It appears that higher blood levels of Vitamin D can lessen the risk of early forms of macular degeneration. The findings were reported in the May 2007 issue of the Archives of Ophthalmology. This is a very important study and adds to the large body of research that points to the fact that Vitamin D is an essential compound, and low Vitamin D is related to many diseases. Of note, even modest increases in Vitamin D levels showed a protective affect, lowering the risk of macular degeneration by 36%. Most labs list the lower limits of normal for Vitamin D to be between 20 to 25 ng/mL. In this study patients in the lowest level of Vitamin D of less than 16.8 ng/mL had a relative risk of 1.0. Levels between 16.8-21.6 ng/mL had a risk of 0.97, not much difference. At levels of 21.6-27.24 the relative risk was 0.75 or a 25% decrease. From 27.24-33.65 the risk was 0.70, and greater than 35 the relative risk was 0.64 or a 36% decrease.
Now here is what I think is exciting and most significant. Many experts, such as those at the Vitamin D Council are suggesting that all of us should have our Vitamin D levels checked and maintain levels of at least 35 ng/ml and up to 50-80 ng/ml. These levels can not generally be obtained with diet alone and one usually needs supplementation to maintain these levels throughout the year. I would strongly recommend that anyone with macular degeneration have their Vitamin D level checked and work with their doctor to bring their level into the upper end of the normal range. I might also suggest that one might want to read a bit more about Vitamin D at the Weston A price Founation.
Michael A. Mong, M.D.
Ophthalmologist
Grapevine Texas
If death was not bad enough, now blindness is a possible complication of obesity and it’s treatment. A series of patients have recently been identified who presented with Vitamin A deficiency from several months to 18 years after gastric bypass surgery. With the increasing frequency of the procedure, both patients and healthcare providers need to be aware of the potential for Vitamin A deficiency in patients who have had any number of surgeries for obesity as well as other surgeries such as liver transplants. I myself identified a young man with severe Vitamin A deficiency after a liver transplant. It would appear that the complaint of night blindness is the most common presentation as it was in this patient as well as the four patients recently reported by researchers from Texas.
So, another good reason to look carefully at one’s diet and lifestyle, avoid the Metabolic Syndrome X, gastric bypass surgery,and purpose to maintain an ideal body weight.
Michael Mong, M.D.
Grapevine, Texas
A recent research report from Finland highlights why I have started this Blog and why I am providing information about Metabolic Syndrome X, diabetes, obesity, and related issues that negatively impact ocular health and general well being. This study reported in a November 2006 issue of Lancet. 2006;368:1673-1679 confirms previous work that indicates that changing peoples lifestyle can reduce the risk of developing Type 2 diabetes by close to 60%. In the Finnish study, the effect of lifestyle interventions reduced the risk of becoming a diabetic by 38% and the effect lasted for a three year period. In a similar report found in the New England Journal of Medicine, February 2002 called the Diabetes Prevention Program Study, showed a reduction in type 2 diabetes by an impressive 58%. This was compared with a lesser reduction with a common medication called metformin. A third medication, Rezulin was also used in the study but had to be stopped due to liver damage in the study participants.
"From a public health point of view there is an important message: an intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals," say Lindstrom and colleagues.
The studies show that helping patients address the fundamental issue (and I must say the principle issue) of diet and exercise is the most effective way to prevent type 2 diabetes. It is more effective than the search for the proverbial "silver bullet". If one’s diet and exercise routines are not what they need to be, medications merely offer a short term "fix" to make one’s lab work look better but lead to increases in weight, hypertension, fatigue, frustration, and a general decline in health. As an ophthalmologist, I also know that diabetes and other Metabolic Syndrome X symptoms such as hypertension and elevated cholesterol and triglycerides lead to destruction of the circulation in the eye and eventual retinopathy and thus damage to the eye.
It make sense doesn’t it. If the problem stems from inappropriate diet and insufficient exercise, the fix is a better diet and increased exercise. Medications at best are a bridge or crutch for most patients to get them started. If you break a leg, you need a cast and a set of crutches. The will heal if given half a chance, the cast comes off and you get rid of the crutches. What would happen to the leg if the cast and crutches are added and never removed? The answer is obvious, nothing good. Likewise, to rely on medications to make up for poor diet and exercise is a prescription for long term failure. Besides, working with patients to address these "lifestyle" issues work the best as these studies show.
I have had increasing success over the last several years at helping my patients loss weight, reduce their blood sugar and HgA1c levels, and even reduce or eliminate medication by taking a few extra minutes to address these key issues. Many patients, if given the right information, are very able and willing to make significant changes in their diets and exercise. It takes a bit more time, but it is the only long term solution for most patients who want to optimize their health and wellbeing.
So, the reason for the blog and effort is to educate interested individuals about the critical issues with respect to Metabolic Syndrome X, diabetes, and the eyes and attempt to effect longterm and lasting changes for the best. I sincerely hope many individual will find this effort of benefit.
Michael Mong, M.D.
Grapevine, Texas
A study published this week in Arch Neurol. 2006;63:1545-1550 gives further support for what I have been advocating for my patients, that taking fish oils such as Carlson’s Cod Liver Oil, can reduce the risk of a number of chronic diseases such as dementia, Alzheimer’s disease and macular degeneration.
