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Preventing Degenerative Disease

Dr. Strands Supplement Recomendations for those with this medical issue:
For patients with this condition, I primarily add 300 mg of grape-seed extract to the nutrients found in Table 1. I also add approximately 6-12 mg of additional lutein to the regime. l have found that if these patients are going to improve, it will occur within the first 4 months.Pharmaceutical Grade Supplements

Eye/MascularDegeneration

The Problems Eyes Have - Dr. Ray Strand

The role of oxidative stress as the cause of degenerative changes in the eyes has generated significant interest in the use of antioxidant vitamins and minerals as a means of preventing or even treating age-related eye diseases. No fewer than six large, multi-centered clinical trials are presently ongoing to study carefully the use of various nutritional supplements in the following diseases.'

Cataracts

Cataract surgery is the most common surgical procedure for patients more than sixty years of age. Its economic impact on the U.S. health-care system is tremendous. In the United States eye surgeons perform 1.3 million cataract surgeries each year at a combined cost of more than $3.5 billion. It has been estimated that a ten-year delay in the development of cataracts in the U.S. population would eliminate the need for nearly half of these surgeries.:

The lens of the eye collects and focuses light on the retina. In order to perform its job properly, it must remain clear throughout our lifetime. As we age, various components of the lens may be damaged and opacities may occur, leading to age-related cataracts.

Medical researchers believe it is essential to determine if supplying adequate levels of antioxidant nutrients to the eyes early in life will preserve lens function, protecting them from cataract formation. Basic research studies support the theory that free radicals are once again the culprit; they arise from ultraviolet sunray damage and form cataracts.;

The natural antioxidants the body makes (glutathione peroxidase, catalase, and superoxide dismutase) form the eye's primary defense system. But researchers have realized that the natural antioxidant defense system is not adequate in fully protecting the eye. In fact several clinical trials have considered the possibility that increased dietary and supplemental antioxidants may be protective against oxidative damage to the lens.~

Antioxidants found in the fluid around the lens of the eye are critical in protecting the lens itself. Thus, cataract development takes place at a much faster rate if this fluid around the lens contains low levels of additional antioxidants. The most important antioxidant in this fluid is vitamin C. Vitamin C is water-soluble and is found in high concentrations around the lens. Other antioxidants found in this fluid are vitamin E, alpha-lipoic acid, and beta-carotene.

Several epidemiological studies have demonstrated the association between the levels of vitamin C, vitamin E, and beta-carotene and the risk of developing cataracts. In Finland a case-controlled study showed individuals who had the lowest levels of vitamin E and beta-carotene had a four- to fivefold increased risk of needing cataract surgery. Another study showed that those individuals who consumed supplemental vitamins had at least a 50 percent decreased risk of developing cataracts.6

Good medical evidence exists showing that the natural antioxidant protection of young lenses decreases significantly with age. Several different clinical studies provide evidence that when people use various antioxidant supplements, this protects the aging eye. Researchers have found the higher the level of vitamin C found in the aqueous fluid around the eye, the greater the protection against cataract formation.~ Because of its synergistic effect, alpha-lipoic acid has been shown to embellish the work of all these antioxidants in protecting the lens of the eye. Recent clinical studies also reveal that both alpha-lipoic acid and vitamin C have the ability to regenerate the intracellular glutathione so it can be used again and again.8

I only hope that over the next few years all physicians will recommend antioxidants as a way to protect against cataracts. As clinical trials begin to report their findings, we'll know more about specific antioxidants and the supplemental levels of these antioxidants. But I believe sufficient evidence exists now to warrant encouraging patients to consume antioxidant supplements as a relatively inexpensive way to decrease this high incidence of cataract formation.

Macular Degeneration

In the United States, age-related macular degeneration (ARMD) is the leading cause of blindness in people more than sixty years old.9 For those who are not familiar with this disease, it is a decay of a critical part of the retina called the macular. This is where the greatest concentration of photoreceptors is located and is the area responsible for central vision. When this area of the eye begins to decline, we essentially lose central vision, our most important aspect of sight. If an individual with ARMD were to look right at you, he would not be able to see your face but could see things around you. In other words peripheral vision remains intact.

