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today's program: Improving Diet >> Annfor Eye Healthome to
and Better Vision.
and we welcome our speaker, We welcJulie Mares. today
Julie received her master's degree in public health
at Champaign University.
ophthalmology and nutritional science here at the UW Madison.
We're pleased to have Julie here
her a round of applause. with us today, and let's give
Julie Mares: Good morning. [APPLAUSE]
highlights about food and Thealthy lifestyles that mightou
help preserve vision as we age
research in this area for about two decades, from the work that
we've done and the work that
And I will focus on work done specifically in a large
population sample, part of which
Madison, Wisconsin. The carotenoids and age-related
eye disease study of about 2,000
in the nationwide women's health women who are participants both
study. initiative and also in our eye
the contribution of taxpayers' Through the help of these women,
the efforts of many people both in our research team and across
six institutions we've learned
share with you today. I'll be telling you about many
research studies, but in
The tool we use in science are particular I'll focus on these.
involve, often, thousands of population studies which
tell us about the foods they people who were kind enough to
and their lifestyles. eAnd they've also allowed us to
take photographs of their eye.
back of their eye, or the retina, that have told us about
early and late changes that contribute to age-related
macular degeneration, a common
And they've allowed us to take age-related eye disease.
show us about early and later photogstage of cataract.ses to
Population studies, together
studies and clinical trials, with information from animal
that help us understand whether combetter eating and betterce
lifestyles can preserve vision. In particular, population
studies tell us about the likely
people over long periods of time impact of these situations in
I'll focus on our latest and how people live.
that plant pigments in our eyes might act as natural sunglasses.
I'll tell you about many of the aspects of diet that might help
preserve vision and an overall
impact might be of overall picture that represents what the
And I'll talk about vitamins, especially two which cost
nothing.
Age-related cataract affects Let's start with cataract.
As we age, the lens of our eye everybody.
Now the lens of our eye focuses light on the back of the eye so
that we can see, and when it
light, smoking, drugs, it causes becomes cloudy as we age, due to
can see on this slide. our vision to be blurred, as you
impairment in young old age, This is the most common vision
65 and 75 years, and it's especially noticeable in driving
where glare becomes a problem.
very late stages, late enough to But it's also very common at
cataract surgery. 30% of people over 65 years have
cataracts at this level, and 50%
their cataracts extracted or of people at age 75 either had
enough to need extraction. have cataracts that are severe
a large contributor to Because it's so common, this is
be increasingly the case as our healthcapopulation ages.is will
The last time it was estimated, cataract surgery, which is just
a simple out-patient procedure
dollars per lens, accounted for 12% of the Medicare budget.
It's estimated that we could cut
just delay the development of thesecataract by 10 years.could
And our research is suggesting
promising ways of slowing that dietcataract.f the most
Cataracts can develop in
They can develop in the center different areas of the lens.
common type for which cataract of the lens, that's the most
lens fibers where cortical surgery is needed, or in the
common in people with diabetes, or at the bottom of the capsule.
Nutrition is one of many risk factors for developing cataract.
As I mentioned, this happens
20s our lenses begin to develop opacities, and the rate of this
is more quick in some than in others.
Light exposure is known to
types of cataract, as is increase the development of some
drugs like steroids, and having smokcertain colored eyes. some
People with brown eyes are more likely to develop cataract at
early ages. It probably has nothing to do
with the fact that the eyes are brown but that this represents
people of a certain genetic background, and we're just
beginning to learn about genetic
The lens is very sensitive to abrupt changes and so in studies
in animals and people, frank
cataract and populations in nuwhich malnutrition is commonse
have sometimes benefited from multivitamins.
Also, it's important to realize that excess nutrients can cause
cataract as well. This has been shown in animals
and humans. Selenium, lead, possibly
Vitamin C, and high body fat
Most of what I am going to talk about today results from studies
of not frank deficiencies or
about more moderate variations excesses but where we've talked
protection over the moderate of intake where possible
people who've had diets that are range has been observed in
are high in antioxidants. lVitamin C, vitamin E and werend
going to focus on the carotenoid
not heard about as much as lutein as well which people have
Lutein is one of the five major carotenoids that are in the
blood.
for many of the plant pigments Now, carotenoids are responsible
There are about 500 in nature. that you see outside in nature.
the foods we eat, and only these There's about 50 carotenoids in
significant quantities in our carotenoidsblood.bsorbed in
Some of these carotenoids you might recognize like beta
carotene which provides an
converted to vitamin A, or the orange color and can be
tomatoes. redDifferently, lutein and in
zeaxanthin are yellow pigments
pigment. and it gives corn the yellow
zeaxanthin has the same chemical Now, lutein is one compound and
different rotation. So I'll be talking about lutein
but I always mean lutein in combination with zeaxanthin.
