LA JOLLA, Calif. Ophthalmologist and nutrition expert Steven G. Pratt, MD, emphasizes to his patients that if they want to experience the benefits afforded by increasing their consumption of lutein, zeaxanthin and other carotenoids, vitamins B, C and E, they should increase their intake of fruits, vegetables and whole grains. He considers nutritional supplements just that supplements to a diet already rich in beneficial vitamins and minerals. But even he admits that as people get older, the variety and consumption of their food decreases, putting them at even greater nutritional risk than the average adult, and making them perfect candidates for ocular supplements.
They all need a general supplement, but if they want to take an ocular supplement in addition, thats fine, he said. For instance, anyone who has macular problems needs even more lutein. Age-related macular degeneration is a horrible disease. I try to give my patients a formula to ward it off or reduce it a longevity and optimum health formula: supplements, sunglasses, etc.
Alcon Laboratories (Fort Worth, Texas) added lutein and zeaxanthin, as well as other vitamins, to its ICaps dietary supplement in response to that need. ICaps also contain zinc in the form of zinc acetate, which is reportedly the easiest form of zinc for the body to absorb. ICaps also features time-release dosing, which may cut down on potential stomach upset, and Betalut, a beadlet that consists of all-natural lutein, zeaxanthin and beta-carotene. According to Alcon, Betalut ensures the potency of these carotenoids.
Most diets lacking in lutein
These nutrients can be derived from food, but statistics paint a bleak picture with regard to trends in nutrition. According to Linda Nebeling, PhD, MPH, RD, of the National Institutes of Health/National Cancer Institute, most Americans do not consume enough lutein- and zeaxanthin-rich fruits and vegetables to get the protection they need. Between the years 1987 and 1992, lutein intake declined by 16% in women of all ages and in men and women between the ages of 40 and 69.
Women in the United States have decreased their consumption of vegetables such as corn, green beans, broccoli, spinach, carrots and winter squash, Dr. Nebeling said. These vegetables are rich sources of carotenoids and other important nutrients. Consuming too little of these foods could lead to an increased risk of disease.
Rodney Horton, OD, president of Medical Ophthalmics Inc., agrees that Americans are not getting enough lutein. Some of the studies that have been done indicate that the average person consumes 1 mg or less of lutein per day, which shows that we have a very serious problem, he said.
The Seton study found that people who consume 6 mg of lutein per day had a 43% reduction in the incidence of macular degeneration, he continued. They found that the recommended dosage for prevention and maintenance is between 6 mg and 10 mg per day. The therapeutic range is somewhere around 20 mg per day.
Medical Ophthalmics includes 6.26 mg of lutein per dose in its MaxiVision Lutein Formula, a daily multivitamin that the company recently launched. The MaxiVision Whole Body formula, the companys premier product, contains 20.4 mg of lutein per dose. The company also recently introduced a lutein supplement, which contains only lutein, at 10 mg of lutein per dose. The supplements are intended for patients who need to increase their intake of lutein, according to Dr. Horton.
Balance is the key
The Institute of Medicine of the National Academies recently reported that insufficient evidence exists to support claims that taking megadoses of dietary antioxidants can prevent chronic disease. A direct connection between the intake of antioxidants and the prevention of chronic disease has yet to be adequately established, said Norman I. Krinsky,
PhD, chair of the studys Panel on Dietary Antioxidants and Related Compounds, and a professor of biochemistry at Tufts University School of Medicine in Boston. We do know, however, that dietary antioxidants can, in some cases, prevent or counteract cell damage that stems from exposure to oxidants.
Dr. Pratt agrees that megadoses of even a good thing can be bad. Megadoses of anything is not good, he said. I am all for a balanced formula where you have all of these nutrients in the formula that really mimic food. Alcon has a product available overseas, Retoxil or ICaps-L, that is the closest thing I have seen to whole food, because it has many of the nutrients that we know are in food in basically the same ratios. The carotenoid ratio is the same as in spinach.
All of the nutrients work synergistically together, and no one nutrient is a magic bullet, Dr. Pratt continued. So if you are going to have a supplement that works, its going to have to mimic food and have more or less the same ratios that food has in it. Otherwise, it may not work and may even be harmful because you may drive down the absorption of one nutrient by too much of another.
The important carotenoid
Robert Abel Jr., MD, ophthalmologist and author, said there are a myriad of opportunities when you look for new answers. According to the World Health Organization, 80% of the world is still using a plant-based medical system, he said. Our earliest pharmaceuticals came out of the rain forest and were still looking for them there. When you realize that genetics are not an absolute, that one out of five genes is a controller gene but four out of five can be induced, you understand that you can create your own chemical environment and [influence] how you may or may not develop a certain genetic predisposition.
This, he said, is where lutein comes in. Beta-carotene used to get all of the attention, but lutein is a very important carotenoid, he continued. Lutein actually reflects blue light and ultraviolet light, and it is present in the macula along with zeaxanthin, but zeaxanthin can be made from lutein, so its not vital.
Dr. Abel pointed out that studies have shown that when a patient is given 2.4 to 30 mg of lutein, an increase in macular pigment density may result. As little as 2 mg of lutein has been shown to double the blood lutein level and affect the amount of pigment in the macula and improve vision, he said. This is measured by flicker heterochromic photometry, and patients will tell you they have better contrast sensitivity. When you see people with macular degeneration gain a line or two, thats hard to refute.
