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Ocular Nutrition: Friend Or Foe COPE: 48735-OP 4/7/2017 Ocular Nutrition: Friend or Foe COPE: 48735-OP Walter O. Whitley, OD, MBA, FAAO Director of Optometric Services – Virginia Eye Consultants Residency Program Supervisor – Pennsylvania College of Optometry Disclosures Walter O. Whitley, OD, MBA, FAAO has received consulting fees, honorarium or research funding from: • Alcon • Advanced Ocular Care • Allergan – Co-Chief Medical Editor • Bausch and Lomb • Review of Optometry – Contributing Editor • Biotissue • Optometry Times • Beaver-Visitec – Editorial Review Board • Ocusoft • Science Based Health • Shire • TearLab Corporation Questions we should ask??? • How would you describe your diet? • What does a healthy diet look like for you? • What did you have for breakfast? • How many servings of fruits/vegetables do you have per day? • How often do you eat fish? • What medications are you taking? Accessed from http://www.aoa.org/news/clinical-eye-care/6-nutrition-questions-you-should-be-asking-patient. -? 1 4/7/2017 Top 10 Vitamin Category SKUs Rank SKU Description $ Sales (000s) 1 Mega Red Omega 3 60ct $34,301 2 Lipozene 30ct $32,593 3 Align Probiotic 28 ct $28,421 4 Centrum Silver Ultra Women’s 100ct $27,357 5 Centrum Silver 125ct $27,234 6 Airborne 10ct $26,578 7 Ocuvite Adult 50+ 50ct $26,133 8 PreserVision AREDS Soft Gels 120ct $25,802 9 Align Probiotic 42ct $25,008 10 Phillips Colon Health 30ct $23,588 Source: Nielsen XAOC 52 weeks ending May 11, 2013 DON’T FORGET ABOUT Home Remedies, Herbal Supplements and Whatever MOM Told Me to Take Herbal Medicine and Nutritional Supplements Fraunfelder FW. Ocular side effects from herbal medicines and nutritional supplements. Am J Ophthalmol. 2004 Oct;138(4):639-47 2 4/7/2017 Age-Related Eye Diseases • More than 30 million people age 40 and older suffer vision loss in the U.S. • Age-Related Macular Degeneration (AMD) – Approximately 21 million Americans have AMD – AMD cases have risen 25% since 2002, largest increase among major eye diseases • Cataracts – More than 22 million Americans have cataracts – 400,000 new cases of cataract occur each year in the U.S. Prevent Blindness America/National Eye Institute 2008 “Vision Problems in the US” W. Reed Moran, Spotlight Health, With medical adviser Stephen A. Shoop, M.D., USA Today, Feb. 2001 Age-Related Eye Diseases • Dry Eye Disease – Approximately 29M Americans suffer from dry eye (1) – Multifactorial – Contact lenses, digital devices, ocular surgery (2) • Glaucoma – It is estimated that over 3 million Americans have glaucoma but only half of those know they have it. (3) – Estimates put the total number of suspected cases of glaucoma at over 60 million worldwide. (4) Sources: (1) Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offstrping study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806. (2) Dry Eye Workshop. The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007;5(2):93-107. (3) The Eye Diseases Prevalence Research Group, Arch Ophthalmol. 2004; Prevent Blindness America; (4) Quigley and Broman "Number of people with glaucoma worldwide in 2010 and 2020", 2006; Key Vitamins and Nutrients 3 4/7/2017 Recommended Daily Value (FDA) Nutrient DV Nutrient DV Nutrient DV Potassium 3500mg Niacin 20mg Selenium 70μg Vitamin A 5000 IU Vitamin B6 2mg Copper 2mg Vitamin C 60mg Folate 400μg Manganese 2mg Calcium 1000mg Vitamin B12 6μg Chromium 120μg Iron 18mg Biotin 300μg Molybdenum 75μg Vitamin D 400 IU Pantotheric Acid 10mg Chloride 3400mg Vitamin E 30 IU Phosphorus 1000mg Thiamin 1.5mg Vitamin K 80μg Iodine 150μg Riboflavin 1.7mg Magnesium 400mg Zinc 15mg Benefits of Multivitamins • Fletcher RH and Fairfield KM. Vitamins for chronic disease prevention in adults: Scientific Review. Journal of the American Medical Association 287:3116-126, 2002. • Webb AL et al. Update: effects of antioxidant and nonantioxidant vitamin supplementation on immune function. Nutrition Reviews 65:181-217, 2007. • Knecht P et al. Flavonoid intake and risk of chronic diseases. American Journal Clinical Nutrition. 76:560-8, 2002. • Holmquist C et al. Multivitamin supplements are inversely associated with risk of myocardial infarction in men and women. The Stockholm Heart Epidemiology Program (SHEEP). Journal of Nutrition 133:2650-2654, 2003. However • Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013; 159:824-34. • Grodstein F, O'Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Long- term multivitamin supplementation and cognitive function in men. A randomized trial. Ann Intern Med. 2013; 159:806-14. • Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, et al, TACT (Trial to Assess Chelation Therapy) Investigators. Oral high-dose multivitamins and minerals after myocardial infarction. A randomized trial. Ann Intern Med. 2013; 159:797-804. 