They usually come together with the foods we eat.
Egg yolks are yellow because of lutein and zeaxanthin and their
in highest concentration in dark, leafy greens, but we don't
see it because there's also a lot of chlorophyll in these.
But you do see it if you boil leafy greens.
The yellow in the water comes from lutein and zeaxanthin.
Population studies that we have done and others have done have
found consistently lower risk for cataracts or cataracts
extraction in people who high levels of lutein in their diet.
That's one of the most
I've observed in population consistent studies.ships that
This is true in our studies, the
disease study on the right and carotenoids and age-related eye
And in many studies the reduced risk is quite marked, between
one and a half to twofold.
nutrition could slow the But because many aspects of
have scored people on diets dwhich reflect overall highe
levels of many protective vitamins, minerals, and plant
pigments. We did this by computing scores
based on adherence to the US
can go online and look up. dietary guidelines, which you
scores, have higher intakes of These are people who have higher
fruits and vegetables. plant foods, from grains, from
protein in their diet from They have adequate levels of
generally have lower levels of beans, eggs, meat, and dairy and
We found that people who score fat if their scores are higher.
United States have about one and above average levels in the
cataract. a hSo it doesn't take much tofor
observe the lower risk. And an identical result was
found in a separate population
overall healthy diets can have a of women, suggesting that eating
development of opacities. pIn our particular study, wee
observed that healthy diets may be the strongest risk factor
that we can modify to slow the
There are some things we can't development of cataract.
our eyes. dIf we have blue or green eyes,
we're less likely to have cataract.
If we have low pulse pressure which represents having flexible
arteries, we are less likely to have cataracts.
But overall healthy diets are among the strongest thing that
we can modify to slow the development of cataract along
with avoiding gross obesity, not
are high in individual nutrients smoking, and having diets that
Now let's turn our attention to likage-related macular C.
degeneration. This is a condition which we can
also observe in the early stage from the photographs that women
allow us to take. And early signs of age-related
macular degeneration are common,
over 65 years of age. prAnd in some, they go on tole
develop advanced macular
present in 5% of us over 65 but steeply increases with age so
that those of us who reach 80,
macular degeneration which about 12% of us will have
It destroys the cones in the severely limits vision.
we often can't see the center of central field of vision so that
can't see people's faces, and this is an area of the retina
that is also used to see fine details so it's harder to read
newspapers and pill bottles, for
And so we'll be talking about diet which not only slows the
development of the late but also
stages of macular degeneration slows the development of early
the number of people who develop which might ultimately reduce
What are the overall risk factors for developing this?
Well, there are some that we
there are some we can modify. Family history is the strongest
risk factor for macular degeneration.
It runs in families.
have been identified specific And igene variants that arethere
associated with exaggerated response to inflammation that
might be responsible in part. Diet is one of many modifiable
risk factors for developing macular degeneration.
Smoking is consistently found in
higher levels of macular many studies to be related to
smoking can reduce this level of degeneration, but stopping
In some studies, people who have risk.
cardiovascular disease, or a history of hypertension,
develop macular degeneration. dWe think that exposure too
sunlight is a strong risk factor, but our population
studies like we do don't
it's because it's very hard to typically see that and I think
we each get because it can be modified by such things as just
turning away from the sun and things like that.
But there is strong literature
especially damaging to the back thaof the eye or the retina.t is
People with high body fatness are more likely to have macular
degeneration. And more recently new data that
I'll share with you suggests
activity and poor vitamin D status are more likely to have
macular degeneration. In terms of diet there have been
many studies that suggest a wide
may modify risks for macular variety of aspects of diet that
that are high in fat and refined degeneration including diets
fats or fish oils or low in fish, low in these carotenoids,
lutein or zeaxanthin, in zinc or in B vitamins.
Let's focus on those
zeaxanthin. I've talked about the fact that
they are many of the carotenoids
And I've talked about the fact found in nature.
And in our lens we think that they reduce the accumulation of
free radicals.
But they are especially concentrated in the back of the
eye, in the retina, and you can see that yellow patch there.
