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Ocular Specific Nutrients

Ocular Specific Nutrients. Introducing: Ultimate DHA Eye Synergistic nutrients for ocular health Protects the eyes from oxidative damage and damaging light Fish Oil Supports Ocular Health Visual development Healthy vision Natural solution for dry eyes Healthy blood flow

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Ocular Specific Nutrients

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  1. Ocular Specific Nutrients • Introducing: Ultimate DHA Eye • Synergistic nutrients for ocular health • Protects the eyes from oxidative damage and damaging light • Fish Oil Supports Ocular Health • Visual development • Healthy vision • Natural solution for dry eyes • Healthy blood flow • Antioxidant lipid mediator • Lutein and Zeaxanthin Support Ocular Health • Macular degeneration • Prevent Age-Related Eye Diseases (AREDs) • Ultimate DHA Eye – Practical Considerations • Fish oil • Lutein • Zeaxanthin • Fish oil is safe • Quality Counts • Quality counts

  2. Introducing Ultimate DHA Eye

  3. Nordic Naturals Ultimate DHA Eye • Condition specific blend of research-based nutrients for ocular health • Prevents age-related oxidative damage to eyes • Fish oil portion = concentrated DHA formula (50% DHA) • Research shows that DHA is specifically indicated for supporting ocular health • Lutein and Zeaxantin • Naturally occurring carotenoids (also known as xanthophylls) • Protects from oxidative stress and high-energy light • Ultimate DHA Eye; 2 soft gels daily • DHA 788 mg • EPA 158 mg • Lutein 20 mg • Zeaxanthin 4 mg

  4. Fish Oilfor Ocular Health

  5. Fish Oil and Ocular Tissue Evidence-based benefits • Supports • Visual development • Healthy vision • Hydration and moisture • Blood flow to ocular tissue • Prevents • Oxidative damage and inflammation associated with Age-Related Eye Disease • Macular degeneration, Retinal degeneration, Cataracts

  6. Omega-3 Fatty Acids – EPA+DHA Fish oil is the best source of omega-3 fatty acids • Docosahexaenoic Acid (DHA) • Visual development • Structural lipid in retinal photoreceptor and synaptic membranes • Protects from light, oxygen, and age-associated damage to the eyes • Eicosapentaenoic Acid (EPA) • Anti-inflammatory • Reduces inflammation of lacrimal gland, meibomian gland, and ocular surface, which are associated with symptoms of Dry Eye Syndrome (DES)

  7. Fish Oil Supports Visual Development DHA • Required for development of neural and retinal membranes • Accumulates rapidly in the brain and retina during gestation and early postnatal life1 • DHA supplementation results in higher visual acuity in infants born preterm2 • DHA and ARA—supplementation of infant formula supports visual acuity and IQ maturation3,4 • 1. Am J Clin Nutr 2006;83:1452S–1457S. • 2. Am J Clin Nutr 2006;83:1458S–1466S. • 3. Early Hum Dev 2007;83:279–84. • 4. Pediatrics 2003;112:e177–83.

  8. Fish Oil Supports Healthy Vision • The essential omega-3 fatty acids attain their highest concentration in the human photoreceptors • The integrity of retinal pigment epithelial (RPE) cells is critical for photoreceptor cell survival and vision • DHA is the precursor of neuroprotectin D1, which directly protects RPE cells Omega-3s are important structural components for retinal photoreceptors and cortical gray matter Neurotrophins enhance retinal pigment epithelial cell survival through neuroprotectin D1 signaling. Proc Natl Acad Sci USA 2007;104:13152–7.

  9. Fish Oil – The Natural Solution for Dry Eyes • Over 10 million Americans suffer chronic persistent inflammation of the ocular tissue that results in burning and redness • Dry Eye Syndrome (DES) is characterized as an inflammatory condition of the ocular tissue • Fish oil supports the body’s natural anti-inflammatory response • Women’s Health Study (a cross sectional study of 32,470 women) • Women who consumed higher amounts of EPA and DHA had significant reduction in the occurrence of Dry Eye Syndrome (DES) • Women who ate five servings of fish had 68% reduced risk of DES compared to those who ate one serving Relation between dietary n6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr 2005; 82:887–893.

  10. Fish Oil Improves Blood Flow • Healthy blood vessels and circulation are key to good eye health • Eye health depends on the integrity of fine vessels that supply blood to the area • Fish oil promotes healthy blood flow • In a review of 36 studies (2002) and a review of 31 studies (1993) • Measurable improvements of blood flow were seen The Omega-3 fatty acids EPA and DHA increase systemic arterial compliance in humans. Am J Clin Nutr 2002;76: 326–330.

