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March 2000

Letter from Dr. Janson
Preserving Eyesight—Start with Diet
Add Exercise for Circulation
Ultraviolet protection
Supplements that help the eyes
A supplement program for eyesight
More on Lycopene
Natural Remedies for Diabetes
In the Health News
By the Way:
References

Letter from Dr. Janson
Dear Friends,
One of the most common questions I hear in my medical practice is “What can I do with nutrition to improve my vision or prevent loss of eyesight.” Indeed, loss of vision is the most feared disability, and many of the problems that lead to visual loss are related to lifestyle choices. Whether your concern is cataracts, macular degeneration, diabetic or hypertensive retinopathy, changing your lifestyle will make a difference.

Vision depends on a clear lens, the rich microcirculation to the retina, and the visual nerve cells of the retina called rods and cones. All of these can deteriorate with age, depending on exposure to toxins and oxygen free-radicals, poor dietary habits, hardening of the arteries, and high blood pressure. Diabetes leads to retinal disease because of damage to the retinal arteries and to cataracts because of high blood sugar levels.

Preserving Eyesight—Start with Diet
First, eat a healthy diet with an emphasis on fresh vegetables and fruits, plus whole grains, beans, seeds, and nuts. The vitamins, minerals, essential fatty acids, and phytochemicals that they provide are important for overall health as well as the eyes. If you wish, add a small amount of organic, lowfat yogurt, organic eggs, and a small amount of fish (unfortunately, it is increasingly difficult to find wild fish due to the widespread use of factory-style fish farming—including the use of antibiotics and other drugs, and genetically engineered growth hormone to increase growth rates). Dairy products contain the milk sugar—lactose, a combination of two simpler sugars, glucose and galactose. Both glucose and galactose are converted through the action of an enzyme called aldose reductase to “sugar-alcohols,” which can cause swelling of the lens. They also attach to proteins that then deposit in the lens. Both the lens swelling and the sugar-protein deposits lead to cataracts.

To avoid these sugar-protein combinations, in addition to reducing milk-product consumption, it is wise to keep all added sugars out of the diet. This means avoiding those addictive sweets—such as the average of two doughnuts per person per day that Americans eat, along with the sodas, cookies, pies, ice cream, and candy. In fact, the American diet is a prescription for disaster when it comes to your eyesight (and many other health issues). Staying with a mostly vegetarian diet of natural, unpro-cessed foods will help preserve the circulation to the retina, the rods and cones, and the lens.

Add Exercise for Circulation
Second, exercise regularly. It helps to maintain a low blood pressure (I’ll talk specifically about managing blood pressure in a future issue) and preserves the blood vessels (the retina is rich in small blood vessels). Exercising for 45 minutes lowers blood pressure for an additional 16 hours after finishing. Exercise also helps to support the health of the cells that line the arteries, called endothelium. These cells help relax the blood vessel muscle and maintain blood flow—another benefit is improved circulation to the heart through the coronary arteries.

Ultraviolet protection
The eyes are subject to a lot of oxidative damage to both the lens and the retina because they are exposed to ultraviolet light and a rich circulation of oxygen from the dense retinal capillaries. Protecting the eyes from too much sun exposure may help delay any degeneration of the lens and the retina. This does not mean avoiding all sunlight. Some sun exposure is healthy as long as it is in moderation, and not enough to tan or burn the skin. The action of sunlight on the skin is important for the production of vitamin D, and light stimulates the pineal gland, suppressing melatonin production during the day. UV-filtering lenses may provide some protection for the eyes, if they actually do what they claim.

Supplements that help the eyes
Many dietary supplements support eye health . They improve vision and help protect the macula (the area of the retina with the sharpest vision) and the lens. The usual antioxidants such as vitamins E and C, and the trace minerals selenium and zinc help the retina and the lens. High levels of vitamin E can reduce cataracts by 60 percent. Other helpful nutrients are the amino acid taurine, carotenoids such as beta-carotene, lycopene (found in tomatoes), and lutein (from spinach and kale), and the anthocyanosides (related to bioflavonoids) found in grapes and blueberries (or bilberry, the European variety). Bilberry may improve night vision, as the anthocyanosides enhance the activity of the rods and cones. It also helps strengthen the retinal blood vessels in diabetic retinopathy.

