Greens and AREDS Supplements for Age Related Macular Degeneration

There appears to be a connection between dietary quality and protection from age-related macular degeneration. Researchers used a healthy eating index developed by Harvard. You basically get scored 1 through 10, based on each food group. If you consume five servings of vegetables a day, for example, your vegetable score is a 10; four servings of fruits a day gets you a perfect fruit score. If you eat vegetarian, you get a perfect 10 in the meat department, etc. Based on these criteria, they concluded that advanced age-related macular degeneration was significantly related to overall diet quality. Vegetarians are said to easily consume 5 to 10 times the average American daily intake of the eye-protecting nutrients, like lutein and zeaxanthin, concentrated in dark green leafies and avocados, but anyone can eat more greens and guacamole.

More than 100,000 men and women were followed for decades in the Harvard Nurses’ Health Study and the Health Professionals Follow-up Study. Greater intake of lutein and zeaxanthin was associated with about a 40 percent lower chance of developing late-stage macular degeneration. How about an interventional study to seal the deal?

The Age-Related Eye Disease Study, or AY-REDS, randomized thousands of men and women with at least the beginnings of age-related macular degeneration to a combination of antioxidants (vitamins C, E, and beta carotene) and/or zinc versus placebos for more than five years. They wanted to use lutein, but at the time they started the study, it wasn’t commercially available. Still, the combination of antioxidants and zinc decreased the odds of progressing to advanced macular degeneration by 28 percent. The AREDS formulation quickly became the medical standard of care for those suffering from the disease.

Now, while the AREDS trial was in progress, two large interventional trials with beta carotene found an unexpected increase in the risk of lung cancer in smokers taking beta carotene supplements. Combined with increasing observational evidence for the benefit of the greens nutrients lutein and zeaxanthin, when the follow-up AREDS2 study was being designed, they decided to try swapping out the beta carotene for so-called “vegetarian” levels of the two macular pigments. There was also promising observational evidence for omega 3s; so, they tried adding fish oil too. Finally, they also pitted the original AREDS cocktail versus a lower zinc version, since only a certain amount of zinc can be absorbed at one time, and the rest is just pooped out, and high-dose zinc supplements can interfere with copper absorption. OK, so what happened with all these tweaks?

The fish oil flopped and showed no benefit, the lower-dose zinc worked as well as the high-dose zinc, and the lutein and zeaxanthin seemed to beat out the beta carotene. Beta carotene has since been largely removed from macular degeneration supplements, especially since AREDS2 itself also found higher lung cancer rates in those in the beta carotene groups. Lutein (10 mg/day) and zeaxanthin (2 mg/day) is now included as the standard of care in supplement formulations along with zinc and other antioxidants for age-related macular degeneration patients.

There is now a consensus among professional eye health associations and guidelines that these kinds of supplements be given to sufferers of macular degeneration. Some (with financial ties to genetic testing companies) suggest such supplements should be given personalized based on genetic testing, but an independent analysis concluded this wasn’t warranted. However, various antioxidant and multivitamin supplements have not been found effective for primary prevention of macular degeneration in the first place, though lutein and zeaxanthin have never been tested. In fact, one study (the Harvard Physicians’ Health Study II) found that those randomized to the multivitamin Centrum Silver developed higher rates of macular degeneration compared to placebo. To prevent the disease in the first place, a diet “high in green leafy vegetables” is recommended instead.

To protect your eyes, everyone is recommended to incorporate two to three servings of greens into your daily diet. So, you can think of this as at least greens at every lunch or supper with bonus points for sneaking them into breakfast (perhaps in a green smoothie or savory oatmeal dish). It may be especially important for white people to eat their green leafies, as they have significantly higher rates of age-related macular degeneration. This is likely due to eye color. Blue eyes let 100 times more light through; so, people with blue or gray eyes appear significantly more vulnerable to damage compared to brown or black, with green and hazel falling somewhere in the middle.