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Are the Best Vitamins for Macular Degeneration Synthetic?

Part One
by Chris A. Knobbe, MD

Are the Best Vitamins for Macular Degeneration Synthetic

Perhaps the better title for this article might be, “Are the AREDS formula vitamins better than a ‘healthy’ diet?” Or alternatively, “Should vitamin supplements, such as the AREDS formulae, be the primary focus of treatment for dry age-related macular degeneration (AMD)?”

In my book on this subject, Ancestral Dietary Strategy to Prevent and Treat Macular Degeneration, I wrote a chapter on this subject, entitled, “Synthetic Vitamins and Multivitamins – Should We Steer Clear?”

In this article, I’ll review some of what I’ve written for the book chapter. I’ll expand in some areas – I’ll skip some areas for brevity – and in other areas, I will bring to light a subject matter that has arisen since I completed the research for the book in early 2016. In both cases, the end-results and my recommendations will be the same.

Ladies and Gentlemen, this is an uber-long article. It has to be. No short review will ever do this subject justice. And just like the book that I’ve published on this subject, my goals are clear…

I intend to provide the background, history, fundamental science, and even the evidence-based research, that could literally save your vision.

That’s what is at stake here – your vision. And, of course, your pocketbook, since consuming vitamin supplements over the coming years could cost you thousands of dollars.

But, it’s your vision that is priceless, right?

To that end, let’s embark on this journey (through this article) together, because if you stay with me, through every step of the way, I believe you will find the conclusions, quite literally, shocking. If you skip to the end for my recommendations, you’ve missed the point. You won’t “get it,” I assure you.

As we approach this subject, I think it is befitting for us to recall that around 400 B.C., the ‘Father of Medicine,’ Hippocrates, wrote, “Let food by thy medicine and medicine be thy food.” For those who are enlightened as to the benefits of ancestral nutrition, Hippocrates’ quote serves as a powerful reminder as to the power of food.

Let’s Dispel the Myth of “Eye Vitamins”

Right off the bat, let’s get one thing straight. There’s no such thing as “eye vitamins.” Just like there is no such thing as “brain vitamins,” “liver vitamins,” “heart vitamins,” or any other organ-specific vitamins.

There are 13 vitamins that are required by humans, and these must be supplied through consumption, or in the case of vitamin D, through the exposure of our unprotected skin to sunshine.

These vitamins include the fat-soluble vitamins: A, D, E, and K, and the water-soluble vitamins: B1 (Thiamine), B2 (Riboflavin), B3 (Niacin), B5 (Pantothenic acid), B6 (Pyridoxine), B7 (Biotin), B9 (Folate), B12 (Cyanocobalamin), and vitamin C.

Every single cell of every single organ and organ system depends extraordinarily so on all of these vitamins, as well as minerals and other cofactors that are required for optimal function. Our scientific knowledge of these fantastically complex, synergistic relationships, between all of these vitamins, minerals, and other nutrients, still remains in its infancy.

But what I intend to show in this article is that certainly a number of vitamins (likely all 13 of them) are required, necessary, and beneficial in both preventing and treating macular degeneration. These vitamins most optimally must be obtained from food. That’s correct. From food. Real, natural, whole, preferably organic foods and, in fact, some very particular foods that also supply the hard-to-come-by fat-soluble vitamins, which are not widely distributed in the food supply.

fruit over vitaminsYes, I intend to show that these vitamins and other nutrients should, most optimally, not come from pills, tablets, “fortified” foods (which are those with artificially placed synthetically derived vitamins), or any other supplements, including the AREDS formula vitamins (such as Bausch and Lomb PreserVision, PreserVision AREDS, MacularProtect AREDS2, ActiveEyes AREDS2, ICaps AREDS Formula, Ocuvite, Ocuvite with Lutein, Pro-Optic AREDS 2, Visionary AREDS-2, Macular Shield AREDS 2, etc.).

Even far more importantly, I intend to also discuss the hypothesis for the true cause of AMD in this article – which has everything to do with the issue currently at hand, i.e., vitamins and AMD. That hypothesis, to be revealed in this article, along with our supportive research, is pending publication in the peer-reviewed journal, Medical Hypotheses, at this time.

So, let’s begin, shall we?

