Macular Degeneration: Important Vitamins and Nutrition

February is Macular Degeneration Awareness Month

Macular degeneration is an issue that has personally affected our family.  My paternal grandmother has macular degeneration and she has lost much of her sight due to this disease.  My father also has some early signs, drusen, which are yellow deposits under the retina that a doctor can find using a dilated eye examination.  The kind of macular degeneration that occurs with aging is abbreviated AMD, which is short for Age-Related Macular Degeneration.  AMD destroys the central vision necessary for activities like reading or driving.  A recent study from Prevent Blindness America and the National Eye Institute has shown that women are at twice the risk of losing their sight, compared to men.  My grandmother’s AMD is severe enough that she cannot see clearly to look at pictures of my children.  She can grasp vague and general details when she sees the children in person, such as their fair hair and complexion.  She can no longer read, or pay her own bills.  She needs assistance to shop for her groceries.  So AMD affects many of the basic tasks that an older adult needs to perform in order to maintain independence.  So with a strong family history, I felt it was prudent to research strategies to prevent macular degeneration.  Here are my findings.

Many researchers have found a link between poor nutrition and macular degeneration.  The Beaver Dam Eye Study showed an increased risk for macular degeneration in  patients with the lowest levels of the antioxidant lycopene, found in certain fruits and vegetables.   In the Eye Disease Case Control Study higher serum carotenoid (beta carotene) levels showed a protective effect against macular degeneration.  In patients with high antioxidant blood levels, the Macular Degeneration Risk Factor Study found less of the most serious type of macular degeneration.

A study published by Dr. David Newsome in the Archives of Ophthalmology in February 1988, showed vision was less likely to deteriorate in macular degeneration patients who were treated with zinc supplementation. Zinc was studied because retinal zinc concentrations are usually high, and zinc is an important cofactor in retinal enzymes (such as retinol dehydrogenase and catalase).  Another study in the Journal of the American Medical Association (9 Nov 1994) showed that consumption of foods rich in the specific carotenoids lutein and zeaxanthin resulted in the most reduced risk for macular degeneration. Dark green, leafy vegetables, such as collard greens and spinach, are especially rich in these carotenoids and were specifically linked to substantially reduced risk. This study controlled for smoking and other risk factors. Smoking appears to increase macular degeneration risk.

According to the AREDS Study (Age-Related Eye Disease Study) vitamin supplements can have a protective effect against the advancement of existing macular degeneration.  Patients were given one of four treatments of zinc, antioxidants alone, a combination, and a placebo.   The specific daily amounts of antioxidants and zinc used were 500mg of vitamin C; 400IU of vitamin E; 15 milligrams of beta carotene, which is equivalent to 25,000 IU of vitamin A as beta carotene; 80 milligrams of zinc; and two milligrams of copper (see multivitamin below). In the AREDS study, this combination reduced the chance of developing advanced ARMD by 25% and preserve vision by 19%.

Harvard researchers have found that patients consuming 5-7 servings of green, leafy vegetables which contain high levels of lutein and zeaxanthin, have a lower chance of developing macular degeneration. They comprise the two dominant yellow pigments in the macula, the center of our vision and the site where macular degeneration occurs and filter out visible blue light which may cause photodamage. Here, and also listed above, is a high quality supplement containing a rare blend of alpha-carotene, astaxanthin, beta-carotene, lutein, lycopene, and zeaxanthin delivering of a broad spectrum of carotenoids.   A sufficient dosage should be taken to provide 25,000 IU of beta carotene, per the AREDS recommendation.  Since oxidation and free radical damage is thought to contribute to ARMD (Age Related Macular Degeneration) supplementation clearly has it’s value.

