Foods Rich in antioxidants, zinc, omega-3, lutein/zeaxanthin
We have been getting questions about foods rich in the vitamins and minerals given in the AREDS. Following is a table that lists such foods. You can see in the lists below that you could get the AREDS dose of vitamin C and beta-carotene in the diet. It’s harder though, to get the AREDS dose of zinc and almost impossible to get the AREDS dose of vitamin E from food alone. Foods Rich in Nutrients that Fight AMDVitamin C: Recommended daily dose 60-90mg. ARED dose is 500 mg per day. Foods rich in vitamin C with amount in milligrams per one cup unless otherwise noted: Fresh orange juice - 124 Broccoli - 116 Brussel sprouts - 97 Strawberries - 74 Grapefruit juice - 67 Kale - 53 Green pepper (5 rings) - 45 Tomato juice - 44 Beta-carotene (converted to vitamin A in the body): Recommended daily requirement is 5000 IU. AREDS dose is 15 mg or around 25,000 IU. Foods rich in beta-carotene with IU per cup: Pumpkin - 54,000 Sweet potato - 32,000 Carrots - 31,000 Spinach - 15,000 Peppers – 8,500 Cantaloupe – 6,000 Apricots – 3,000 Romaine-lettuce – 2,700 Vitamin E: Recommended minimal required daily dose is 20 mg or 30 IU. AREDS dose is 400 IU (about 268 mg). Foods rich in vitamin E with milligrams per cup or per tablespoon for oils: Sunflower seeds - 64 Almonds -56 Sunflower oil - 7* Safflower oil - 5* Peanuts - 16 Soybean oil - 5* Spinach - 3 Olive oil - 2* Flaxseed oil – 2 * Unfortunately these oils are also high in omega-6 fatty acids which may not be good for patients with AMD. Zinc: Recommended minimal daily requirement is 15 mg/day. AREDS dose is 80 mg per day. Foods rich in zinc with milligrams per cup unless otherwise noted: Oysters (6 medium) - 76 Turkey (dark meat) - 10 Chicken - 7 Crab - 5 (average but varies with type of crab) Kidney beans - 2 Yogurt - 2 Brown rice - 1.2 Spaghetti (whole wheat) - 1 Copper (trace element): Recommended minimal daily requirement is 2 mg. High zinc intake can cause copper deficiency, so 2 mg given in AREDS. Found in shellfish, beans, peas, whole wheat bread, and chocolate. A source for additional information about the amount of nutrients in foods is the US Department of Agriculture (USDA) - Nutrient Database for Standard Reference. http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl
Q&A: What foods or supplements maximize absorption (ie, blood levels) of zeaxanthin or lutein?
Question: A very knowledgeable reader asked the following:
If we assume for now that the best natural or nutritional supplements are zeaxanthin or lutein, what foods or supplements maximize absorption (ie, blood levels)? The reason I am asking this is that I read somewhere that corn has very high zeaxanthin levels, but the bioavailability is low for some reason. If this is so, one may have the same problem with orange peppers, etc, or even with certain nutritional supplements. Also with nutritional supplements it is very hard to know what is actually in them and how effectively the actual formulation is absorbed.
Perhaps all that one needs to do is take some fatty food like cold water fish at the same time to increase absorption of a lipid soluble compound...
I am also wondering whether antioxidants in the macula are very different from other antioxidants, given that they have to work effectively at unusually low PO2 levels.
Answer: These are hard questions. It is clear that oral ingestion of lutein and zeaxanthin increase the serum level and increase the pigment levels in the macula in most but not all people. Recent evidence showed that supplementation with lutein increases the macular pigment more than with zeaxanthin. There is competition in the gut for absorption between lutein and zeaxanthin and most nutritional tables don’t separate them but list them together. Corn has very high levels of zeaxanthin which may make the bioavailability of the lutein less. High doses of fiber in corn may also decrease the bioavailability. As the reader suggested, the concomitant intake of fat seems to increase the absorption of both.
We should be suspicious of nutritional supplements because no one is monitoring them. The FDA is too busy making sure pharmaceutical drugs are safe. Whenever possible, I think it’s better to get the nutrients from colorful fruits and vegetables than from supplements. I would trust your diet more than supplements.