A Little History on AMD

Before we examine the benefits, faults, risks, and even the reduced lifespan of those consuming synthetic multi-vitamins (yes, it’s true, and AREDS formulae are multivitamins), it only makes sense to review just a glimpse of the medical history that I uncovered when I dug deep into the scientific literature on the subject of macular degeneration. Why look at the history of macular degeneration, you may ask?

The answer lies in the fact that the history of the increasing incidence and prevalence of AMD and the history of the modern refining and Westernization of the diet, are deeply correlated. We’ll come back to this.

I’ll only briefly touch on the history of AMD here, because I’ve covered this in minor detail in the Introduction article located on this site, and in far greater detail in my book on this subject.

In brief, I completed an extensive review of the historical scientific literature on macular degeneration and found an abundance of evidence that would lead us to believe that macular degeneration was an extraordinary medical rarity, from 1851 until about 1930.1 Perhaps just as importantly, I couldn’t find even a shred of evidence anywhere in any scientific paper, textbook, or atlas, which might lead us to believe that macular degeneration was not rare during that period of time.

This historical medical literature search also supports the conclusion that the prevalence of AMD began to climb in the 1930s, in both the U.S. and the U.K., such that by the 1970s, at least in the U.S., macular degeneration had elevated to epidemic proportions.1 The U.K. followed suit – and many other developed nations were in the queue for epidemics of AMD at that time, with AMD prevalence rising to double digits by the 1990s and early 2000s for many nations.2

Here are just a few highlights from more than a century’s worth of literature:
  • Herman von-Helmholtz invented the ophthalmoscope and published its design in 1851.3  This allowed ophthalmologists, for the first time, to begin to view the fundus (macula, optic nerve, vessels, and retina).
  • Helmholtz’s ophthalmoscope design spread throughout the world within a decade of his publication.3 That is, ophthalmologists were using ophthalmoscopes all around the world by 1861.
  • By the mid-1850s through the 1870s, ophthalmologists were producing illustrations and atlases of the retina (including macula) of the eye, yet none of the images depicted macular degeneration.4 Today, macular degeneration is the most commonly encountered retinal condition, affecting nearly one in three people over the age of 75.5
  • In fact, twenty-three years would pass after Helmholtz’s invention, before macular degeneration was described for the first time. Ophthalmologist, Jonathan Hutchinson, of London, England, presented four cases with descriptions consistent with macular degeneration, that he had collected in his practice. There were no pictures or illustrations of these cases, but the text descriptions were consistent with probable macular degeneration. The year was 1874. 6
  • In 1880, ophthalmologists Landolt and Snellen had collected 86 different types of ophthalmoscopes in use around the world.7
  • In 1889, famed Austrian physician, ophthalmologist, and professor, Ernst Fuchs (1851 – 1930), published his Lehrbuch der Augenheilkunde (English translation, Textbook of Ophthalmology), of just under 800 pages in length. The book was translated into English in 1892. Though he dedicated some 40 pages of the book to conditions of the retina and choroid, he wrote only one sentence regarding macular degeneration: “Finally, a disease of the macula is observed in old people, which usually affects both eyes about equally, and is referable to senile changes.” 8
  • In 1889, Fuch’s Textbook of Ophthalmology reviewed that six different mydriatic (pupil dilating) agents were in use, including Atropine, Cocaine, Homatropine, duboisine (also called hyoscyamine), hyoscine, and gelsemine.9 Obviously, ophthalmologists were dilating patient’s pupils, routinely, even by the 1860s and beyond.
  • In 1895, German ophthalmologist Otto Haab published a paper in which he had evaluated some 50,000 ophthalmic patient records and concluded that macular degeneration was about as rare as myopic maculopathy and traumatic maculopathy, both of which are exceedingly rare conditions.10,11
  • On the occasion of the 50th anniversary of the ophthalmoscope, in 1901, an exhibition was put on in Atlantic City, New Jersey, where no less than 140 different brands and/or versions of ophthalmoscope were on display.7
  • By 1913, ophthalmologist Edward Landolt reported that 200 different models of ophthalmoscope had been produced worldwide.7
  • In 1920, the U.S. Census Bureau showed that there were 4.9 million people over the age of 65, as compared to 35 million over the age of 65 by the year 2000. If the same prevalence of AMD existed in 1920, as it did in 1990 (22.8% of those aged 43 to 86 years),12 there should have been over 1.1 million people affected with AMD in the year 1920. Yet, there were perhaps no more than 50 cases of AMD documented worldwide to that point.13

This latter point defeats any possible speculation that there wasn’t a high prevalence of AMD due to the absurd and ridiculous old canard that ‘people didn’t live as long.’ The belief system that people ‘didn’t live as long,’ comes from math-challenged individuals who don’t understand the difference between longevity (which is the typical lifespan of an individual who does not die prematurely due to infections, accidents, war trauma, etc.) and average lifespan.