4 4/7/2017 Nutrients for Healthy Eyes • 500 mg/day Vitamin C • 400 IU/day Vitamin E • 25 or 80 mg Zinc / 2 mg Copper per day • 10 mg Lutein / 2 mg Zeaxanthin per day • 350 mg DHA / 650 mg EPA per day Vitamin C • Why is it important? – Body unable to synthesize – Antioxidant capability • How much do I need each day? – 75 – 90 mg/day (DRI) – 500 mg/day (eye health) • Where can I get it in my diet? – Citrus fruits and juices Jacob, R. A. and G. Sotoudeh (2002). "Vitamin C function and status in chronic disease." Nutrition in clinical care 5(2): 66-74. (2001). "A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age- related macular degeneration and vision loss: AREDS report no. 8." Arch Ophthalmol 119(10): 1417-36. Chiu, C. J. and A. Taylor (2007). "Nutritional antioxidants and age-related cataract and maculopathy." Experimental eye research 84(2): 229-45. Vitamin E • Why is it important? – Body unable to synthesize – Antioxidant capability • How much do I need each day? – 22 IU/day (DRI) – 400 IU/day (Eye Health) • Where can I get it in my diet? – Nuts, fortified cereals, sweet potatoes (2001). "A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age- related macular degeneration and vision loss: AREDS report no. 8." Arch Ophthalmol 119(10): 1417-36. Chiu, C. J. and A. Taylor (2007). "Nutritional antioxidants and age-related cataract and maculopathy." Experimental eye research 84(2): 229-45. Chew, E. (2007). “Age-related eye disease study 2 protocol.” National Eye Institute Protocol 07-EI-0025. 5 4/7/2017 Zinc • Why is it important? – Essential trace element • How much do I need each day? – 8-11 mg zinc/day (DRI) – 40 – 80 mg zinc/day (Eye Health) • Where can I get it in my diet? – Red meat, poultry, mixed nuts • Copper – High zinc may cause copper deficiency – 2 mg included in AREDS study (2001). "A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age- related macular degeneration and vision loss: AREDS report no. 8." Arch Ophthalmol 119(10): 1417-36. Chew, E. (2007). “Age-related eye disease study 2 protocol.” National Eye Institute Protocol 07-EI-0025. Grahn, B. H., P. G. Paterson, et al. (2001). "Zinc and the eye." Journal of the American College of Nutrition 20(2 Suppl): 106-1http://eathealthylivefit.com/wp-content/uploads/2014/05/Foods-Minerals- Zinc-EatHealthyLiveFit_com-300x206.png8. How Much Do I Need Each Day? • 10 mg/day lutein • 2 mg/day zeaxanthin • Dietary Guidelines for Americans* – Equivalent to 4 - 8 mg lutein & zeaxanthin / day – < 4% Americans meet guidelines – U.S. average: 1 – 2.5 mg/day *9 servings of fruits and vegetables every day; recommendation based on the reference 2,000 calorie diet. HHS/USDA. Dietary Guidelines for Americans 2005. http://www.healthierus.gov/dietaryguidelines/CDC. National Health and Nutrition Examination Survey Data 2001-2002. http://www.cdc.gov/nchs/about/major/nhanes/nhanes01-02.htm Richer, S., W. Stiles, et al. (2004). "Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age- related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial)." Optometry75(4): 216-30. Stringham, J. M. and B. Hammond (2008). "Macular Pigment and Visual Performance Under Glare Conditions." Optometry & Vision Science 85(2): 82-88. Chew, E. (2007). “Age-related eye disease study 2 protocol.” National Eye Institute Protocol 07-EI-0025. Internal Pair of Sunglasses Carotenoids such as lutein and Good nutrition zeaxanthin filter helps reduce the blue light to block risk of chronic eye production of free diseases such as radicals macular degeneration and The sun emits may improve photo oxidizing visual function (UV) rays that are harmful to Sunglasses the eyes reduce free radicals 6 4/7/2017 Essential Fatty Acids - DHA/EPA • Why are they important? – Important role in many bodily organs/systems • How much do I need each day? – 350 mg DHA / 650 mg EPA per day • Where can I get them in my diet? – Flax, fleshy fish like tuna or salmon Fliesler, et al. Prog Lipid Res (1983) 22:79-131 Connor, et al. Nutr Rev (1992) 50:21-29 Cho, et al. Am. J. Clin. Nutr. (2001) 73:209-218 Birch, et al. Ped. Res. (1998) 42: 201-209. Chew, E. (2007). “Age-related eye disease
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