Save Your Sight!
Page 5
4. Eat whole, unprocessed foods made from ingredients you recognize. Buy organic whenever possible.
5. Nutritional supplements added to a healthy diet keep your eyes (and the rest of you) functioning at their best!
6. If you have eye disease, take the nutritional prescription recommended daily, without fail.
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YOUR MULTIVITAMIN SHOULD INCLUDE…
Beta-carotene/carotenoids: 10,000–15,000 IU
Vitamin A: 5,000–10,000 IU
The B vitamins:
Thiamine (B1): 25–50 mg
Riboflavin (B2): 25–100 mg
Niacin (B3): 50–100 mg
Pantothenic acid (B5): 50–100 mg
Pyridoxine (B6): 50–100 mg
Vitamin B12: 1,000–2,000 micrograms (mcg)
Biotin: 100–300 mcg
Choline: 50–100 mg
Folic acid: 400–800 mcg
Inositol: 150–300 mg
Calcium: 300–500 mg for men; 600–1,200 mg for women
Vitamin D: 100–400 IU
Vitamin C: 2,000–10,000 mg (2–10 g)
Vitamin E: 400–800 IU
Boron: 1–5 mg
Chromium: 200–400 mcg
Copper: 1–5 mg
Magnesium: 300–500 mg, and up to 800 mg for specific health problems
Manganese: 10 mg
Selenium: 25–50 mcg
Vanadyl sulfate: 10–25 mcg
Zinc: 10–30 mg
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4
Preventing and Healing Macular Degeneration
Age-related macular degeneration is the most common cause of blindness in Americans over the age of fifty. Up to fifteen million people who fall into this age group are affected. Up to 10 percent of senior citizens in the seventh decade of life have vision loss from macular degeneration. Between the ages of seventy-five and eighty-five, up to 28 percent of Americans will lose some central vision due to age-related macular degeneration (ARMD). It is the fastest-growing cause of legal blindness in the United States.
If you are over sixty-five, if you have blue, green, or hazel eyes (brown eyes have more protective melanin pigment over the retina), if you have been frequently exposed to sunlight, especially without protective eyewear, if you are a smoker, or if you are a postmenopausal woman, you are more likely to develop this disease.
For such a prevalent problem, there is very little that mainstream medicine can do to stop its progression towards total central blindness.
How the Eye Is Damaged in Macular Degeneration
Within the eye is a layer filled with tiny blood vessels (choroidal capillaries) that nourish the retina. In people who make poor diet and lifestyle choices over the years, these capillaries become clogged with calcium deposits and cholesterol. Oxygen can’t reach the retina and the cells starve and die.
In other instances, the capillary lining (endothelium) may become weakened, allowing fluid and blood components to escape where they shouldn’t. The result is increased pressure in the area of the retina, which can cause death of retinal cells.
The role of oxidation in this process is complex. It plays a part in the blood vessel diseases that lead to clogged capillaries, arteries, and veins. Lack of antioxidants in the diet allows free radicals to run rampant, and this process carries much of the responsibility for the vessels becoming blocked in the first place. (Refer to Chapter 10, where we discuss the circulatory system in detail.)
Once blood flow to the retina is reduced or cut off, the natural antioxidant defenses of the body that are carried in the blood can’t counter the sunlight-caused oxidative damage going on in the retina, and deterioration is accelerated.
The retinal pigment epithelium (RPE) is a single cell layer that brings nutrients and oxygen into the retina, flushing wastes into the bloodstream. The aging spots (drusen) that often occur in macular degeneration appear on the RPE. Thirty percent of adults have drusen, and in many no visual impairment results, so the deterioration may go unnoticed. But meanwhile, the macular degeneration can continue to progress.
Macular degeneration occurs in and around the retinal blood vessels that surround the macula.
Calcium deposits also can build up in the membrane that lies between the choroidal capillary layer and the RPE. This blocks exchange of blood, nutrients, and wastes, threatening the health of the retina.
A substance called lipofuscin, which is hardened vitamin A that has been used and discarded by the retinal cells, also can accumulate in the RPE, clogging normal cell metabolism. This process is the result of passing years. Lipofuscin plays a key role in the production of harmful free radicals and leads to lipid peroxidation (“tagging” of blood-borne fat molecules by free radicals, rendering them dangerous to your cells). Overexposure to ultraviolet and (especially) blue light is the first step in lipofuscin’s generation of free radicals.
A layer of nerves links the retina to the optic nerve. Within this layer are protective pigments that are yellow in color, called lutein and zeaxanthin. These are members of the group of antioxidant substances known as carotenoids, found in colorful vegetables and fruits. Green, leafy vegetables like spinach, kale, and collard greens are rich in lutein and zeaxanthin. In a study of 870 people aged fifty-five to eighty years, those who ate spinach or collard greens two to four times a week were half as likely to develop macular degeneration as those who ate them once a month or less. These pigments provide a blue-light “sunglass” filter for the central retina.