There is a strong basis in biology for the neuroprotective effects of DHA (which is a major component of Fish Oil), writes Martha Clare Morris, Sc.D., Rush University Medical Center, Chicago, in an accompanying editorial.
"Lipids, a collective term for fats and oils, make up about 50 to 60 percent of the brain’s dry weight, and DHA is the most abundant fatty acid found in the cell membranes of the brain’s gray matter, she writes. Studies done in the 1980s and 1990s found that DHA is important to a variety of brain cell components and functions. "Indeed, the level of DHA in the brain has been shown to be very important for learning ability and memory in early life in studies of rodents, baboons and humans," Dr. Morris writes. "It is only recently that the omega-3 fatty acids have been investigated for their importance to the aging brain. The DHA composition of the brain decreases with age as a result of increased oxidative [result of oxygen exposure] damage to the lipid membranes."
Michael Mong, M.D.
Grapevine, Texas
For several years I have been encouraging my patients to consider adding high quality Cod Liver Oil to there diets. In addition to the growing body of evidence that Omega-3 fatty acids play a critical role in reducing ones risk of macular degeneration, Cod Liver Oil is a rich source of natural Vitamin D3. It now appears that there is growing recognition that the common form of Vitamin D that most people are taking, Vitamin D2, is not as effective as the natural form, Vitamin D3. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006 Oct;84(4):694-7. "The emergence of 25-hydroxyvitamin D as a measure of vitamin D status provides an objective, quantitative measure of the biological response to vitamin D administration. As a result, vitamin D3 has proven to be the more potent form of vitamin D in all primate species, including humans. Despite an emerging body of evidence suggesting several plausible explanations for the greater bioefficacy of vitamin D3, the form of vitamin D used in major preparations of prescriptions in North America is vitamin D2. The case that vitamin D2 should no longer be considered equivalent to vitamin D3 is based on differences in their efficacy at raising serum 25-hydroxyvitamin D, diminished binding of vitamin D2 metabolites to vitamin D binding protein in plasma, and a nonphysiologic metabolism and shorter shelf life of vitamin D2. Vitamin D2, or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification." I encourage all interested individual to look carefully at their Viatmin D3 intake.
Researchers looked at the dietary magnesium intakes of 4,637 Americans, aged 18 to 30 years, who were free from metabolic syndrome and diabetes at baseline. During 15 years of follow-up, 608 people developed metabolic syndrome. Results showed the multivariable-adjusted hazard ratio of metabolic syndrome for participants in the highest quartile of Mg intake was 0.69, compared with those in the lowest quartile of intake. In other words, people with the highest Magnesium intake were about 30% less likely to develop Metabolic Syndrome. They also showed Mg intake was inversely correlated to individual components of the metabolic syndrome, including fasting insulin levels. Or in plain English, the more Magnesuim one took, the lower the fasting insulin levels were. The researchers concluded young adults with higher magnesium intake have a lower risk of development of metabolic syndrome. The study appeared in the March 27 issue of Circulation (113:1675-82, 2006).
Another study of 527,265 U.S. men and women between the ages of 50 and 71 revealed that those who are overweight have a 20% to 40 % increased risk of premature death. Of those who are obese, the risk of premature death is 3 to 4 times greater. Here is a link to an Ideal Body Weight Calculator. From the article: Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old
April 18, 2006 — A high glycemic index diet is associated with an increased risk of developing early age-related macular degeneration (AMD), according to the results of a study published in the April issue of the American Journal of Clinical Nutrition. The editorialists suggest that the effect may result from other constituents common to that pattern of diet.
“Several dietary factors have been linked to age-related maculopathy (ARM), the early form of age-related macular degeneration, and there is reason to think that dietary carbohydrate may play a role in the development of ARM,” write Chung-Jung Chiu, MD, from Tufts University in Boston, Mass, and colleagues.
“The purpose of the present study was to examine the relation between dietary carbohydrate quality, as measured by dietary glycemic index (GI) or total carbohydrate intake, and ARM.” “Our results suggest that dietary GI may be an independent risk factor for ARM,” the authors write. “With no effective therapy for AMD, the related social and medical burden will continue to increase. Prevention remains the best approach for addressing this public health issue, and dietary modifications may provide one of the most cost-effective strategies.”
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As many of you know, I have been trying for the last several years to educate my patients on the many beneficial properties of Omega-3 fatty acids (so called fish oils). Diets high in fish oils and low in vegetable oils have been shown to reduce the risk of macular degeneration. Many studies in the last year or so have detailed case after case where these natural and essential dietary compounds are able to lessen the risk of vision loss and actually improve vision in several cases. NOW, researchers are discovering how. It appears that the cells underneath the retina (the retinal pigment epithelium or RPE for short) contain high amounts of DHA, one of the Omega-3 fatty acids. The RPE cells use the DHA to produce a substance, NPD1 that actually can turn off genes that produce substances that are harmful to the retina. WOW, fish oil can protect the eye by turning off harmful genes. The author of this recent study is quoted as saying “DHA has been shown by Dr. Bazan to promote survival and inhibit cell death not only of photoreceptor cells, but also of neurons in an experimental model of Alzheimer’s disease.”
So…If you want your eyes to be healthy and possibly prevent future injury and macular degeneration, I recommend taking (with input from your physician of course) a high quality fish oil such as that provided by Carlson Labs.
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