nutrition

Three’s a Charm

These supplements are essential to offer in your practice.

KIMBERLY K. REED, O.D., F.A.A.O.

Maybe you’ve decided to take the plunge and either sell or recommend specific nutritional products in your office. To make knowledgeable and science-supported nutritional recommendations to your patients and, therefore, achieve successful nutritionally oriented merchandising, I believe three basic supplements are essential to offer.

1 A quality multivitamin

Yes, this may seem very old school. But ample evidence exists that, throughout life, the use of a multivitamin/mineral supplement (often called MVM) can delay cataract onset and cataract surgery, reduce cancer risk and promote systemic and ocular wellness. And don’t forget: Roughly 2/3 of the original AREDS population took Centrum Silver (Pfizer, New York, N.Y.) throughout the study. Further, the percentage grew to a whopping 89% of the AREDS2 participants. It is impossible to discount the potential contribution of the humble MVM to these study results.

How early is too early to discuss nutrition with your patients? Never. Nutrition is a lifetime accumulation of habits and preferences, and young patients who have typical American/Western diets are notoriously lacking in essential vitamins and minerals.

► How to pick one: Look for a reputable manufacturer that has certification credentials, such as from the Council for Responsible Nutrition and the U.S. Pharmacopeial Convention.

2 A quality, highly bioavailable omega 3 supplement

Despite some recent hype about omega 3s having “no effect” in the prevention of cardiovascular events or eye disease, a huge volume of literature supports the benefits of omega-3 fatty acids in cardiovascular health, dry eye/ocular surface disease, incident AMD and more.

► How to pick one: Look for an overall content of EPA + DHA (in mg) of at least 70% of the total “serving size” of the supplement. A triglyceride formulation vs. an ethyl ester formulation is thought to be more bioavailable. Several high-quality supplements are available with attractive merchandising profiles for optometric practices.

3 A highly concentrated lutein + zeaxanthin combo

This should have at least 10mg lutein and 2mg zeaxanthin. A 10/2 dosage combination is shown to have additional benefit in reducing the risk of progression to vision loss in advanced AMD in the AREDS2 study, and several other studies support these findings. Consider this supplement for any patient at risk for AMD.

I recommend it for young family members of AMD sufferers, as well as those otherwise at risk (light-skinned, smokers, lightly pigmented irises/maculae, high BMI, a self-reported high dietary glycemic index intake and/or hypertension). No known risks are associated with this intake level in healthy patients.

► How to pick one: Choose formulations that have been studied in the scientific literature and have been found associated with visual outcome improvements. Also, remember that lutein and zeaxanthin, in the aforementioned sufficient quantities, are sufficient to create meso-zeaxanthin, which is another important macular pigment, at the macula.

A caveat

Remember to always give careful consideration to patients taking warfarin sodium (Coumadin, Bristol-Myers Squibb), pregnant and breast-feeding patients, those with kidney and/or liver disease, those with very low or very high body weight and those who have had modifications to their gastrointestinal system. These patients have special nutritional needs, so nutritional supplements may cause harm. OM

DR. REED IS AN ASSOCIATE PROFESSOR AT THE NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OPTOMETRY IN FORT LAUDERDALE, FLA., A MEMBER OF THE OCULAR NUTRITION SOCIETY AND AUTHOR OF NUMEROUS ARTICLES ON OCULAR NUTRITION, DISEASE AND PHARMACOLOGY. SHE IS ALSO A FREQUENT CONTINUING EDUCATION LECTURER. TO COMMENT ON THIS COLUMN, E-MAIL DR. REED AT KIMREED@NOVA.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.