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Vitamins and AMD

Part Three
by Chris A. Knobbe, MD

Vitamins and AMD

The Part Two research (regarding vitamins and AMD), as completed first by Weston A. Price, and subsequently by Cordain and colleagues, as well as literally thousands of other researchers who’ve added to this body of work, draws correlative data between Westernized, processed-food laden diets, and the numerous “diseases of civilization.” The latter includes heart disease, numerous cancers, type 2 diabetes, metabolic syndrome, hypertension, Alzheimer’s disease, dementia, osteoporosis, gout, insulin resistance, obesity, acne, myopia (nearsightedness), and even autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, and many more.35,36All of the aforementioned diseases are either rare or virtually absent in hunter-gatherer populations and in those who continue their native, traditional diets.37

Westernized Diets and Macular Degeneration

Man-made, Processed, Nutrient-Deficient Foods are Associated with Degenerative Disease

Man-made, processed, nutrient-deficient foods are associated with degenerative disease.

Our own research draws the same correlations between increasing processed food consumption and increasing prevalence or incidence of age-related macular degeneration (see the Introduction for a brief review or my book, for full references and detail). We’ve analyzed this data in 25 nations – and the results are nothing short of compelling.

For those who don’t know the history of how our diets have gradually been overtaken by these nutrient-deficient, processed, man-made, and even toxic food components (e.g., sugars, polyunsaturated oils, and trans fats), please refer either to my Introduction, or book. Suffice it to say that the processed food elements have gradually replaced our own native, traditional, nutrient-dense foods – all of which primarily began in 1880. As the evidence clearly shows, the concept of vitamins wasn’t even officially promulgated until 1912.

We didn’t have any vitamins to supplement or fortify any foods until the 1930s.

Yet, this is the era – between 1851 and 1930 – when clearly, macular degeneration was a medical rarity. So does it make sense to subscribe to the tenet that synthetic vitamins are the most optimal way to treat this condition?

On a more personal note, virtually all of the nutrition researchers with whom I now most closely associate, have been educated by, espouse, and are aligned with the research findings and philosophy of Weston A. Price. This would include researchers such as Sally Fallon and the entire Weston A. Price Foundation team and scientific advisory board, the Price-Pottenger Nutrition Foundation scientific advisory board, Chris Masterjohn, Ph.D., Stephan Guyenet, Ph.D., Denise Minger, and many others. In fact, all of the research that we’ve completed, which draws a correlation between the incidence and prevalence of macular degeneration and processed food consumption in 25 nations, is founded upon the Weston A. Price principles.

Synthetic Vitamins – Will They Rescue Us From Macular Degeneration?

So, will multivitamins rescue anyone from AMD? Will they prevent AMD? Halt its progression? Will they hurt

AREDS 2 Formula

Will synthetic vitamins provide the benefits they lead us to believe?

people? Even make macular degeneration worse? More complicated still, is the effect of vitamins on one’s AMD contingent upon their own genetics? These are a few of the questions that will be addressed as we move forward.

Beginning at this point in this particular text is where almost all scientific papers, textbook chapters, and presentations begin on this subject. That is, the discussion usually begins with, “We assessed whether a multivitamin/multi-mineral supplement would prevent (or prevent progression) of age-related macular degeneration…”

There’s no background, no historical review of vitamins or synthetic supplements, no review or attention to the ever-increasing consumption of nutrient-deficient, man-made, processed foods and all of the attendant chronic, degenerative conditions associated with such (e.g., heart disease, cancer, type 2 diabetes, obesity, etc.), little or no individual dietary history consideration, no historical view or review of the (increasing) prevalence of AMD throughout history, etc.

And the analysis I’ve given you thus far just begins to scratch the surface.

I’m not criticizing these researchers, or their studies. That’s exactly how we allopathic physicians, of which I am one, are trained. Anything that happened more than just a few years ago is immaterial. But this myopic approach leads to ever-increasingly absurd conclusions.

