Diet and nutritional supplementation management for macular degeneration

Photo Cred: CDC/Unsplash

By Kat Black

Macular degeneration is the leading cause of blindness among older adults in the United States – but according to Neda Gioia, OD, CNS, FOWNS, the founder of Integrative Vision in Shrewsbury, New Jersey, integrative treatment plans can prevent the disorder from progressing to that point.

Gioia shared an experience with an active patient, who had moderate macular degeneration and wanted to avert further vision loss. She was also suffering from digestive issues.

First, Gioia ran tests for lutein and zeaxanthin, which are the main carotenoids found in the human retina and discovered that her scores were low. “Carotenoids are really the key piece for macular degeneration,” she said. “So, we went into digestion. We doubled, tripled the general amount [of carotenoids] that she was taking.” Gioia applied a partial gut protocol to help her with digestive enzymes and instructed her on the best phytonutrient foods to consume.

Within three to four months, Gioia said, her patient’s lutein and zeaxanthin scores doubled, and her macular degeneration has been stable ever since. “She also feels better digestively. Overall, she feels a little bit healthier,” said Gioia. 

Gioia said that macular degeneration is one of the most common issues she sees in her practice, especially in adults aged 65 and older. The condition, which destroys the central part of the retina (or macula), is expected to affect 5.44 million people by 2050, according to the Centers for Disease Control and Prevention.

There are two types of macular degeneration: wet and dry. “Dry macular degeneration causes gradual central vision loss and results from aging and thinning of tissues in the macula or deposit of pigment,” according to Marc Grossman, OD, LAc, founder of Natural Eye Care in New Paltz, New York on his website. “Wet macular degeneration arises from the body’s attempt to make up for lack of nutrients by building extra blood vessels beneath the retina, but the new blood vessels leak fluid which causes permanent damage to the retinal cells.”

One of the reasons patients may seek complementary treatment for macular degeneration, said Grossman, is that conventional treatment options are limited. The only treatment that exists for wet macular degeneration is anti-vascular endothelial growth factor (anti-VEGF) therapy, which is administered via eye injection and blocks VEGF, a protein that can promote excessive blood vessel growth in the eye. There is currently no available treatment for dry macular degeneration. However, Grossman said in an interview that with the help of nutritional treatment protocols, he has been able to stabilize macular degeneration in his patients and in some cases, reduce the number of injections they need. 

“Macular degeneration has been proven to be a nutritionally responsive condition,” he said.

Gioia and Grossman both emphasized that in addition to nutritional interventions, smoking cessation, and blue light protection are important factors in preventing age-related macular degeneration.

Nutritional Supplementation

Both Gioia and Grossman agreed that when it comes to treating macular degeneration, antioxidants – specifically the carotenoids lutein and zeaxanthin – are key. “Classically, lutein and zeaxanthin ingestion can help prevent these conditions [macular degeneration, glaucoma, and cataracts] that are not genetic. We really have to get it from our environment, from our food. There are studies that show that people who have high numbers of these nutrients have a better experience with macular degeneration,” said Gioia.

The nutrients tested in the Age-Related Eye Disease Studies (AREDS) and (AREDS 2) conducted by the National Eye Institute reduced the risk of progression from intermediate to advanced age-related macular degeneration by about 25 percent, according to the NEI website. Among these nutrients are vitamin C, vitamin E, and zinc.

According to Grossman, zinc is crucial to maintaining a healthy macula and can be found in meat, seafood, nuts, grains, and legumes. He recommends 11 milligrams (mg) daily for men and 8 mg daily for women. He advises zinc supplementation for vegetarians and vegans.

Other nutrients that play a role in macula health, said Grossman, include astaxanthin10, meso-zeaxanthin, and resveratrol. Vitamin D deficiency was also found to be associated with increased risk of age-related macular degeneration in a 2015 study published in JAMA Ophthalmology.

Leafy Greens and Low-Fat Diet  

Grossman suggested juicing as an easy method for accessing organic, dark leafy greens, which contain lutein and zeaxanthin. One juicing recipe that he prescribed for a macular degeneration patient includes broccoli, green and red bell pepper, raspberries, apples, and leafy greens such as kale, collard, and/or spinach.

A 2016 study published in EMBO Molecular Medicine found that high-fat diets exacerbate choroidal neovascularization (CNV), or the abnormal blood vessel growth that causes wet macular degeneration, by altering gut microbiota. 

Both Grossman and Gioia recommend a Mediterranean diet, which has an omega-6 to omega-3 ratio of about 4-5:1 and higher level of omega-3 than the typical western diet (10-20:1). According to a 2011 study in Collegium Antropologicum, a decreased omega-6 to omega-3 ratio is associated with protection against neovascular macular degeneration.

“Fish oil and omega-3 balance is huge in eye care,” Gioia said. “If you abide by the Mediterranean diet, which is shown to navigate you throughout your future, you’re going to avoid not only general systemic conditions but also ocular conditions.”