Nutritional Approaches to Eye Health

1. Nutritional Approaches to Eye Health Sally Duffin BSc Nutr Med, MBANT, MHFI www.nutritioninyork.co.uk

2. Sight – a special sense • Sight, touch, smell, hearing and taste make up our 5 basic special senses. • Other senses include balance, pain, temperature and body position.

3. Sight – a special sense • Our special senses provide us with key information about our surroundings via highly detailed, precise receptor cells in our sensory organs • These cells transmit information from our environment to the brain where it is interpreted

4. Aims of the Webinar • Examine the visual system • Look at various eye disorders that have the potential to be nutritionally influenced • Explore nutritional approaches to supporting healthy eye function

5. Eye Development • Early pregnancy; physical structure of the eye • Last trimester & early life; neurological components and connections • Visual development involves genetic coding, brain activity, post-natal visual stimulation (after full term pregnancy) and established, protected sleep cycles

6. Eye Development • Early life visual stimulation; visual development is taking place up to the 40th week of pregnancy. • Premature babies must be protected from light to allow development to continue as if in-utero • At birth visual pathways for receiving stimulation from movement, patterns, shapes & light intensities are complete • Age 2-3 months, colour recognition begins • Development continues to age 3

7. REM Sleep • REM = Rapid Eye Movement • During the 7th month of pregnancy the infant brain begins to establish sleep states; REM and non-REM sleep. • During foetal REM sleep retinal cells stimulate the growth of nerve pathways to the brain which lead to the development of the visual cortex, the area of the brain that ‘sees’ the image from the retina • Disruption to REM sleep interferes with visual development – light, alcohol and nicotine

8. Eye Structure Conjunctiva– covers the cornea Cornea – eyeball surface, focuses light towards the lens Anterior chamber Iris – controls the amount of light going into the pupil, the dark hole in the centre of the eye Ciliary body – muscles that adapt the lens according to what focus is required Lens – focuses light onto the Retina & Macula Vitreous – filled with vitreous humor, a thick gel-like fluid which maintains intraocular pressure and the shape of the eye and holds the lens and retina in place Sclera – tough outer coating of the eyeball and the white of the eyeball. Covered by the conjunctiva at the front of the eye Optic nerve – transmits visual information into the brain

9. Accessory Eye structures: • Eyelashes & ciliary glands • Eyelids • Eyebrows • Surrounding muscle tissue

10. Eye Disorders • Functional eye disorders and systemic diseases affecting eye health • Eye is intimately involved with and influenced by the neurological, vascular and metabolic systems • Ophthalmological examination • Iridology • Epigenetic changes

11. Functional Eye Disorders • Macular Degeneration Dry • Most common type • Long development time • Final stage is total loss of central vision • painless • Macular Degeneration Wet • Found in 10-15% of AMD sufferers • Develops rapidly • Body grows new blood vessels in the macula • If diagnosed quickly, treatments are available

12. Functional Eye Disorders • Inflammation; conjunctivitis, blepharitis, hayfever & allergies, uveitis, styes • Cataracts • Glaucoma • Retinopathy; retinal disorders resulting in loss of vision or impaired vision: diabetic retinopathy, retinopathy of prematurity

13. Systemic Conditions Diabetes Hypertension Thyroid Stroke Multiple Sclerosis Rheumatoid arthritis Pregnancy

14. Systemic Conditions • Diabetic retinopathy • Common consequence of poor blood sugar control

15. Systemic Conditions • Thyroid; • Underlying issue is auto immunity • Antibodies attacking thyroid can also affect orbital contents = Thyroid Orbitopathy • Treat underlying thyroid imbalance • Hypertension; • “nicking” of retinal veins • Stroke; • Erratic eye muscle control • Visual neglect • Dry eyes • Increased sensitivity to light

16. Systemic Conditions • Multiple sclerosis; damage to the nervous system can result in loss of visual field, changes in eye movement, pupillary response • Rheumatoid arthritis & Sjorgens syndrome; auto-immune conditions = inflammation • Pregnancy; gestational diabetes, increased demand for nutrients associated with eye health.

