash, persimmons, Brussels sprouts and broccoli.

Even though the addition of omega-3 fatty acids did not improve the AREDS formulation for AMD, vegetarians and other people who don’t eat fatty fish may have low levels of the omega-3 fatty acids DHA and EPA. DHA is needed for building and repairing the retina, and research suggests that omega-3s (DHA and EPA) are useful for treating dry eye syndrome (DES).⁶ Therefore, suggest a fish oil supplement for non-fish eaters.

BE A SUPPLEMENT DETECTIVE

Look with a critical eye

Supplements are not approved, tested or guaranteed for safety by the government. You need to inform patients, especially older adults, of the benefits as well as the risks, how much to take them and for how long.

After confirming the research in large, randomized clinical trials that a supplement has benefits, read the label. The Supplement Facts panel lists the contents, the amount of active ingredients per serving and other added ingredients, such as fillers, binders and flavoring ingredients. Some supplement labels may not contain the ingredients. Also, the supplement may contain more or less of the proper nutrient amounts, or they may contain additional and sometimes harmful ingredients.

If you have questions, check the label for the manufacturer’s contact information. Also, some independent organizations test supplements to guarantee the potency and the lack of contaminants — but not the supplement’s safety or effectiveness. When choosing supplements, look for a seal of approval on the label from one of these organizations:

• US Pharmacopeia. Labeled as USP. (www.usp.org).

• ConsumerLab.com. Labeled as CL.

• NSF International. Labeled as NSF (www.nsf.org).

Ask questions

Review what vitamin, mineral or other dietary supplements your patients take. Talk to them about supplements to avoid future complications and cutting down on excess dosages, which will help them save money on unnecessary products. Ask the following:

• What supplements are you taking?

• How often do you take them?

• What is the dosage?

• Why are you taking them?

• What other over-the-counter medications do you take?

• What prescription medications do you take?

Not all supplements are equal, so check the label, ask questions, and be aware of false claims.

Also, ask whether your patients are experiencing any unusual symptoms. Side effects could result from a medication or from the mega-dose AREDS supplement, which contains high amounts of zinc — patients may not think to connect their symptoms to a supplement.

Some supplements increase the potency of medications while others decrease it, so make sure the combination of their dietary supplements and medications are safe and not causing harm by checking blood work or asking about side effects. Also, keep patients aware of supplements’ effects on other procedures. For example, vitamin E can thin the blood, so it should be discontinued before surgery to avoid the risk of bleeding. Also, vitamin C and vitamin E might decrease the effects of some types of chemotherapy, according to the National Institutes of Health’s Office of Dietary Supplements, and some supplements can cause skin sensitivity reactions during radiation treatments, according to the American Cancer Society.

Recognize false claims

Be aware of any claims on the label that might be misunderstood, such as “proven to prevent blindness.” For more on false advertising, visit the Federal Trade Commission’s website (http://www.ftc.gov).

When recommending a supplement, be sure that claims are backed by scientific evidence from a reputable source. Don’t make a decision on just one study. Also, the FDA suggests using caution when you see these statements:

• It’s a quick and effective cure.

• It will cure a disease.

• It’s totally “safe” or “all natural” (arsenic is natural).

• It contains an “ancient remedy” or “scientific breakthrough.”

• There are personal testimonials with amazing results.

• There’s a limited availability. (“Hurry. Buy now.”)

• It offers a no-risk “money-back guarantee.”

The National Institutes of Health’s Office of Dietary Supplements provides a resource on supplements (http://ods.od.nih.gov).

Conclusion

Food should always act as the first line of defense for promoting good eye health and preserving vision, so tell patients about “eye friendly” foods. However, with some eye diseases, research shows that patients can benefit from supplements, and they may fill some nutrient gaps.

Be equipped to recommend the most beneficial supplements as well as counsel patients on how to use them. Base your decisions on science and facts, not personal beliefs or biases. OM

REFERENCES

About the Author
	Ruth Frechman, MA, RDN, CPT, is the owner of On the Weigh in Burbank, Calif., and author of the multi-award winning book, “The Food Is My Friend Diet.” Email her at Ruth@RuthFrechman.com.