Macular degeneration presents itself in two different forms: wet and dry. Ninety percent of cases involve the dry form, in which central vision gradually reduces and may progress to the wet form about 10 percent of the timed" No proven treatment for the dry form of macular degeneration currently exists.

The wet form causes a more rapid reduction in central vision, the development of new vessels, and possible vessel leakage. The wet form of macular degeneration is potentially treatable via laser photocoagulation. This treatment attempts to slow the new vessel production, which causes swelling (edema) and leakage or bleeding into the retina, and to stop the bleeding this leakage may cause. Blindness usually still follows rather quickly, however.

Prevent Blindness America estimates that 14 million Americans have evidence of ARMD. The Beaver Dam Eye Study reports that 30 percent of the people in the U.S. over the age of seventy-five have ARMD and 23 percent of the remainder will develop ARMD within five years.

Mechanism of Injury to the Retina

In recent years several researchers have made interesting proposals as to the actual cause of age-related macular degeneration (ARMD) These the vies suggest that light that enters the eye and is focused on the macula of the retina causes significant free-radical production in the outer aspect of these photoreceptors. Again, if antioxidants are not available to readily neutralize these free radicals the free radicals can cause damage to the photoreceptors. This form of oxidative stress has also been shown to create damage to the high concentration of polyunsaturated fats (PUFAs) in the outer retina and photoreceptors.

Much like the oxidation damage to the LDL cholesterol the oxidized and damaged PUFAs cause the formation of lipofuscin-a group of lipid/protein products that are collected within the retinal pigment epithelium. Lipofuscin creates even more oxidative damage to the retina, and researchers believe it is actually the cause of damage to and destruction of these sensitive photoreceptors.

These toxic substances can accumulate in the pigment epithelium cells and are eventually excreted in the form of drusen. Drusen formation is one of the first indications to an ophthalmologist that a patient is developing ARMD. As these drusens accumulate between the pigment cells and their blood supply' they block the exchange of nutrients and the photoreceptor cells can no longer function. causing an area of blindness.

The Generation of Free Radicals in the Retina

As I stated, when the retinal pigment and photoreceptors absorb light, the process forms free radicals. High-energy ultraviolet light and visible blue light are especially capable of producing enemy free radicals in the retina of the eye. As you may guess, patients exposed to this high-energy light over an extended period of time have a significantly greater risk of developing ARMD. Studies suggest that as we get older, the antioxidant defense systems that protect us against the free radicals caused by high-energy light waves declines significantly.11 This obviously upsets the balance our body creates between antioxidants and free radicals and leads to increased damage to the retina of the eye.

Several studies have shown that people with macular degeneration had low levels of zinc, selenium, vitamin C, carotenoids, and vitamin E when compared to people who did not have macular degeneration.12 Clinical studies examined the effects of supplementing individual nutrients to see if they could improve or slow down the development of ARMD. Following is a condensed compilation of the results.

Carotenoids

Now, Ray, eat your carrots. They're good for your eyes. I can still hear my mother urging me to eat my creamed carrots before I could get down from the table to play.

Did your parents ever tell you to eat carrots too? Doctors believed then that the beta-carotene found in carrots was necessary for good eyesight and night vision. This is true to a degree, but beta-carotene is only one of a dozen important carotenoids found in the body. It is actually more important to eat corn, leafy green vegetables, and collard greens because they contain high levels of carotenoids called lutein and zeuxanthine.

Because lutein and zeaxanthine are yellow, they efficiently absorb the blue light portion of visible light. Blue light is the major high-energy light that can damage the lens and the retina of the eye. When these two nutrients are present in the lens and macula, our eyes absorb blue light and minimize oxidative stress. They essentially act like internal sunglasses. They screen out the harmful, high-energy light and decrease the number of free radicals that the photoreceptor cells produce. These nutrients are also very potent antioxidants and as such are able to help neutralize any free radicals that occur in this area of the eye.

