macular degeneration and...
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March 3, 2016
MACULAR DEGENERATION
AND NUTRITION
Presented by Julie Maries, PhD
ProfessorOctober 10, 2018
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Macular Degeneration and Nutrition
Things we cannot control:
Our genes
Our outside environment
Preserving Vision
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Macular Degeneration and Nutrition
Preserving Vision
Things we can do for ourselves:
Get medical treatment
Avoid excessive sunlight
Don’t smoke
Eat well
Be active
Consider supplements, if needed
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Based on research conducted by
many, and supported by taxpayers
and participants. At UW:
…and
collaborators at
8 Universities
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Macular Degeneration and Nutrition
The Evidence: Nutrition Matters
• Clinical trials prove nutritional interventions:
• Lower risk for chronic diseases that are promoted by processes
that also promote poor eye health
(high blood pressure or blood sugar, oxidative stress, inflammation)
• Slow the progression of age-related macular degeneration
(AMD): AREDS1 and AREDS2
• Improve vision (New, early research)
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Macular Degeneration and Nutrition
If you have AMD: The American Academy of
Ophthalmology Recommends this supplement
tested in the AREDS 2 Trial:• Lutein (10 mg) and Zeaxanthin (2 mg)
(replaces beta-carotene)
• Vitamin C: 500 mg
• Vitamin E: 400 IU
• Zinc: 80 mg (with 2 mg copper)
• Talk with your doctor about whether this supplement or
alternatives might be best for you.
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Macular Degeneration and Nutrition
The Evidence: Nutrition Matters
• Population studies suggest that healthy diets:
• Lower chances of having early AMD
• Work synergistically with physical activity and not smoking
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Macular Degeneration and Nutrition
Healthy Diets Lowered Age-Related Macular
Degeneration Presence 2 to 3 fold
Percent with Intermediate
Macular Degeneration in
Women 50-74 years
from CAREDS, Mares et al. 2011, Arch Opthal
Least Healthy Diets Most Healthy Diets
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Percent with
Intermediate
Macular
Degeneration
Among
Women 50 to
74 years
CAREDS, Mares et al. 2011, Arch Opthal
No Regular Exercise
Healthy Diet Scores: lowest 20%
Smoked (more than 8 years)
Moderate Exercise: 8-10 hours per week
Healthy Diet Scores: highest 20%
Never Smoked
A Combination of Healthy Lifestyles: Lowered
Estimated Risk for AMD 3-Fold
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Macular Degeneration and Nutrition
Healthy diets and lifestyles lowered estimated
risk for AMD associated with high genetic risk
Healthy Life Style Score:
• Nutrient-Rich Diet
• Physical Activity
• Low Lifetime Smoking
High
Low
P for trend = 0.04
Odds for AMD associated with CFH
risk variants*In women with stable diets from CAREDS, Meyers et al., 2015, Ophthalmology
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Macular Degeneration and Nutrition
Healthy Diet Patterns
• Mediterranean
• Dietary
Approach to
Stopping
Hypertension
(DASH)
• US Dietary
Guidelines
Heart
Disease
Deaths
Per
10,000
People
% Calories from Saturated Fat
Finland
US
Crete
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Macular Degeneration and Nutrition
Healthy Diet Patterns
• Mediterranean
• Dietary Approach to
Stopping Hypertension
(DASH)
• US Dietary Guidelines
• Abundant in Fruits and
Vegetables• Whole
• 5 to 9 per day (1-3/meal)
• Contain• Whole Grains
• A Daily Variety of Protein
Sources• Plants (nuts, beans,
legume)
• White Meat, Fish, Eggs,
Dairy (> 2/week)
• Red and Processed meat
<2/week
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Macular Degeneration and Nutrition
What is a Healthy Diet?
Varied, real food, and plant-food rich
http://nutritionforeyes.Ophth.wisc.edu/http://www.picserver.org
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Physical Activity, Sun (mornings)
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Some differences in Mediterranean Diets with
relevance for AMD
Emphasize higher intake of:
Omega-3 fatty acids
Long-chain: Fish
Short-chain: walnuts,
olive oil [less]Greens
en.wikipedia.org/wiki/Mackerel
en.wikipedia.org/wiki/Walnutsel
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Macular Degeneration and Nutrition
Fish/Seafood also Provides other Nutrients
related to Healthy Eyes and Lower AMD Risk
• Vitamin D
• B vitamins (especially B12)
• Minerals (selenium, zinc)en.wikipedia.org/wiki/Mackerel
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Macular Degeneration and Nutrition
Greens
• Salads, stewed
• Herbs
• Teas
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Macular Degeneration and Nutrition
Lutein
Macular Pigment:
In white and blue light
Light
© Max Snodderly, 2002
and Zeaxanthins
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Macular Degeneration and Nutrition
Most Abundant Carotenoids
• Beta-carotene
• Alpha-carotene
• Beta-cryptoxanthin
• Lycopene
• Lutein/Zeaxanthin
Vitamin A
Diet/Blood
Eye
Neural Retina
Mesozeaxanthin
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Macular Degeneration and Nutrition
Measurement of Lutein
and Zeaxanthin Pigments
in the Back of the Eye
“Macular Pigment”
-Simple, Non-Invasive
© Max Snodderly, 2002
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Macular Degeneration and Nutrition
The Carotenoids in Age-Related Eye Disease Study
(CAREDS) of the Diet and Vision Study in women (53 to 86 years)
OR
IAWISites
WHI
1994-98Observational Study
93,676 women
CAREDS
2001-04
2,005 women
• Macular pigment density
• Intake: Diet, Supplements
• Photographs of retina and lens
• Vision function tests
• Diet, lifestyles and health
histories
• Blood: For nutrient, lipid
and genetic information
6 years
CAREDS 2
2016-2018
674+ Women15 years
• Macular pigment density
• Intake: Diet, Supplements
• More retina imaging
• New vision function tests
WHI: Annual Follow-Up
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Macular Degeneration and Nutrition
2001-2004: Macular pigment was higher in
women who…
2. Consumed
Healthy Fats1. Had gene variants
for proteins that help
us take lutein
• Into our body
• Through our blood
• Into our retina
Intestine
Retina@ Max. Snodderly, 2002
3. Had high
Fiber Diets
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Macular Degeneration and Nutrition
2016 – 2018 Early Findings…
Fifteen year increases in macular pigment levels were
more common in women who:
• Had low levels ~ fifteen years earlier
• Obtained lutein in AREDS2- type
supplements (usually10-12 mg/day)
• Ate eggs (~ 10 /week)
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Macular Degeneration and Nutrition
New Research Findings and Direction:
Macular pigment was higher in women and men who report
being breast fed (preliminary)
How much does breastfeeding matter to health of
eye (and brain)?
• Infant formulas did not add lutein and zeaxanthin
until ~ 2012.
• They are still not routinely added.
pixabay.com
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March 3, 2016
RESOURCES
October 10, 2018
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March 3, 2016
Websites with additional information about diet and
eye health:
www.ophth.wisc.edu/dvs
http://maresgroup.ophth.wisc.edu
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March 3, 2016
For information about the content and quality of
health and nutritional products, and independent
testing of their content
https://www.consumerlab.com
Search for recent December 2018 update: Vision
Supplements Review (with Lutein and Zeaxanthin)