Less than a decade ago, my thinking process and viewpoint was the same as the typical allopathic physician. And that’s exactly where I thought the studies should begin. I’ve only been “enlightened” for about seven years (at the time of this writing). And herein, I’m attempting to enlighten you as well.

Now, back to synthetic vitamins and AMD: Let’s begin with a little background on studies that have assessed these issues, and I’ll do my best to be brief (it’s impossible, by the way, in order to do justice to this critical issue).

Studies Leading Up to the AREDS (Age-Related Eye Disease Study)

The 1971–1972 National Health and Nutrition Examination Survey (NHANES), conducted by the U.S. Centers for

Dark, Leafy Greens, such as spinach, kale, and collard greens reduce the risk of AMD.

Dark, leafy greens, such as spinach, kale, and collard greens reduce the risk of AMD.

Disease Control (CDC), showed that diets rich in pro-vitamin A precursors (carotenoids), were inversely correlated to AMD development.38

The vitamin A precursors, generally known as the carotenoids (like beta-carotene, alpha-carotene, beta-cryptoxanthin, etc.), may be converted in the body to vitamin A. However, the process is inefficient, highly variable from person to person, and greatly dependent on a multitude of factors including genetics, the gut microbiome (bacterial profiles in the gut), and the other foods consumed along with the carotenoids (e.g., saturated and monounsaturated fats increase absorption).39

And while we’re on the subject, the polyunsaturated “vegetable oils,” (I often place in quotes, because none of these are from vegetables, they’re seed oils primarily), have been shown to severely decrease the absorption of the carotenoids in the diet. These oils literally cause destruction of the carotenoids, unless significant antioxidants are present, which is often not the case.40

For those not aware, our research has strongly implicated the polyunsaturated “vegetable oils” as major causative factors in AMD, with no less than ten studies in support.41

In 1994, Johanna Seddon, M.D., Walter Willett, M.D., and colleagues at the Massachusetts Eye and Ear Infirmary, published a landmark study in the Journal of the American Medical Association. That study showed that participants who consumed the darkest, leafy green vegetables, like spinach and collard greens, had a 43% lower risk of developing AMD than did those who consumed the least.42 Although this is one of the studies that actually addressed dietary elements, I point out this one because it likely influenced the AREDS 2 study, where lutein and zeaxanthin were given in the form of supplements.

So all of this began to lead investigators to the following question: Could synthetic vitamins, given in a pill, possibly prevent macular degeneration? So, let’s dig into this.

Do Synthetic Vitamins Prevent AMD?

For those unfamiliar with Cochrane, formerly known as the Cochrane Collaboration (the name many of us still prefer), it is an organization of around 37,000 scientists, researchers, and other professionals who work collaboratively as a global network to provide credible, unbiased health information. With that said, in 2012, Cochrane published their review which sought, “To examine the evidence as to whether or not taking antioxidant vitamin or mineral supplements prevents the development of AMD.” Their conclusion? They wrote:

We included four randomized controlled trials in this review; 62,520 people were included in the analyses. The trials were conducted in Australia, Finland and the USA and investigated vitamin E and beta-carotene supplements. …  People who took these supplements were not at decreased (or increased) risk of developing AMD.43

Cochrane’s final conclusion reads as follows:

There is accumulating evidence that taking vitamin E or beta-carotene supplements will not prevent or delay the onset of AMD. There is no evidence with respect to other antioxidants supplements, such as vitamin C, lutein, zeaxanthin, or any of the commonly marketed multivitamin combinations.43

In another recent review, published in the Annals of Internal Medicine, in November 2017, the conclusion that antioxidant vitamins do not prevent AMD was, once again, confirmed by all available studies thus far, with that headline captioned below.

Antioxidant Vitamins Do Not Prevent Age-Related Macular Degeneration

At least with all the available evidence in studies completed thus far, synthetic multivitamins do not appear to have any clear benefit in preventing the onset of AMD. So, if you think you might be able to stave off the development of AMD by taking your multivitamin, there’s not a shred of evidence to support that conclusion.