That's right in the area where
And there we know that lutein and zeaxanthin can absorb blue
light.
the blue light that hits the They can absorb 70% to 90% of
So we think that that is the back of our eye.
possible of these carotenoids. large part of the protection
antioxidants like vitamin C and E and quench free radicals that
are pretty common in that area
things. due More recently, excitingther
information in the last couple
just help us see better. years suggest that these can
has been shown to aid sight Iunder conditions of glare int
college students and to quicken recovery of vision after bright
lights and to increase the
might be especially important in ability to see contrast, which
Now these experiments, as I mentioned, were conducted in
college students. We don't understand the
practical significance of how much they help us see better.
But hunters have, for a long
glasses which helps them to see time, far in the distance.cking
In fact, you can go into
glasses, blue-blockers, put them Walgreens and they sell hunters
different it is to look across on when you go and see how
them off. tYou can get an idea how thath
yellow patch might work in your eye.
See if it makes things see
I've heard that some people that better.
degeneration say that it helps are starting to get macular
So they might simply help us see them to have blue-blockers on.
development of macular better but they might slow the
ability to absorb blue light. I've told you that people whose
diets are high in lutein and
and also there's a similar zeaxanthin have fewer cataracts,
that suggests that people whose diets are high in these pigments
also are less likely to have
Our study suggests that they advanced macular degeneration.
macular degeneration but the also have fewer signs of early
more studies are needed to know datwhether we can slow the so
development at the very earliest
So how do we get macular stages.
Is it simply by taking a lutein supplement or eating more in our
diet? Well, we've done some research
to understand this better.
widely. And in the study of about 2,000
women, we measured the macular
It can be done simply and noninvasively using a machine
like you see here.
like this are now in some Aoptometrist's office, although
the reliability of the
kind of variable in terms of individual machines is still
We've used this machine and how it works is the people look into
the box and blue light is flickered together which that
pigments absorbs together with
doesn't absorb. anAnd so simply by turning thet
knob until the flicker stops, we
of yellow pigment in the back of have an estimation of the amount
It's relatively simple. Using this machine, we have
found that women whose diets are
have more macular pigment, as you'd expect, but it's not all
due to the lutein and zeaxanthin.
Even after adjusting for lutein intake, high levels of fruits
and vegetables are related to more macular pigment.
We think that it's the other
vegetables that might spare the antturn over of lutein.and
Other researchers have found
certain foods might enhance certain aabsorption.ooking or
We know that carotenoids are
cooked or when they're chopped more absorbable when they're
Also adding fat can help. There's been such a focus on
reducing fat in our diet but a
fat soluble pigments in. little is helpful to get these
particularly easy way to get Also, eating eggs is a
It is a bio-available source lutein and zeaxanthin.
small amount relative to leafy that is, even though eggs have a
and into the retina more readily greens, it gets into the blood
greens. tNow, supplements are out therey
and they can enhance macular
people and we're trying to pigment, but they don't in all
given the same amount of understand why, why two people
levels get into their eye and supsome people not at all.rent
But they're out there.
If you do use them, I would suggest limiting to the amount
we would normally consume in
because we don't really know the foods, about 10 milligrams,
time of consuming very high effects ovedoses. periods of
We've also noticed in these experiments that people who have
diabetes or a large amount of abdominal fat where these
pigments also accumulate have lower levels of pigment in their
retina at all levels of dietary intake.
So it might be that we need more
levels of abdominal fat. if we have diabetes or higher
represent some genetic factors We think these probably
blood, and we're currently that influence the lipids in our
more answers in about a year to understand why it is that some
of us accumulate it and some of us don't.
Some people are avoiding leafy
If you like leafy greens, these are a wonderful source of lutein
and zeaxanthin and also other vitamins and minerals and
beneficial plant compounds. If people are on blood thinners
their doctors may have advised
amounts of vitamin K in leafy greens interfere with the action
of blood thinners.
necessary, eating a consistent But avoiding them isn't
So if you like leafy greens, you level is.
nutritional power houses, work want to eat more of these
blood thinners to the amount of leafy greens that you want toe
regularly consume.
stones you might have been told to avoid kale and spinachy
because they have oxalates. But newer research suggests that
this isn't an important contributor to kidney stones.
Quite the opposite. Having a large amount of animal
foods, milk, meat, etc, in our
low amount of plant foods contributes to more acidic blood
which tends to pull calcium from
in places like the kidney. our bones which can then deposit
stones, what you can do is eat If you want to avoid kidney
animal foods, as well as diets high in plant foods over
It's not necessary to avoid the leafy greens.