  11. Fish Oil Prevents Oxidative Damage • DHA converted into lipid mediator that is responsible for protecting ocular cells from oxidative stress • Protecting from oxidative damage is the foundation to preventing visual and cognitive decline • DHA is most highly concentrated in photoreceptors, brain, and retinal synapses • DHA accounts for approximately 30–35% of the total fatty acids found within the eye • Fish oil – The best source of DHA Rotstein NP, et al. Protective effect of docosahexaenoic acid on oxidative stress-induced apoptosis of retina photoreceptors. Invest Ophthalmol Vis Sci 2003;44:2252–2259.

  12. Fish Oil Improves Overall Eye Health • Obstacles to healthy eyes and visual longevity are • Incomplete visual development • Poor circulation to eye tissue • Inflammation • Dry eyes • Free radical damage to eye tissue • Fish oil • Supports ocular development • Improves circulation • Supports the body’s natural anti-inflammatory response • Supports the production of bioactive lipid mediators that protect from free radical damage Studer M, et al. Effect of Different Antilipidemic Agents and Diets on Mortalit, A Systematic Review. Arch Intern Med 2005;165:725–730. Durrington P, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease. Heart 2001;85(5):544–548.

  13. Lutein and Zeaxanthin

  14. Lutein and Zeaxanthin • Natural xanthophylls not synthesized by the human body that must be consumed from the diet • Fat-soluble nutrients that occur in the retina of the human eye • Provide protective pigment that filters out harmful light • Found in green leafy vegetables such as spinach and kale, and in egg yolks and animal fat • Proven benefits: • Individuals with a diet rich in lutein and zeaxanthin are more likely to have healthy vision than people who do not • Daily supplementation of 10 mg of lutein for one year is associated with healthy eyes and vision • Increased dietary intake of, or supplementation with, lutein and zeaxanthin was found to result in increased plasma levels, which were positively and significantly associated with macular pigment optical density Zhao L, Sweet BV. Lutein and zeaxanthin for macular degeneration. Am J Health Syst Pharm 2008;65:1232–8. Richer S, et al. 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). Optometry 2004. 75:216–230.

  15. Fish Oil + Lutein and Zeaxanthin Possibly the next standard of care for Macular Degeneration and other Age Related Eye Diseases (AREDs) • 2001: The National Eye Institute completed the Age-Related Eye Disease Study (AREDS) • Zinc, vitamin C, vitamin E, and beta-carotene established as the “Standard of Care” for age-related causes of vision loss • 2007: The National Eye Institute initiates AREDS II • Omega-3 fats (DHA and EPA), lutein, and zeaxanthin on Age-Related Eye Diseases • The results of ARED Study 1 and ARED Study 2 may result in a new “Standard of Care”

  16. AREDS II : Advancing Our Understanding Researchers analyzed the dietary intake of participants in original AREDS trial and chose the most promising nutrients for the AREDS II study Results of AREDS • Highest intake of DHA had a 50% lower risk of advanced AMD • Highest EPA had nearly the same 50% decrease in their risk of developing advanced geographic atrophy (a severe form of "dry" AMD) • Highest intake of lutein and zeaxanthin had a 50% lower risk of developing new AMD during the trial compared to the control group • For people with high intakes and elevated blood levels of lutein and zeaxanthin, a decreased risk of both neovascular (wet AMD) and dry AMD was observed

  17. ARED II : Advancing Our Understanding • Randomized study of 4000 participants aged 55 to 80 who have Macular Degeneration in one eye • Participants will receive one of four supplements: • Placebo • 10 mg of lutein along with 2 mg of zeaxanthin, • 1 g of DHA and EPA • Combination of lutein, zeaxanthin, DHA, and EPA

  18. Don’t Wait – Prevention Starts Today • We won't know the results of AREDS II for a number of years • In the meantime, it makes good sense to recommend to patients • Eat a diet rich in fruits and vegetables for antioxidant nutrients, especially dark green leafy veggies which are good sources of lutein and zeaxanthin • Eat fish at least 2–3 times weekly for omega-3 fats • We also need to understand most individuals fail to comply with diet changes • Solution = Ultimate DHA Eye