The National Eye Foundation also encourages the use of daily multivitamins because they provide other essential nutrients not contained in the AREDS formulation.  These quality multivitamin formulas are well balanced and provide the 2 mg of copper that is recommended to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.  The amounts of the key nutrients recommended by AREDS would be very difficult to obtain from diet alone.  Remember that no amount of vitamin supplements will take the place of a healthy diet, but they can be an important tool to increase nutrient levels and provide extra insurance.   Be aware that multivitamins that state they contain 100% of the minimum daily requirements: vitamin C 60mg, beta-carotene 5000 IU; vitamin E 30 IU; and zinc 15mg, are not sufficient.  These doses are far below that used in AREDS. Patients with AMD may need far more than the 100% daily requirements.  A multivitamin complements the AREDS formula, it does not replace it.

It is very important to recieve regular eye examinations from an eye care professional.  Early detection of macular degeneration is crucial in order to preserve vision.  For “dry AMD” the most common early sign is blurred vision. It becomes more difficult to see details in front of you, such as faces or words in a book. Often this blurred vision will go away in brighter light.  As AMD advances there becomes a blind spot in the middle of the field of vision, which will enlarge over time.  For “wet AMD” the classic early symptom is that straight lines appear crooked, caused by fluid from the leaking blood vessels behind the macula. A small blind spot may also appear resulting in loss of one’s central vision.  For more information, visit the Macular Degeneration Foundation.

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Calcium and Other Important Nutrients to Prevent Osteoporosis

Calcium and Related Nutrients for Bone Health 

Many individuals make the mistake of thinking that calcium is all that’s needed for bone health. However, bones are made of more than calcium. Bones also contain several minerals as well as protein. The protein serves as a matrix to which the minerals necessary for bone formation attach.

While many perceive osteoporosis to be “not enough calcium in the bones,” osteoporosis is more complicated than that. Insufficient calcium in the bones is called rickets, which is caused by inadequate vitamin D. Osteoporosis involves both low levels of minerals as well insufficient protein in the bones.

So, simply taking calcium by itself will not help bone health. Other minerals, vitamins, and protein are also needed. The intestinal tract also needs to be healthy and fully functional as the site where dietary calcium is absorbed into the bloodstream. Several studies have shown that both prebiotics and probiotics such as these, improve the absorption of calcium by improving intestinal health. Because hormones also play a significant role in bone health, the risk of osteoporosis increases with age, especially in females. Treating hormone deficiencies with the appropriate bioidentical hormones is important for older adults. Lastly, weight-bearing exercises cause the bones to signal the body’s need to increase bone density.

When considering a calcium supplement, it is important to be aware of the supporting nutrients necessary for calcium absorption. Vitamin D is one of these nutrients. The body manufactures its own vitamin D under the right conditions. The first ingredient required is natural oils on the skin. Your body forms vitamin D in these oils. If you take frequent, warm or hot showers with soap, these oils may not be present on your skin in sufficient amounts. Secondly, you must have sufficient exposure to the sun’s ultraviolet light. During winter, in northern latitudes, in areas with smog from air pollution, and when our skin is protected by sunscreen, we cannot form adequate vitamin D from sunlight. Also, be aware that if you shower too soon after sun exposure you may not have the opportunity to absorb the vitamin D from the skin into your bloodstream. Most of us need some extra vitamin D from supplements.

There are still other supporting nutrients required. Vitamin K is a nutrient supported by new research as necessary for modifying osteocalcin, a bone protein, so it can properly bind minerals and hold them in the bone matrix. Magnesium is another important nutrient, which we need to take in proper balance with calcium. To be incorporated into bone, calcium needs the help of certain enzymes, which require magnesium to work properly. We tend to be more deficient in magnesium than calcium. The proper calcium to magnesium ratio is approximately 2:1. Phosphorus is also required for calcium absorption. The American diet tends to be overly abundant in phosphorus, in contrast to calcium and magnesium. Yet another necessary, but little known nutrient, is boron. Boron has been shown in recent studies to aid bone metabolism when taken in the proper amount. Lastly, manganese, copper, and zinc are co-factors that activate enzymes to help build bone mass. Here is an excellent example of a balanced calcium supplement.   Calcium supplements should always be taken with food that includes some fat, because dietary fat increases calcium absorption.  You can also use a complete protein supplement to provide the extra protein necessary to form the bone matrix.