As with cataract, we've looked
diets are related to risk for at homacular degeneration.ealthy
We score people's diets on the
But also, which I've already current US dietary guidelines.
that reflected adherence to a dMediterranean diet pattern.s
This is a pattern that which was
Crete who had long lives and low eaten by people on the island of
'50s and '60s when it was rates of hestudied.ase in the
This dietary pattern is even
is recommended by the US dietary richer in plant foods than what
It doesn't focus so much on fat amount but on fat type, giving
higher scores for the intake of monounsaturated fats such as
olive oil or walnuts and lower
saturated fats in meat scores for high intake of
It also includes points for moderate wine consumption and
points for intake of fish which has been associated with lower
risk for macular degeneration in
So we gave women scores based on many studies.
observed that healthy diet these two diet patterns, and we
age-related macular degeneration patterns lowered early
two to threefold. Scoring on adherence to the US
diet guidelines, people with the
those women had early signs of lowest 20% of levels, 18% of
to only about 10% of women who macular degeneration, compared
pattern. scored high on that diet
Mediterranean type diet pattern, Women who had high scores on the
had even lower odds for having the more plant rich diet type,
Only 6% of them had early signs of macular degeneration.
However, in these women from
only 55 women had diets that Wisconsin, Iowa, and Oregon,
And so we will be repeating these types of studies across
the world in women who consume
understand whether this result Mediterranean diet patterns to
Let's turn to vitamins but we'll sticks.
nothing, vitamin D first talk about two that cost
Vitamin D, you all know, is the sunshine vitamin because we can
make it in our skin on exposure to sunlight.
And it's not just for bones.
improve bone health, but more recently it's been understood
that it helps lower inflammation
the development of abnormal blood vessels, both things that
contribute to macular degeneration.
Two studies that we've
representative sample of the conducted, one in a
in this carotenoids and Aage-related eye disease study,
have found that women who had high levels of vitamin D in the
blood had lower odds for having early macular degeneration and
it was, again, a large impact,
adjusting for other things that aboI've told you about.er
Importantly, beyond a certain level, higher blood levels of
vitamin D didn't have higher
So it may not be necessary to have boatloads of vitamin D.
Also, we found some evidence
with other aspects of diet. thFor example, the protectiveher
relationship of vitamin D was stronger in people who also had
diets that were high in lutein
these things work together. whicSo how to get vitamin D.how
Well, obviously from sunlight.
to 30 minutes a day is adequate to provide good blood levels of
vitamin D.
skin we may need a little more As we age or if we have darker
But now we're coming on October and this is a time when the
angle of the sun is low and so
ultraviolet light. our skin does not get a lot of
latitudes, that is north of Washington, DC, or LA, we don't
make a lot of vitamin D from the
April, and we need to get it sun between about October and
Natural sources are few. instead from foods.
water, egg yolks, and some They include fish from cold
But many foods are fortified mushrooms.
aware, including milk, some cereals, some orange juices now,
and increasingly soy milks and
People who don't get adequate levels from foods can supplement
and generally people recommend
This is an area of considerable betwdebate right now. IUs.
Let's talk about vitamin O. I'm sure you never heard about
it because I made it up, but it represents physical activity
because of the oxygen it
also nourish our tissues and delivers to our tissues which
We found that physical activity is associated with lower odds
for macular degeneration and two
recently as well. oIn the study that we did wes
estimated that risk could be cut
about an hour and a half of inlight activity, such as of
housework or gardening, and an
brisk walking. hour of moderate activity, like
is outside we're also getting Anvitamin D at the same time.ty
How much impact could be made if
lifestyles together? we put all these healthy
not smoking. Diet, physical activity,
well, and here you see the We studied this in our sample as
signs of macular degeneration stratified by people who had the
highest levels of healthy lifestyles and the lowest
levels. Women who had the highest
levels, only 6% of women who had
activity, low smoking, and high diet, had macular degeneration,
compared to 18% who had the lowest healthy lifestyle score.
So that's a threefold difference
that we can do something about. Some people wonder if the impact
of diet and lifestyle could be
prone to develop macular stronger if we're genetically
We don't know, but we're degeneration.
answers to this question so chopefully we'll have moreme
answers in the near future. So we worry about passing along
our genes to our children, to our grandchildren, if we have
macular degeneration, but we
things that we can pass along which are healthy lifestyles.
We know that hypertension, for
can be influenced by diet in our example, in our early midlife
And it's likely that the vision changes we're talking about
begin fairly early in life. So we can also pass along the
love of gardening, the good taste of a piece of fruit from
the garden or from our local
season, or walks outside in nature and pass along then
healthy lifestyles that might help protect them as well.