John G. Meyer, Bausch & Lomb Pharmaceuticals (Tampa, Fla.) product manager, said that until recently, pharmaceutical-grade sources of lutein were not commercially available, but now that lutein has been converted into a stable form, Ocuvite has included it in its newest formulation. The original Ocuvite formula is still available, but Bausch & Lomb has added Ocuvite Lutein capsules to its line of dietary supplements to address additional nutritional needs.
Ocuvite Lutein capsules contain 6 mg of lutein per capsule; they also contain vitamins C and E, plus essential minerals zinc and copper. The capsules have been formulated so patients can take multiple doses per day or take their existing multivitamin along with Ocuvite Lutein without worrying about excessive dosing of any one component.
Bausch & Lomb saw the need to diversify its dietary supplement line because it saw the need for different amounts of vitamins for different situations, Dr. Abel said. The company created Ocuvite Lutein capsules with 6 mg of lutein for those patients who were behind the eight-ball and had already developed macular problems.
Spencer P. Thornton, MD, FACS, recommends ScienceBased Healths (Corte Madera, Calif.) ocular nutritional supplements, he said, because they are a synergistic blend of antioxidants, multivitamins, essential trace minerals and phytochemicals that are focused on the nutrition of the retina and the entire eye.
The antioxidants I recommend to my patients are natural products that are under high quality control, he said. They are formulated by a group of PhDs and MDs who monitor the quality from the very sourcing of the material to the manufacturing of the material. The products dont overdo any one thing. He emphasized: It is a supplement, not a replacement.
ScienceBased Health markets Ocular Essentials and OculaRx for general eye health, as well as HydroEye for dry eye, MaculaRx for patients who have presented with symptoms of macular degeneration, as well as Optic Nerve Formula. The company recently began to market HydroEye in a kit along with OculaRx to laser in situ keratomileusis patients.
Ocular Essentials costs less and is about half the potency of OculaRx, according to ScienceBased Health Director of Education Ellen Troyer, MT, MA. Among other things, OculaRx includes 5 mg of lutein, which has been shown to reduce macular degeneration, as well as bilberry, which increases capillary blood flow and has been shown to improve night vision, Ms. Troyer said.
Dr. Thornton is enthusiastic about ScienceBased Healths product line, but he said that beyond endorsing a product, he is endorsing the idea of nutrition in medicine and the idea of physicians getting involved so their patients come to people who are knowledgeable rather than skeptical. Ophthalmologists keep telling me they need to see documentation first, but its all there in the journals, he said. Theyre just not looking in the right ones.
For Your Information:
- Steven G. Pratt, MD, can be reached at 9850 Genessee Ave., Ste. 310, La Jolla, CA 92037; (858) 457-3010; fax: (858) 457-0028. Dr. Pratt has no direct financial interest in the products mentioned in this article. He is a paid consultant for Alcon.
- Linda Nebeling, PhD, MPH, RD, can be reached at the National Institutes of Health/National Cancer Institute, EPN 4078, 6130 Executive Blvd., 7335 MSC, Bethesda, MD 20892; (301) 496-8520; fax: (301) 480-2087. Dr. Nebeling has no direct financial interest in the products mentioned in this article, nor is she a paid consultant for any companies mentioned.
- Rodney Horton, OD, is president of Medical Ophthalmics Inc. He can be reached at 40146 U.S. Highway 19 N., Tarpon Springs, FL 34689; (727) 943-9400; fax: (727) 938-8430.
- Norman I. Krinsky, PhD, can be reached at Tufts University School of Medicine, Biochemistry Dept., Arnold Bldg., 136 Harrison Ave., Boston, MA 02111; (617) 636-6861; fax: (617) 636-2409. Dr. Krinsky has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Robert Abel Jr., MD, can be reached at Concord Plaza, Naamans Bldg., 3501 Silverside Rd., Wilmington, DE 19810; (302) 477-2600; fax: (302) 477-2650. Dr. Abel has no direct financial interest in the products mentioned in this article. He is a paid consultant for Bausch & Lomb.
- John G. Meyer, product manager, can be reached at Bausch & Lomb, 555 W. Arrow Highway, Claremont, CA 91711; (813) 975-7784; fax: (813) 975-7774.
- Spencer P. Thornton, MD, FACS, can be reached at 5070 Villa Crest Dr., Nashville, TN 37220; (615) 373-1236; fax: (615) 373-0333. Primary Care Optometry News could not confirm whether or not Dr. Thornton has a direct financial interest in the products mentioned in this article or if he is a paid consultant for any companies mentioned.
- Ellen Troyer, MT, MA, director of education, can be reached
at ScienceBased Health, 300 Tamal Plaza, Ste. 220, Corte Madera, CA 94925; (888) 433-4726; fax: (415) 927-0990.
- Alcon Laboratories can be reached at 6201 South Freeway, Fort Worth, TX 76134; (800) 862-5266; fax: (817) 241-0677.
- Medical Ophthalmics Inc. can be reached at 40146 U.S. Highway 19 N., Tarpon Springs, FL 34689; (727) 943-9400; fax: (727) 938-8430.
- Bausch & Lomb can be reached at 8500 Hidden River Parkway, Tampa, FL 33637; (800) 423-1871; fax: (909) 399-1525.
- ScienceBased Health can be reached at 300 Tamal Plaza, Ste. 220, Corte Madera, CA 94925; (888) 433-4726; fax: (415) 927-0990; Web site: www.ScienceBasedHealth.com.