I know that a lot of people are tempted to do both, in otherwords eat a diet rich in these nutrients and then take megadoses of supplements. I would be careful about overdoing it because there is often competitive inhibition between various nutrients. For instance, too much zinc can make you anemic by inhibiting copper metabolism.
We think that vitamins C, E, and beta-carotene work in the macula as they do elsewhere in the body. We know from epidemiological studies that diets high in these vitamins are associated with a lower risk of AMD. We also know from the AREDS trial, that supplementation reduces the rate of progression to severe AMD and also visual loss.
I hope this helps. If you have a question or topic for me to discuss, then please send me an e-mail.
Q&A: Taking part in clinical trials/choosing the correct supplement
Question: A reader asked the following question: Is there any research going on at this time that one can become a part of? I am 66 years of age and have been told that I have external drusens...2004. My sister, age 64 had external drusens, but now has "hard drusens" that have invaded the iris, if I understand her correctly. Our father, who died at age 92 had macular degeneration and was legally blind. I have been taking ICAPs with lutein, but in reading your current article, I might not be taking the correct product.
Answer: I am not sure what your doctor meant by “external drusen.” He may have meant, “extensive drusen.” With your father’s history though, it sounds unfortunately like you have early AMD. There are no studies that you can take part in right now. The Complications of AMD Trial (CAPT) is testing whether light laser to the macula of patients with drusen reduce the risk of visual loss. This trial has completed recruitment and will announce its results shortly. I would not have laser now though.
The National Eye Institute is planning the Age-Related Eye Disease Study 2, which is testing whether supplementation with 10 mg of lutein, 2 mg of zeaxanthin, and one gram of docosahexaenoic acid (DHA) is helpful in reducing the progression of AMD. DHA is one of the omega-3 polyunsaturated fatty acids that has been found to he so helpful in also reducing inflammation and cardiovascular disease. AREDS 2 will be an excellent study but has not yet started.
As I wrote in the July 5th blog, ICAPS with lutein has only 6,600 international units (IU) of beta-carotene, yet the AREDS study used 25,000 IU. I worry about this. I would take one of the supplements listed in the blog that contains the full AREDS dose. Then you could take lutein 10mg and zeaxanthin 2mg separately if you wish and one gram of docosahexaenoic acid (DHA) which is one of the active forms of omega-3 fatty acids. You are also able to get these amounts of lutein/zexanthin in your diet by eating the following vegetables:
Kale- 22 mg per cup
Turnip greens- 18 mg per cup
Spinach- cooked 15 mg per cup
Collard greens- 15 mg per cup
Spinach raw- 7 mg per cup
Corn- 3.0 mg per cup
Peas 2.2 mg per cup
Brussel sprouts 1 mg per cup
You should eat take in 1.5 grams of omega-3 fatty acids per day or around 10 grams per week on average by eating the following:
Wild Salmon- 4 mg per cup
Sardines 3.5 mg per cup
Herring- 2 mg per cup
Tuna- 2 mg per cup
Halibut- 1 mg per cup
Seeds and nuts also have omega-3 oils that are converted by the body into the active form in a ten to one ratio. So it takes 10 grams of nut oil to make one gram of the active form of fatty acid found in fish. The following nuts are high in omega-s oils:
Flaxseeds- 56 grams per cup
Flaxseed oil- 2 grams per tablespoon
Walnuts- 9 grams per cup
If I were you, I would take the regular I-CAPS or one of the others listed, and then eat a diet rich in the above nutrients. Thanks for asking.
ClinicalTrials.gov ( http://www.clinicaltrials.gov/) provides regularly updated information about federally and privately supported clinical research in human volunteers. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. The information provided on ClinicalTrials.gov should be used in conjunction with advice from health care professionals. If you have a question or topic for me to discuss, then please send me an e-mail.