Other nutrients also play a role. Glutathione, made from the amino acid cysteine, participates in the chain of reactions that control free radicals and helps to regenerate vitamin E. It is part of an enzyme called glutathione reductase that depends on vitamin B2 (riboflavin).
Recent evidence shows that both lutein and lycopene play a role in eye protection. Lutein is present in the lens, suggesting an antioxidant role in cataract prevention. In one study, people with low levels of lycopene were more than twice as likely to have macular degeneration compared to those with the highest levels. Another study supports the role of lutein in prevention of macular degeneration.

A supplement program for eyesight
For a complete supplement program for the eyes, especially as you get older, I recommend starting with a comprehensive multivitamin mineral. To that, add daily doses of vitamins C (at least 3000 to 4000 mg) and E (400 to 800 IU), bilberry (200 mg), lutein (10 to 20 mg), and lycopene (10 to 20 mg). I also think it is a good idea to take ginkgo biloba (120 mg of standardized extract), which helps the circulation in small blood vessels and has been shown to protect the retina, taurine (500 to 1000 mg), and N-acetyl-cysteine (100 to 200 mg), also important for retinal cells. Quercetin is a bioflavonoid that blocks the sugar-alcohol formation from glucose and galactose. If you recall, these molecules lead to swelling of the lens, contributing to cataracts. Usually 400 to 800 mg daily is an adequate dose.
Put this entire program together, and you are likely to maintain your vision well into advanced years, and you may well reverse some of the damage that has already been done.

More on Lycopene
Lycopene is valuable for more than just your eyes. Research shows that it helps men with prostate cancer for both prevention and in reducing the spread of the cancer. In men given 30 mg of lycopene daily for just three weeks before prostate surgery, their tumors were already smaller than in the controls. Also, the cell markers for cancer growth were decreased, and biomarkers of cancer cell death were increased.

The evidence is also strong that lycopene helps prevent cancers of the lung and stomach, and it is suggestive for tumors of the pancreas, colon, rectum, esophagus, mouth, breast, and cervix, so both men and women will benefit from taking it.Lycopene also protects LDL-cholesterol (the "bad cholesterol") from oxidation. Oxidized LDL damages the arteries, so lycopene, from food and supplements (along with other antioxidants, B vitamins, coenzyme Q10, and magnesium) is a great nutrient for heart protection, as well as cancer prevention and treatment, and vision.

I suggest that you eat tomato products and consider supplements of 10 to 30 mg of lycopene.

Natural Remedies for Diabetes
Diabetes mellitus, or sugar diabetes, is a failure to properly metabolize sugar, specifically blood glucose. It results from either the reduced function of the pancreas, which produces insulin, or more commonly, from the inability of the cells to respond to insulin, called insulin resistance. Insulin is essential to move sugar into the muscles, where it can be burned for energy.

Adult onset diabetes (Type II) is almost always the result of poor health habits and being overweight. Insulin and oral medications are usually unnecessary if you exercise regularly, take your supplements and eat the right diet—high fiber, complex carbohydrates, low fat, and mostly vegetarian—these foods control blood sugar and provide essential phytonutrients.

The long-term complications of diabetes include retinopathy, cataracts, hardening of the arteries, and diabetic neuropathy—nerve degeneration with numbness and tingling starting in the feet and legs. Diabetes can often be reversed and the complications treated and prevented with lifestyle changes and specific dietary supplements.

Even Type I diabetics can reduce their insulin doses with a complete approach to blood sugar management. However, medical supervision of diabetes is usually essential, and I do not recommend trying to manage diabetes by yourself.

Supplements for diabetes
Numerous supplements help diabetes. Unrelated to normal nutritional levels, it is often necessary to take high doses of the trace mineral chromium, up to 1000 mcg per day, to regulate blood sugar, because diabetics are resistant to its effects. Chromium improves insulin activity and lipid levels, and it is depleted by the fatty, sugary American diets that are now spreading around the world.

The essential fatty acid GLA (gamma-linolenic acid), derived from borage oil or primrose oil, can treat diabetic peripheral neuropathy. The typical dose is 240 mg, from 1200 mg of borage oil or 3000 mg of primrose oil.

In a previous newsletter I mentioned the value of the antioxidant alpha-lipoic acid. While as little as 100 to 300 mg daily might be adequate as a potent antioxidant, 600 mg will improve blood sugar control, and 1000 mg daily can reverse diabetic neuropathy(even better along with GLA).