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VEGETABLES RICH IN LUTEIN AND ZEAXANTHIN
Spinach
Mustard greens
Kale
Broccoli
Parsley
Celery
Green peas
Brussels sprouts
Pumpkin
Squash
Carrots
Yams
Corn
Green beans
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Early Detection of Macular Degeneration
Macular degeneration develops very slowly, and the time to catch it is in the early stages. Even better, take steps to prevent it altogether early in life. The more advanced the disease, the harder you’ll have to work to make progress in halting it.
SYMPTOMS OF MACULAR DEGENERATION
Normally straight objects appear bent or wavy.
A dark, blank or blurry spot appears in the center of your vision.
When you cover up one eye, what you’re looking at changes size or color.
Charlie, a fisherman, is a good example. He came to our clinic to have his eyes checked for the first time in his life.
“I can’t see to drive anymore, especially at night,” he told me. “I’m having trouble reading. Guess it’s come time for me to get some glasses.” Charlie loves his work, and when he’s not out on the water casting his nets, he’s at the harbor doing repairs on his boat. He’s not planning to retire any time soon, although he’s almost seventy, and he gets plenty of exercise. His dark tan gives him a look of good health. His smoking habit has lasted fifty-five years, and he doesn’t have much desire to quit now. “I’m gettin’ too old to be depriving myself of the little pleasures,” he said as I made a few notes in his chart.
I asked Charlie exactly how his vision had changed over the past few months. “It’s real odd,” he said, his pale blue eyes crinkling at the corners. “The outlines of things are sorta wavy. Things that oughta be straight seem to be bent in the middle. I’m having trouble seeing people’s faces, even. The other day my grandson came by the harbor where I was working, and I didn’t recognize him. Now my daughter’s worried I’m senile, but I just couldn’t make out his face.” He thought a moment. “Oh, also, when I go below from outside in the sun, I’m practically blind for a good minute or two before my eyes get used to the dark. I end up tripping all over the place down there.”
A diagnosis of early macular degeneration wasn’t hard to make in Charlie’s case. When I looked at his retinas I saw
patches of drusen, age spots much like those that appear on the skin of people often exposed to the sun. Charlie also was tested with a copy of the Amsler grid, which looks like a piece of graph paper with a dot at its center. I asked Charlie to look at the central dot and to tell me whether the lines began to seem wavy. “Well, yeah, now that you mention it,” he murmured. “That’s some neat trick!” Not surprisingly, Charlie had never heard of the disease I had diagnosed him with.
The Amsler Grid: Wearing your reading glasses, cover one eye, and focus on the dot in the middle of the grid above. Then repeat the test for the other eye. In healthy eyes, all of the lines are straight, and the squares are the same size. If there is any distortion, as in the diagram below, you may have macular degeneration.
Blurring at the center of vision may be a symptom of macular degeneration.
How Macular Degeneration Gets Started and Develops
Macular degeneration takes years to develop, and vision loss can be very subtle in its earlier stages. The affected part of the eye lies in a pit only 2 mm wide in the center of the retina. The retina, which is a paper-thin, postage-stamp-sized area on the inside back portion of the eyeball, is the part of the eye that does the miraculous and delicate work of translating light energy into nerve impulses. These impulses travel from the eye to the brain along the optic nerve, and the brain then translates the message from the nerve into a picture of what you’re looking at.
Age spots on the eye called drusen are an early sign of macular degeneration.
There are two kinds of macular degeneration. The dry (nonexudative) form is much more common, less severe, and rarely causes blindness, but can become the more dangerous, wet (exudative) form at any time.
The dry form of macular degeneration can consist of either poor circulation in the tiny blood vessels of the eye, or damaged blood vessels that create scar tissue and new blood vessel growth that blocks vision.
Blood seeping out of the retinal vessels (hemorrhage) is one characteristic of wet macular degeneration. The increased fluid pressure caused by hemorrhage damages the macula. The wet form also can involve growth of new blood vessels to replace clogged ones. The body’s intelligence is counterproductive here because the vessels grow over the macula, causing total central blindness. Even in this most severe form of macular degeneration, all sight is not lost; some peripheral vision is maintained.
Careful food and supplement choices can help you to avoid or diminish these problems, as you’ll see in this chapter.
Much of the advice we give to ARMD patients is geared towards halting the progression and preventing the shift from the dry form, which doesn’t usually cause total loss of central vision, to the wet form, which does. In neither form is there loss of peripheral vision, but when the disease is advanced, it’s still nearly impossible to move around normally, read, watch TV, or identify people.
We think that macular degeneration is caused by a combination of oxidation damage and the consequences of poor circulation. Your retinal cells are especially vulnerable to oxidation because they are exposed to ultraviolet radiation.
Human eyes contain a dark pigment called melanin, designed to prevent back reflection of light. It also serves as a shield from ultraviolet radiation. Those with light-colored eyes don’t have as much melanin pigment at the back of their eyes as do dark-eyed people; this explains why dark-eyed people are less likely to have ARMD. No matter what your eye color, melanin begins to deteriorate by the age of fifty, and that’s when macular degeneration develops in earnest.
The macula is right at the focal point of light’s entry into the eye. People who work outdoors without proper eye protection, like our friend Charlie, show signs of macular degeneration more often and earlier in life than those who spend much of their time indoors.