It is also important to know, that while 99% of the body’s calcium in contained in the bones and teeth, the remaining one percent has other very important functions in the body. One of these crucial functions is the conduction on nerve impulses. Undersupply of calcium also can cause irritability of the muscles, resulting in cramps and even spasms.

Pregnant mothers should be aware of the importance of an adequate calcium intake, along with its supporting nutrients. A unmet high demand for calcium during pregnancy or lactation can result in future bone loss for the mother.  During both my pregnancies, I found that a good quality calcium supplement with magnesium, such as one of these provided relief for my leg cramps that I sometimes experienced at night. This also greatly reduced my extreme tooth sensitivity to hot and cold.

Part 2: Treating Hypothyroidism, Important Nutrients

(Also see part 1 on Treating Hypothyroidism, here and my post on the Thyroid and Adrenals here.)

The body needs certain building blocks to produce and utilize thyroid hormone.  Sometimes hypothyroidism does not show up on blood tests because, while thyroid hormone is present at normal levels in the blood, some of these key nutrients to utilize it are missing.  The missing link may be in the process of converting thyroid hormone into its usable form, getting it into the cells, or activation within the cells.  The following are some of the important nutrients, vitamins, and minerals that the body uses to achieve proper thyroid function:

Iron:  In order to produce thyroid hormone, the body must first convert the amino acid phenylalanine into tyrosine.  Sufficient iron is required to make this conversion.

Iodine and manganese:  After the tyrosine reaches the thyroid gland, manganese and iodine are used to convert it into thyroxin (T4) This is what most doctors prescribe, in synthetic form, for patients with hypothyroidism.  Unfortunately it may not help if you are not able to convert T4 into T3, the form of thyroid hormone that enters the cells where it can do its job.  Please note that many believe that the US RDA for iodine is much too low, providing only one tenth of the necessary iodine at best.  I chose to use Lugol’s Iodine solution to supplement iodine.  Some people prefer kelp, but you need to make sure your source is of sufficient potency.

Zinc and Other Minerals:  Zinc must be present in sufficient quantity for the liver to convert T4 into T3.  A simple way to check for zinc deficiency is to try zinc lozenges.  If the lozenges taste bitter or metallic, you are probably not deficient in zinc.  Excess copper, often correlated with low levels of zinc,  interferes with the conversion of T4 to T3.  High blood calcium levels often show up concurrently with the excessive copper.  High blood calcium makes the cells less responsive to T3.  Please note that dietary intake and calcium vitamin pills rarely cause high blood calcium unless intake is extremely high over a period of time, or there is some other problem present. Selenium:  Inside the cell, selenium is needed to help thyroid hormone work.  Low selenium will cause thyroid hormone to become inactive.  The body also uses selenium to produce an enzyme that assists in converting T4 to T3.

Protein:  Extra protein may be helpful to give the thyroid the necessary amino acids to produce thyroid hormone. It is important to purchase supplements from a company that conducts independent tests for potency, purity, and clinical performance.  They should be able to prove that their product raises blood levels of the nutrient(s) provided.

Here are a few of my favorite supplements for thyroid function.

Zinc
Lugol’s Iodine
Iron
For manganese and selenium, this quality multivitamin has more than most available on the market.

Note: This information does not constitute medical advice.
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Treating Hypothyroidism

I came across some very good information on a message board recently and I thought anyone with hypothyroidism could really benefit from this.  I have had Hashimoto’s for over 20 years and I have learned a lot recently about how nutrition affects the thyroid gland and what supplements can help.