Lutein / zeaxanthin and Omega-3 poly-unsaturated fatty acids in AMD
The supplements used in the Age-Related Eye Disease Study (AREDS) were vitamin C, vitamin E, beta-carotene, and zinc ( see the July 5th blog). There is accumulating data however that lutein / zeaxanthin and omega-3 poly-unsaturated fatty acids may also help reduce the progression of AMD. Lutein and zeaxanthin are members of the carotenoid family, like beta-carotene, and are the only two carotenoids in the macula. They are much more concentrated in the macula than anywhere else in the body so you would think that they must be there for a reason. Lutein and zeaxanthin protect against light damage by being very efficient absorbers of blue light, which has the most energy in the visible spectrum and is the most damaging. You could think of them as sun block for the macula. They are also good anti-oxidants and scavenge reactive oxygen molecules like the antioxidant vitamins. The Age-Related Eye Disease Study ranked their study participants into five groups according to the amount of dietary intake of lutein and zeazanthin. The group who had the highest intake, the top twenty percent, had a forty percent reduction in the risk of atrophic or neovascular AMD. These patients probably were the ones who had an overall healthier diet and ate all those good things like carrots and squash and spinach so it is unknown whether it was the overall diet or just the lutein and zeaxanthin which made the difference. Smokers have less lutein and zeaxanthin pigment in their macula and some researches believe that may be one mechanism why smokers have an increased risk of AMD. The National Eye Institute is planning a study called AREDS 2 which will test whether supplementation with lutein and zeaxanthin slows the progression of AMD. The planned doses have been tentatively set at ten milligrams of lutein and two milligrams of zeaxanthin daily. Patients with AMD may decide that they should go ahead and take these supplements now thinking that at least they won’t be harmful. We don’t know that for sure, however. We thought that beta-carotene supplementation would be helpful in smokers and then discovered that it increased the risk of lung cancer. We thought that very high doses of vitamin E might protect against heart attacks and found that the opposite may be true. The other emerging story in that of omega 3 poly-unsaturated fatty acids. These fatty acids are mainly found in fish and nuts. These fatty acids have anti-inflammatory properties and may be anti-angiogenic, which may mean that they protect against the formation of the new blood vessels found in the wet form of AMD. A number of studies have found a reduced risk of AMD in patients who have diets rich in omega-3 poly-unsaturated fatty acids. For instance in the AREDS study there was a fifty percent reduction in advanced AMD for the group who had the highest intakes compared to the group who had the lowest. It didn’t take much of the omega 3 poly-unsaturated fatty acids to be effective because the highest intake group on average ate only one serving of broiled or baked fish a week. The National Eye Institute’s AREDS 2 trial will also test if supplementation with omega 3 poly-unsaturated fats reduces the progression of AMD. If you have AMD, you could run out and buy supplements that contain lutein / zeaxanthin or omega-3 poly-unsaturated fats. Or probably better yet you could eat one serving of a vegetable every day that contains a lot of lutein / zeaxanthin such as kale (22 mg per cup), spinach (15mg per cup), broccoli, peas, or brussels sprouts two servings per week (for omega-3) of salmon, sardines, herring, trout, halibut, soybean oil, or walnut oil. That diet will give you plenty of both lutein / zeaxanthin and omega-3 oils.
Proposed Topics About Age-Related Macular Degeneration
Drs. Folk and Wilkinson publish their new book, Protect Your Sight, in a novel way. Video Introduction to Dr. Folk's Book - Protect Your Sight
Read Dr. Folk's most recent articles on age-related macular degeneration. Topics Index - Introduction: patient with dry AMD.
- Comparison of vitamin/mineral supplements.
- Update from the ASRS Meeting- Lucentis®
- The omega 3 and lutein/zeaxanthin story
- Foods rich in antioxidants, zinc, omega 3, lutein/zeaxanthin
- Micronutrients in other macular diseases
- Life-style changes that can help.
- Update from the Retina Society Meeting
- Treatments for the wet form of AMD I
- Treatments for the wet form of AMD II
- Avastin
- Avastin - Update
- Safety of Avastin, Lucentis, Macugen posted June 2006
- Cardiovascular Safety of Lucentis Compared to Macugen
- Lucentis vs PDT: ANCHOR study, 1-year results
- PIER and Torpedoes for Lucentis
- Cataract Surgery and AMD
- Plaquenil & AMD
- AREDS 2; see also New Studies Underway: AREDS 2 (January 2007)
- 2005 End of the Year Summary
- Seeing things that aren't there
- Vision Loss Simulators by guest author, Mark Wilkinson, OD
- Treatment Trends at the U of Iowa
- Update from the 29th Annual Macular Society Meeting, February 2006
- FDA grants priority review to Lucentis for wet AMD
- Update from the ARVO Annual Meeting, 2006
- Lucentis is here!