17. Key Nutrients Antioxidant vitamins – ACE Omega-3 fats Magnesium Zinc Vitamin D Proanthocyanidins Carotenoids

18. Antioxidant Nutrients • Nutritional Update Service – “Antioxidants Support Eye Health” • AREDS – Age Related Eye Disease Study sponsored by National Eye Institute & National Institutes of Health • Antioxidants protecting cells from free radical damage • Aloe Vera to support antioxidant absorption Nutrient combination; • 500mg Vit C • 15mg beta-carotene • 80mg zinc oxide • 2mg copper • 400iu Vit E

19. Omega-3 fatty acids • Powerful anti-inflammatory & immunomodulatory effects through modifying and regulating eicosanoids and intracellular signalling • DHA particularly important as high concentrations are found in the retina • DHA can support the health of and even increase macular pigment optical density • MPOD is a measurement of the thickness of the macular pigment. Low MOPD is a risk factor for AMD. • Krill oil provides omega-3 fats in highly bioavailable phospholipid form

20. Magnesium, Zinc & Vitamin D Magnesium • Context of wider health issues • Metabolism & energy production • Protein synthesis • Function of nervous system and muscle function Zinc • Specific antioxidant actions – high concentrations in retina • Wider health issues; insulin function, auto-immunity • Metabolism of vitamin A – conversion of beta-carotene to vitamin A may be compromised in hypothyroidism • Cell division and replication • Metabolism & energy production

21. Vitamin D • Associated with a reduction in the accumulation of amyloid-beta in the retina • Regulatory & modulating effects on the immune system • Associated with a lower risk of developing MS

22. Carotenoids Lutein & Zeaxanthin = non-vitamin A carotenoids called xanthophylls Macula gains its yellow pigmentation from these nutrients Absorb harmful UV rays that may damage the macula Protect the lens from oxidative damage, reducing the risk of cataracts In plants and algae these compounds absorb blue light and are required for photosynthesis Bright yellow, orange and dark green vegetables are excellent food sources

23. Proanthocyanidins • Type of flavonoid • Give plants and fruits their colour – the darker or stronger the colour, the higher the levels of flavonoids • Bilberry, grapeseed (OPC), red wine, dark purple grapes • Citrus bioflavonoids, quercetin, green tea polyphenols • Powerfully antioxidant, supportive to tiny capillaries

24. Summary • Vision is one of our many Special Senses • Eye is composed of delicate, intricate structures prone to damage • Eye disorders can be specific or a symptom of a wider health condition • We can nutritionally support eye health with antioxidants, vitamin D, essential fats, carotenoids and flavonoids.

25. Nutrigold Newsletters and Updates Service • An Alphabet of Antioxidants • Fish Oils • Importance of Supergreens • Learn More about Vitamin D • Benefits of Krill Oil • Benefits of Vitamin C • Antioxidants Support Eye Health • Webinars – ‘Pre-conceptual Care’, ‘Pregnancy’, ‘Thyroid’, ‘Understanding the Omega Oil Revolution’

26. References • Editorial (2009) Clinical & Experimental Ophthalmology vol 37:1 accessed online 05/12/12 • http://www.rnib.org.ukaccessed online06/12/12 • Seeley R. et al (2008) Anatomy & Physiology Eighth Edition McGraw-Hill, New York • Graven S. & Browne J.V (2008) Visual Development in the Human Foetus, Infant & Young Child Newborn & Infant Nursing Reviews vol 8:4 194-201 • http://www.nlm.nih.gov/medlineplus/encyc/article/000737 accessed online 20/12/12 • Friedman M (2005) Fundamentals of Naturopathic Endocrinology CCNM Press, Toronto • http://www.rnib.org.uk/eyehealth/eyeconditions/eyeconditionsdn/pages/diabetes accessed online 20/12/12 • “Eyes May Reveal Multiple Sclerosis Progression” http://www.medicalnewstoday.com/articles/254469.php accessed online 07/01/13 • Ash M. (2012) RA – bacteria, diet and hormones: a fixable mix? CAM Magazine Sept. 2012

27. Age-related Macular Degeneration Linked to Low Antioxidant Levels & Sunlight Exposure http://www.medicalnewstoday.com/articles/125576.php accessed online 07/01/2013 • Nutrigold Nutritional Update Service - “Antioxidant Support Eye Health” • http://en.wikipedia.org/wiki/Age-Related_Eye_Disease_Studyaccessed online 07/01/2013 • http://www.nei.nih.gov/amd/accessed online 07/01/2013 • Vinson J.A. et al (2005) Effect of Aloe Vera preparations on the human bioavailability of vitamins C and E Phytomedicine vol 12 issue 10: 760-765 • Johnson E.A. et al (2008) The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins and macular pigmentation The American Journal of Clinical Nutrition vol 87 no.5:1521-1529 • Vitamin D shows eye health benefits http://www.nutraingredients.com/Research/Vitamin-D-shows-eye-health-benefits-Studyaccessed online 05/12/12

28. Multiple Sclerosis risk lower when Vitamin D levels are higher http://www.medicalnewstoday.com/articles/246486.phpaccessed online 07/01/2013 • Gao S. et al (2011) Lutein and zeaxanthin supplementation reduces H2O2-induced oxidative damage in human lens epithelial cells Molecular Vision Online http://www.molvis.org/molvis/v17/a343/accessed 07/01/2013