We've talked about food and vision in terms of just the
mechanics of the eye. But it's not just about eyes.
We're starting to learn that our
brain. ability to see also involves the
important for people who have cataracts, macular degeneration,
diabetic retinopathy because our
for some of the lack of vision brain allows us to compensate
We don't know a lot about this. We do know that more physically
active people, people with
have cognitive deficits so we betexpect that the act to seeto
involving both the eyes and the brain might be even more when
you consider brain impact.
activity. SavIt's not really only aboutal
physical health.
foods that are harmful or I hbeneficial, causing us tofic
struggle at every mealtime about
I think the research over the past 50 years causes us to fear
foods.
fat and things that might not be Worrying about eating eggs and
meals that we're eating. good for us instead of enjoy the
increasing time spent going to So for some of us this means
stores and less time enjoying find vitamigood food.nts in drug
But it seems to me that savoring
and especially more important as good food is just as important
And the sensory input that we get from vision and hearing is
reduced.
senses enjoying good food. This is a way to enjoy our
too much about this. So I encourage you not to worry
of our diet, not the impact of a It's kind of the larger impact
to like that are not thought by some people to be healthy forn
us. Similarly, with physical
activity there's much more than an opportunity to get vitamins D
and vitamin O.
walk in nature never fails to deliver more than I expect.a
May be you've found the same. Supplements certainly abound.
You'll see many of them in
And specifically for eye health. Walgreens.
help some people. Let'If you have macularmight
degeneration, some US doctors do
was shown to reduce the risk of sprogressing to a more advancedt
stage in the age-related eye
Often it's known by the AREDS supplement label.
This is a supplement that had very high doses of beta
carotene, a carotenoid which, by
eye, vitamin C, vitamin E, and the way, does not get into the
So some supplements that are out zinc.
added lutein with zeaxanthin, which does get into the eye,
fish oils, selenium, and some have lower levels of vitamin E
and zinc which might be safer.
in a new age-related eye disease This is currently being tested
It's important to avoid excess study trial.
If you smoke, don't take beta carotene, high levels of beta
carotene are associated with an increased risk for lung cancer.
Multivitamins are probably okay.
nutrients in foods, and they No more than the amount of
providing some vitamin D. mighThey might be especially of
important if you're going through a period where your diet
is particularly compromised or
compromised over a long time. But do be aware that vitaminss
and minerals can really add up
get not only from one supplement if you consider the vitamins you
foods are fortified with but many of them, the fact that
with nutrients, energy bars, and nutrients, cereals are fortified
share the vitamins you're taking so it's probably a good idea to
doctor that you're working with to make sure you're not gettingr
too much. Because too much might not be
good and we know this is the
Vitamin C, zinc, beta carotene, vitamin A, folate, selenium, and
vitamin C.
have in supplements are really And do consider that what we
If these AREDS supplements could current best guesses.
degeneration, just imagine what foods, which provide a more wide
array of vitamins and minerals
might do. Probably a lot as our data iss
suggesting. We don't know yet if different
doses or combinations would work
Whether they benefit some people better.
studied. more than others, that's being
family members at risk take supplements such as these high
dose AREDS supplements? The benefit is unknown.
We don't know yet whether it
Certainly, multivitamins would would help people.
helpful. provide vitamin D which might be
these high dose supplements might provide risks that we,
still don't understand, taking
But certainly the research that we've discussed today supports
the idea that healthy foods and exercise may be a way of slowing
the development of macular
I often get asked about herbals. degeneration.
and astaxanthin might improve People sayeye health.wolfberry,
Folk traditions suggest they
haven't done systematic will and research.t, we just
But getting these in the store
way of getting a level that's a in pgood consistent level.ain
The safety is largely untested. And these substances or other
substances can be found in foods
think are helpful. such as the compounds that we
blueberries, and goji berries thought to improve vision,
they're high in zeaxanthin. You can get that in leafy greens
or a particular high source would be red peppers.
Astaxanthins, been thought to be
That provides the pink color in prsalmon.e.
Again, you can get that by
What about cataracts? The evidence suggest
multivitamins might help, especially in people who are
likely to have deficient diets. High doses don't.
A recent Swedish study suggested
a day increased the risk for consuming one gram of vitamin C
So we've talked about ways to preserve eye health through
foods and healthy lifestyles, and I hope this encourages you
to enjoy real food, all types,
the outdoors, and to pass it on. mostly plants, move and enjoy
[APPLAUSE]