These are in addition to your B complex, extra vitamins C and E, coenzyme Q10, minerals, and all the other nutrients that help eyesight.

In the Health News
•Physical activity appears to confer benefits to post-menopausal women that goes beyond the help with bone density. Women who get regular moderate to vigorous exercise more than four times a week are half as likely to get diabetes as those who do not exercise. Even less exercise, as long as it is regular, reduces the risk of diabetes by about 30 percent. Of course, diet also helps by maintaining a normal weight, and high fiber helps to control blood sugar—even in those who are already diabetic, a vegetarian diet of unprocessed, high-fiber foods helps.

•Recent studies show that aspirin has side effects of kidney and gastrointestinal damage, even if taken in the low doses recommended to reduce platelet aggregation for prevention of heart disease. This is disappointing to some physicians, but effective alternatives to aspirin are probably better anyway. Vitamin E, garlic, ginkgo biloba and other herbs, and the essential fatty acids in fish oil, flaxseed oil, and borage oil (GLA) will have the same effects without any of the potential side effects. These seem like a better choice.

Diet and Disease
•Yet another article supports the value of a diet high in vegetables. Researchers report that cruciferous vegetables, such as broccoli and cauliflower, dramatically reduce the risk of prostate cancer. For those men who ate more than 28 servings of vegetables a week, the risk was reduced by 35 percent. If they ate at least three servings of cruciferous vegetables a week, the risk was reduced by 41 percent. These contain isothiocyanate, a phytochemical that helps detoxify carcinogens.

By the way:
I just attended a conference on genetically modified foods, once again confirming that there is little safety data to support the increased farming of these crops. In addition to the unknown risks to human health when genes are inserted from one species to another, it creates a risk to the environment, a risk to other species, such as butterflies and bees, and possible changes in the genetic makeup of native plants. The agribusinesses that are selling these seeds couch their deception by saying there is "no evidence of harm" when what they mean is they have no data at all! They could just as well say they have no evidence of safety, but that wouldn't sell products.

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References

Preserving Eyesight
Am J Hypertens 2000;13:44-51.

Hambrecht R, et al., Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med 2000 Feb 17;342:454-460.

Travis G, et al., Cell 1999;98:13-23.

Mares-Perlman JA, et al., Serum antioxidants and age-related macular degeneration in a population-based case-control study. Arch Ophthalmol 1995 Dec;113(12):1518-23.

Snodderly DM, Evidence for protection against age-related macular degeneration by carotenoids and antioxidant vitamins. Am J Clin Nutr 1995 Dec;62(6 Suppl):1448S-1461S.

Lycopene
Giovannucci E, Tomatoes, tomato-based products, lycopene, and cancer: review of the epidemiologic literature.J Natl Cancer Inst 1999 Feb 17;91(4):317-31.

Gann PH, et al., Lower prostate cancer risk in men with elevated plasma lycopene levels: results of a prospective analysis. Cancer Res 1999 Mar 15;59(6):1225-30.

Agarwal S, Rao AV, Tomato lycopene and low density lipoprotein oxidation: a human dietary intervention study. Lipids 1998 Oct;33(10):981-4.

Diabetes
Riales R, Albrink MJ, Effect of chromium chloride supplementation on glucose tolerance and serum lipids including high-density lipoprotein of adult men. Am J Clin Nutr 1981 Dec;34(12):2670-8.

Anderson RA, Chromium, glucose intolerance and diabetes. J Am Coll Nutr 1998 Dec;17(6):548-55.

Jacob S, et al., Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Radic Biol Med 1999 Aug;27(3-4):309-14.

In the health news
Folsom AR, et al., Physical activity and incident diabetes mellitus in postmenopausal women. Am J Public Health 2000;90:134-138.

Cohen JH, Kristal AR, Fruit and vegetable intakes and prostate cancer risk. J Natl Cancer Inst 2000 Jan 5;92(1):61-8.

Cryer B, Feldman M, Effects of very low dose daily, long-term aspirin therapy on gastric, duodenal, and rectal prostaglandin levels and on mucosal injury in healthy humans. Gastroenterology 1999 Jul;117(1):17-25.

Caspi D, et al., The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum 2000 Jan;43(1):103-8.

 


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CONSULTATIONS:

From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.


Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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