Studies show Lutein Helps Protect the Eye

Patients who took lutein and zeaxanthine in supplementation were not only able to raise their blood levels of these nutrients but also significantly increased the levels within the eye. Macular pigment, which protects the

retina from being damaged, increased 20 40 percent in these studies, while blue light transmitted to the macular photoreceptors and macular pigment decreased nearly 40 percent.'3

The Journal of the American Medical Association reported in its November 9' 1994, issue that patients who had the highest intake of the two yellow nutrients, lutein and zeaxanthine' from their diet had a 43-percent decreased risk of developing ARMD over those who had the lowest intake. Interestingly' these same benefits were not apparent with patients who had high levels of beta-carotene. Lutein and zeaxanthine are the only carotenoids that are specifically deposited within the macula of the eye.'' Though beta-carotene found in creamed carrots is healthy for us to eat, it will not provide a decreased risk of ARMD. Perhaps what Mom really meant was, "Eat your carols" as in carotenoids.

Vitamin C

People with low levels of vitamin C have an increased risk of developing ARMD. Vitamin C is highly concentrated in the fluid within the eye (aqueous humor) and is a very important antioxidant for the retina. Studies indicate that supplementation with vitamin C can slow down the progression of ARMD. Vitamin C also has the ability to regenerate both vitamin E and the potent intracellular antioxidant glutathione.'5

Vitamin E

ARMD patients have low levels of vitamin E in the area of macula, where high-energy light produces excessive free radicals that damage the photoreceptors. Even though vitamin E is not the most important antioxidant within the eye, it is still a critical player. When a patient takes vitamin E in supplementation, he may provide protection against the development of ARMD.'6

Coenzyme Q10

By now you are familiar with CoQ10 from the discussion on cardiomyopathy in Chapter 7. CoQ10 is a potent antioxidant that is fat-soluble. This nutrient has been found to be a great protector of fats throughout the body. The retina of the eye, which is made up in large part by fat, is no exception.

Patients with ARMD show significantly depleted amounts of CoQ10. Those patients with normal levels of CoQ10 have greater capacity to resist oxidative damage that excessive free radicals cause.17 CoQ10is new in the study of ARMD, and its effects appear promising.

Glutathione

Glutathione is a very potent antioxidant found within every cell in the body. It is especially critical within the lens of the eye as well as the pigment and photoreceptor cells of the retina. Clinical studies have shown that as we age, the level of glutathione declines. This fact is imperative to consider in relation to the increase of diseases in the eye as we age. Several studies have looked at trying to increase the level of this crucial antioxidant within the lens and retina of the eye.

Among researchers, it is a well-known fact that our body absorbs oral glutathione poorly; raising cells levels of glutathione via this method are next to impossible.'8 The best way to increase intracellular glutathione levels is to provide nutrients that the body needs to manufacture its own glutathione. Remember, glutathione peroxidase is one of the natural antioxidant defense systems that the body creates. The nutrients needed for the body to make its own most effective, natural defense are selenium, vitamin B6, N-acetyl-Lcysteine, and niacin.

As you learn more about cellular nutrition, you will begin to realize the importance of providing all of these precursor nutrients to the cell. In this case alpha-lipoic acid and vitamin C are also critical because they both have the ability to regenerate glutathione. Since it is difficult to increase the levels of glutathione within the cell, these nutrients should also be present in supplementation so that the glutathione can be used again and again.

Researchers have demonstrated that when the photoreceptor and retinal pigmented cells have optimal levels of antioxidants present, they are much better able to protect these cells from oxidative damage. The lens of the eye is also better protected against oxidative damage when glutathione levels are higher. 19

Zinc and Selenium

Zinc and selenium are important minerals our antioxidant system needs. Zinc is critical for the function of our catalase antioxidant defense system and selenium is necessary to the glutathione peroxidase system. Both of these antioxidant defense systems are essential in the battle against free radicals produced in the eye. If these two minerals are not available in adequate amounts, the two defense systems simply cannot perform at their optimal level. Several studies now show that when these minerals are supplemented, especially zinc, ARMD can actually be stabilized and improved.20

"What Your Doctor Doesn't Know About Nutritional Medicine May Be Killing You."
Dr. Ray Strand http://www.raystrand.com/bookstore.asp

Additional Information:

Benefits of Lutein in Eye Diseases: http://www.healthcastle.com/lutein.shtml