Many people have symptoms of hypothyroidism but when the doctor orders blood tests, they come back “normal.”  Part of the problem is due to overly broad reference ranges.  Also, many doctors rely solely on the TSH, which is only a small part of the picture.  To accurately access the thyroid when problems are suspected you need the following labs drawn:  TSH, Free T3, and Free T4.  These 3 should be checked every time the thyroid levels are ordered.  It is the relationship of these three values that will allow a knowledgeable doctor to assess the thyroid properly.  Initially the doctor should check the for thyroid antibodies using TPO and ATA in the hypothyroid patient to rule out Hashimoto’s.   A patient with Hashimoto’s should continue to have TPO and ATA checked to verify the effectiveness of treatment in reducing thyroid antibodies.  For more information about interpreting lab values, visit http://www.drrind.com/thyroidscale.asp#tests
However, diagnosis and monitoring of hypothyroidism should not be based solely on laboratory values.  Here is a list of symptoms of hypothyroidism.

LOSS OF HAIR
WEIGHT GAIN
COLD HANDS AND FEET
CELLULITE
WEIGHT GAIN ON THIGHS AND HIPS
DRY SKIN
LOW BODY TEMPERATURE
LOW BLOOD PRESSURE
LOW ADRENAL FUNCTION
MENSTRUAL IRREGULARITIES
INFERTILITY
PMS
OSTEOPOROSIS
SUGAR CRAVINGS AND HYPOGLYCEMIA
UNEXPLAINED FATIGUE
CHRONIC FATIGUE
CONSTIPATION
MUSCLE CRAMPS AND SPASMS
PROBLEMS DIGESTING FATS AND OILS
SLUGGISH LIVER
COPPER TOXICITY

An easy test you can do at home is a basal temperature.  Is your temperature immediately upon awakening below 97.8?  For a woman in the childbearing years, the best time to check is 2-3 days after your period starts.  Check the temperature before you get out of bed, talk, or do anything else.  Most people with a basal temp below 97.8 will have symptoms of hypothyroidism as well.  It can be helpful to monitor basal temps daily and keep a graph to track change over time.  Keep in mind that a menstruating woman has a di-phasic temperature graph which is higher in the second half of her cycle due to the influence of progesterone.  Temperature readings can also be used to check adrenal function.  In that case they are taken throughout the day, starting 3 hours after waking, and a daily average then is plotted.  You can learn more about temperature patterns and adrenal function here on Dr. Rind’s website.

Hypothyroidism is more common is women, probably because the female hormones exert their effects on thyroid function.  Progesterone aids in the retention of zinc and potassium in our cells.   Zinc and potassium allow the thyroid hormone to enter the cell and then to be converted to the active form known as T3.  Some authorities believe that progesterone facilitates the action of thyroid hormone, while estrogen is antagonistic to thyroid hormone.  So if a woman has low progesterone and/or a high level of estrogen, it is more difficult for the thyroid hormone to do its job.  Weight gain on the hips and thighs, common in women with hypothyroidism,  is associated with high estrogen and/or low progesterone.  Estrogen can cause copper retention if zinc or progesterone levels are too low. Copper has been found to be an antagonist to thyroid hormone.

The thyroid also needs sufficient iodine to function properly.  Years ago, store-bought bread contained iodine.  However, the iodine has been replaced with bromine, which displaces iodine from the thyroid gland.  So it is best to use flour that is unbrominated and unbleached.  Also purchase only breads that are made with unbrominated flour.  In my opinion, a good quality sprouted or a true sourdough bread is best.  Check the labels on everything you use made with wheat flour.    Chlorine and fluoride also displace iodine from the thyroid gland.  The risks of water floridation, including adverse effects on thyroid function, were recently discussed by the scientific community, see ‘Second Thoughts about Fluoride,’ Reports Scientific American. Particularly if you have city water piped in, you should treat your water to remove these harmful substance. If you have well water, you should also have it tested, as you can have high levels of naturally occurring fluoride and other contaminants. You may need to filter your well water, depending on the test results. Please note that only reverse osmosis or a filter specifically designed to remove fluoride will take the fluoride out of your water.  If you choose reverse osmosis, many sources recommend adding minerals back into the water before drinking. See part two on treating hypothyroidism here
Note:  The information here does not constitute medical advice.

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