Within your eyes, protective shields of vitamin E and carotenoids (both of which are antioxidants, derived from the foods you eat) work to balance free radicals, staving off sun damage. Macular disease usually starts near the edge of the macula, where antioxidant protection is weakest and where daily bombardment by solar radiation first takes its toll.
Mainstream Treatments for Macular Degeneration
Taking good care of yourself physically, emotionally, mentally, and spiritually is your foundation for everlasting vision, but there are still times when surgery and other mainstream interventions are necessary. We perform eye surgery in our clinics every day, and the patients who do best are those who take care of themselves on every level.
If your ophthalmologist recommends these procedures or drugs, you will know what to expect and you will be able to make educated choices about your treatment.
For the dry form of macular degeneration, there is no mainstream medical treatment. Ninety percent of macular degeneration sufferers have the dry form. This means that they have some deterioration of the retinal cells responsible for central vision, but little or no growth of new blood vessels over the central retina (macula).
Laser Treatment
For those who have the wet form of macular degeneration, laser treatment (photocoagulation) can be used to stop the growth of these sight-threatening new blood vessels. A tiny laser beam is aimed at leaks in blood vessels, and when it hits them, it seals them shut. This procedure doesn’t restore vision or permanently arrest the progression of the disease. It is a temporary stopgap measure. Laser treatment can actually destroy retinal tissues and impair vision even more. Because it isn’t a permanent solution, repeated treatments are required, and with each treatment more retinal tissues are damaged by the treatment itself. We want to emphasize that laser surgery works only for those with the advanced wet form of this disease. Once new blood vessels have begun to grow, nutritional therapy becomes much less effective, and your choices are limited to drugs, surgery, or radiation treatments.
The worse your vision is to start with, the better your chances for improvement with laser surgery. Very few people with macular degeneration meet the eligibility criteria for laser surgery. Look at it as a last resort.
We recommend that all but the most severe macular disease patients postpone laser treatment until they’ve tried the preventive and restorative options found in this book for six to nine months. If your eye doctor suggests laser treatments, be sure to ask her or him the following questions:
What percentage of your patients have kept their vision for five years after laser treatment?
Would you have laser treatment if you were in my position?
Can you tell me about any cases where vision has actually improved following laser surgery?
Will you read the surgical consent form out loud to me and explain any details I don’t understand?
Radiation Treatment
Ionizing radiation, the same kind used in the treatment of cancer, has also been used in the treatment of wet macular degeneration. The drawbacks of this method are much the same as those of laser treatment: The “cure” may do more damage than the disease. Preservation of remaining vision is the aim with most of these mainstream treatments; they don’t bring back vision that’s been lost. The adverse effects of exposure to radiation are well known: It works by killing unwanted cells, but often takes healthy tissues with the unhealthy ones. In this way it can delay the growth of new blood vessels over the retina. This is another last-resort treatment for advanced disease where there is significant central vision loss.
Photodynamic Therapy
A new experimental treatment called photodynamic therapy is being studied. Using special molecules that make cells more sensitive to light, surgeons purposely cause the production of free radicals. They try to do so only in diseased tissues, so that the body’s natural oxidation process can do the job of destroying unwanted blood vessel growth. Photodynamic therapy is also meant only for the treatment of advanced macular degeneration.
Anti-angiogenesis Drugs
Another emerging mainstream therapy for those with wet macular degeneration is anti-angiogenesis (angio means “blood vessels�
�� and genesis means “creation” or “formation”). This treatment uses drugs to prevent the new blood vessel growth that occurs in the wet form of macular degeneration. Thalidomide, the drug given to pregnant women in the sixties that caused severe birth defects in thousands of children, is now being used as an anti-angiogenesis drug. So far it’s been shown to be safe for this type of treatment, but it is very expensive and its effectiveness is as yet unproven.
Interferon is another anti-angiogenesis drug. Its value in the treatment of wet macular degeneration has not been shown convincingly, and there are major side effects. Some researchers think it holds promise as a companion treatment to laser surgery. In one study, 18 percent of those treated with interferon had to discontinue the drug because of severe adverse reactions. Flu-like symptoms including fever, headaches, muscles aches, and chills affect almost half of those treated with interferon.
Stay Away from Aspirin
The blood-thinning action of aspirin has led some eye doctors to recommend it for improving blood flow to the retinas of those with either form of macular degeneration, but some studies have shown that aspirin actually can cause macular degeneration by creating retinal hemorrhages (tiny leaks in the blood vessels of the retina). Other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can cause tiny retinal hemorrhages in healthy eyes. Those with macular degeneration have very delicate eye vessels and often also have high blood pressure. Both factors predispose them to retinal hemorrhages, which will only be aggravated by NSAIDs. Aspirin and other NSAIDs are also damaging to the delicate lining of the gastrointestinal tract.
The bottom line is that although aspirin may help prevent blood clots and improve blood flow to the retina, the risks seem to outweigh the benefits in those with eye disease. There are plenty of natural ways to improve blood flow to the retina that are without risk. For example, nutrients with anti-inflammatory action include omega-3 and omega-6 fatty acids, garlic, magnesium, and vitamin E.