  • In 1927, the eminent and prolific ophthalmologist, Sir Stewart Duke-Elder, of Great Britain, published his first comprehensive textbook of ophthalmology, Recent Advances in Ophthalmology. The text was some 340 pages in length, yet missing from the entire textbook was any mention of macular degeneration. In fact, in the opening pages of the book, Duke-Elder wrote, “The two ‘major’ diseases of ophthalmology, cataract and glaucoma…”14

Typical of most any ophthalmology textbook of that era, there was no mention whatsoever of the condition of macular degeneration.14 Duke-Elder gave substantial attention to other retinal conditions, which had been the case in most textbooks of ophthalmology since the 1850s and 1860s.

  • In 1940, when Duke-Elder’s published his next textbook of ophthalmology, he dedicated some 13 pages to the condition of macular degeneration, including 17 images, six of which were in full color. In stark contrast to his 1927 text, he wrote, “Senile Macular Degeneration, first described as a clinical entity by Haab (1885), is a common cause of failure in central vision in old people.”15
  • By 1966, Duke-Elder, in his textbook series, System of Ophthalmology, published in 1966, wrote, “SENILE MACULAR DEGENERATION, first described as a clinical entity by Otto Haab (1885), is a common cause of failure in central vision in old age, occurring in some 25% of people between 65 and 80, and 30 to 40% over the age of 80 years.”16

In my own exhaustive search regarding the history of AMD, I believe that Duke-Elder may have been the first ophthalmologist to recommend synthetic vitamins for AMD. In his 1966 textbook, he wrote:

Perhaps the most useful – and innocuous – method of therapy is an abundance of vitamins associated with nicotinic acid [vitamin B3, or Niacin].16

Duke-Elder’s assertion that the synthetic vitamins were “innocuous” will be challenged in this article.

However, at the time that Duke-Elder made the statement (1966), there was no research to indicate the potential harm (and general lack of benefit) of synthetic supplements.

  • From 1973 to 1975, the United States’ Framingham Study, in Framingham, Massachusetts, published findings that some 8.8% of subjects between the ages of 52 and 85 years had AMD, while 27.9% of those between the ages of 75 and 85 had the disease.17,18,19

This indicates an epidemic of macular degeneration, with over four million Americans affected.

Though I’ve just picked a few of the most salient and cogent pieces of historical medical evidence for this article, I hope you’re beginning to see, that in the court of medical evidence, macular degeneration was unquestionably a medical rarity until 1930. In fact, it appears that the disease was almost non-existent between 1851 and about 1930.

The evidence then strongly suggests that the disease began to increase in prevalence in the 1930s and, of course, rose to epidemic proportions by the 1970s, at least in the U.S. and U.K., as I wrote previously.

Why is this important?

Well, if AMD were once a medical rarity, especially just about 85 years ago and prior, then how can we:

  1. Consider this a disease of aging or genetics, and/or
  2. Believe that synthetic vitamins, or multivitamins, would be the most beneficial way to treat this disease?

With regard to aging and/or genetics as causes of AMD, neither could possibly explain the dramatically increased prevalence of AMD. I’ve dealt with this in great detail in my book, and briefly in the Introduction article.

Given that this article is intended to deal with the question as to whether synthetic vitamins should play a role in the treatment of existing macular degeneration, which includes the AREDS (Age Related Eye Disease Study) vitamin formulae, I’ll deal with that question almost exclusively in this article.

Did Our 19th Century Ancestors “Take” Multivitamins?

Hopefully, the above question alone should lead us to believe that synthetic multivitamins would not be necessary to prevent or to treat macular degeneration.

Note: synthetic vitamins are not purported or believed by any authorities to prevent macular degeneration – only to treat macular degeneration. We’ll delve into that research, shortly.

And in case you’re wondering why I have been prefacing the term “multivitamin” with the term “synthetic,” it is because I want to make a clear distinction between vitamins that come in the form of pills and tablets, from those that come in actual food. After all, they behave in dramatically different ways, as you’re about to see.

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See References Here.

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This is Part One of an eight-part series.

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