- Glare and Age-Related Macular Degeneration by guest author, Mark Wilkinson, OD
- Lucentis is here. Now what?
- Patients with AMD need your help
- Dietary Fat and AMD
- AARP and Diet
- Lucentis / Avastin and PDT
- Update on Avastin vs. Lucentis (March 26, 2007)
- Update on Avastin vs. Lucentis (March 26, 2008)
- From Paris- The 24th Annual Meeting of the American Association of Retinal Specialists and the 6th Annual Meeting of The European Vitreoretinal Society, Cannes, France
- Lucentis sets new high standard for treatment of neovascular AMD
- Results of the MARINA and ANCHOR Trials Published
- How Safe is Fish?
- Complications of AMD Trial (CAPT) Results Announced
- Good Vessels-Bad Vessels
- Live from The Meeting of the American Academy of Ophthalmology, Las Vegas
- More Treatments for Wet AMD from the AAO Annual Meeting (2006)
- More from the AAO 2006 Annual Meeting
- Pain with Intraocular Injections and Is One Injection Enough?
- The Treatments of Choice (December 2006)
- A Success Story
- New Studies Underway: AREDS 2
- New Studies Underway: DENALI
- New Studies Underway: CATT
- Treatment Trends for Neovascular AMD 2003-2006
- Problems with PDT
- Avastin or Lucentis in Pregnancy
- Avastin and Hypertension
- Update from the 30th Annual Meeting of the Macula Society (6-13-2007)
- More from the Macula Society Meeting- Reinjection Intervals for Wet AMD (6-20-2007)
- Clinical Trials for Wet AMD (8-27-2007)
- Inflammation and AMD (9-17-2007); Update: Inflammation and AMD (6-24-2008); Possible treatments for Inflammation in AMD
- Genentech Pulls the Plug on Avastin® (10/13/2007)
- Who’s to Blame for High Drug Prices? (10/16/2007)
- Fluorescein Angiography and Pregnancy (11-13-2007)
- Treatments for Dry AMD (11-19-2007)
- Query: Worried About Stroke After Treatment (11-28-2007)
- Comment: Anxiety and the Injection Procedure (11-30-2007)
- Video: The Latest in AMD (12-4-2007)
- Reader Question: Lucentis and Risk of Stroke? (1-2-2008)
- Reader Concern: Not Responding to Treatment (1-22-2008)
- The Tell Tale Heart (1-28-2008)
- Vitamin E (2-12-2008)
- Update on Intravitreal Injections at the University of Iowa (3-4-2008)
- An update on Cataract surgery and AMD (3-17-2008)
- Update on Avastin vs. Lucentis (March 26, 2008)
- Clear Sailing (Regarding the SAILOR Trial) (April 16, 2008)
- Dietary Supplements and The Brain (April 24, 2008)
- Inflammation and AMD, an update (June 24, 2008)
- Possible treatments for Inflammation in AMD (July 10, 2008)
- Bye... Bye... Beta-carotene. Say Hello to Lutein/Zeaxanthine (July 30, 2008)
- A Very Big Clue to Understanding Dry AMD (Sept. 22, 2008)
- CATT Revisited (Sept. 26, 2008)
Labels: table of contents
Q&A: Should mom with significant vision loss from macular degeneration take the AREDS supplements?
Question: A daughter writes that her mother has severe AMD and has been legally blind for the last three years. She asks if her mother should still take the AREDS supplements. Answer: The answer is yes. The AREDS (Age-Related Eye Disease Study) looked at the results of vitamin and zinc supplementation specifically in patients with advanced disease and vision loss. They presented the results at the last Macular Society Meeting in February. The supplements slowed vision loss compared to placebo in patients with advanced disease. So even if patients have lost a lot of vision due to AMD, they should still take the supplements discussed in the July 5th blog. If you have a question or topic for me to discuss, then please send me an e-mail.
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