  19. Ultimate DHA Eye

  20. Synergistic Nutrients • Omega-3s and Carotenoids are found together in the eye • In Vitro evidence shows they function synergistically • “These results show for the first time the direct neuroprotection of photoreceptors by xanthophylls and suggest that zeaxanthin and lutein, along with DHA, are important environmental influences that together promote photoreceptor survival and differentiation.” • Human Clinical Trials provide additional support • Forty-nine women were randomly assigned to placebo, DHA, lutein, or lutein + DHA supplement • Conclusion: Lutein and DHA aid in prevention of age-related macular degeneration Chucair AJ, et al. Lutein and zeaxanthin protect photoreceptors from apoptosis induced by oxidative stress: relation with docosahexaenoic acid. Invest Ophthalmol Vis Sci 2007;48:5168–77. Johnson EJ, et al. The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation. Am J Clin Nutr 2008;87:1521–9.

  21. Benefits Beyond the Eye • The combined protective activity of omega-3 fats and xanthophylls extends beyond ocular health • The cognitive benefit of DHA and lutein in elder women was explored in a double-blind, intervention trial of DHA and lutein supplementation for eye health • Subjects underwent cognitive tests measuring verbal fluency, memory, processing speed and accuracy, and self-reports of mood at randomization and upon completion of the trial • Following supplementation: • Verbal fluency scores improved significantly • Memory scores and rate of learning improved significantly • There was a trend toward more efficient learning • CONCLUSIONS: These exploratory findings suggest that DHA and lutein supplementation may have cognitive benefits for older adults Johnson EJ, et al. Cognitive findings of an exploratory trial of docosahexaenoic acid and lutein supplementation in older women. Nutr Neurosci 2008;11:75–83.

  22. Ultimate DHA Eye Nordic Naturals Ultimate DHA Eye • AREDS 2 nutrients • Prevents age-related oxidative damage to eyes • Fish oil: concentrated DHA formula (50% DHA) • Provides 788 mg DHA 158 mg EPA • Lutein • Provides 20 mg Lutein • Zeaxanthin • Provides 4 mg Zeaxanthin

  23. Ultimate DHA Eye is Safe • Research shows that pure fish oil supplements are safe with generally no adverse effect • 3+ grams of fish oil may be contraindicated with blood thinning medications–best to monitor • It is generally recommended to stop taking fish oil one week before major surgeries • Purified fish oil supplements have significantly less impurities than fish • The FDA has ruled that up to 3 g of EPA + DHA is safe to be included in the food supply of Americans without fear of adverse events • Food and Drug Administration. Safety Reporting Requirements for Human Drug and Biological Products. • In 2004 The FDA confirmed the Joint Expert Committee on Food Additives' ruling that lutein and zeaxanthin are safe for human consumption • Maximum acceptable daily intake level is 2 mg per kg of body weight. Hence, for a 160 lb person, that would mean an intake of approximately 145 mg of lutein/zeaxanthin.

  24. Quality Counts

  25. Fish Oil Quality Counts Choosing the right fish oil product for your patients is key • Burping/fish smell due to rancid, poorly manufactured oil • Fish oil can easily oxidize • Must process in nitrogen environment • Molecular distillation—removes PCBs and mercury

  26. Fish Oil Quality Standards are Voluntary • In the United States there are no required manufacturing standards • There are three voluntary guidelines for manufacturers to consider • Norwegian Medicinal Standards • European Pharmacopoeia • Council of Responsible Nutrition Standards are related to limits for heavy metals, dioxins, PCBs, and measurements of freshness

  27. Third-Party Testing • Purity – absence of environmental toxins • Potency – fatty acid content verified • Freshness – measurement of oxidation (rancidity) To verify quality, all finished product should be independently tested for

  28. Summary • Fish oil supports visual development, healthy vision, blood flow, and anti-inflammatory activity • Fish oil, Lutein, and Zeaxanthin work synergistically to prevent oxidative damage and inflammation associated with Age-Related Eye Diseases (AREDs) • Ultimate DHA Eye is safe • Freshness, purity, and taste are key components of a high quality product • Nordic Naturals Ultimate DHA Eye is a condition specific product ideal for protecting the eyes from the damaging effects of aging

  29. FOR INTERNAL USE ONLY Thank You!Disclaimer: This information is provided by Nordic Naturals, Inc. for educational purposes only. Current and peer-reviewed research is cited. It is not intended as medical advice of any kind.The educational information in this document is not intended to diagnose, treat, or cure any disease, nor has this document been reviewed or approved by the FDA.

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