Moving on to the next logical question:

Do Synthetic Vitamins Slow the Progression of AMD?

The next question is: Do multivitamin/multi-mineral supplements delay the progression of AMD once it is already established? The Age-Related Eye Disease Study (AREDS) sought to answer this question.

The AREDS trial, which lasted nearly six years before the first results were published, involved 3,640 subjects, 55 to 80 years old, who were randomized to the AREDS supplement containing vitamins E and C, plus beta-carotene, zinc, and copper, versus placebo.

According to the AREDS researchers, for those with category 3 or 4 macular disease (category 3 is intermediate AMD and category 4 is advanced disease in one eye), “The risk reduction for those taking antioxidants plus zinc was 25%.”

 However, this is relative risk reduction. What you want to know is your absolute risk, since relative risk is…well, relative.

Let me give you an example, where relative risk can make insignificant numbers sound massive.

So, let’s say a research team wants to know if Drug A will help to prevent death from an “Ugly Disease.”  They give 100 patients the drug and 100 patients a placebo. One year later, 1 person died in the treatment group and 2 died in the placebo (control) group. The researchers then state this: “Drug A reduced the risk of death from ‘Ugly Disease’ by 50%.”

Why 50%? Because the relative difference in deaths is 1 versus 2, (1/2 = 50%).  The research team proclaims a fantastic victory with a magnanimous drug that cuts the risk of death from ‘Ugly Disease’ by 50%!

But the absolute difference in deaths is just one person per 100 in the treated group versus 2 people per 100 in the control group, for an absolute difference of 1%.  So now you know what your risk of death with treatment, or without (if you have ‘Ugly Disease’)  – and that difference in this study was 1%.

Or might the difference just be due to chance? That’s where larger treatment numbers come into play and which allows us to calculate “statistical significance,” i.e., an attempt to statistically determine if the numbers are due to chance alone. We won’t go into that right now.

Back to the AREDS: For those with category 3 or 4 macular disease, at 5 years from the onset of the study, the probability of progression to advanced AMD was 28% for those given placebo, 23% for those given antioxidants (vitamins E, C, and beta-carotene), 22% for those given zinc, and 20% for those given antioxidants and zinc (the AREDS formula).44

From this, the difference between 20% and 28%, is just 8%.

Eight percent is the absolute difference in numbers of patients progressing from intermediate AMD (or advanced AMD in one eye) to advanced AMD, during the five-year follow-up. Eight percent of patients translates to 1 in 12.5, but since you cannot have half a person, this is one in 13.

That is, one in 13 was better, as a result of the AREDS formula. And from this, we get the Number Needed to Treat (NNT), which is also 13.

That is, you will need to treat 13 patients with the AREDS formula for one patient to benefit. Right, one out of 13 achieves a benefit.

I would like to mention a couple of additional findings that the AREDS investigators mentioned. In their own verbiage:

After accounting for age, sex, and race, participants in AREDS had higher or similar dietary intake of vitamins A, C, and E, and zinc than the general population sample from the Third National Health and Nutrition Survey (data not shown).44

This would indicate that the group was representative of typical Americans, at least in this regard, and this is exactly what we would expect, given that the study was completed at eleven centers around the United States.

Second, the AREDS investigators found that “Fifty-seven percent of AREDS participants were using a multivitamin or at least 1 ingredient found in the AREDS formulation at the time of their AREDS screening examination. About half of those supplementing were taking RDA doses rather than the 5- to about 15-fold higher doses of the AREDS ingredients.”44

The investigators allowed the participants to continue their supplements. In fact, they provided Centrum without lutein, which is a widely available multivitamin/multimineral supplement with RDA level doses. They found that “Approximately 67% chose to take Centrum”44 and a total of 13% of the AREDS participants who were not taking supplements before the study, then decided to also take a multivitamin “along with the study medication.”44

This indicates that about 70% of the participants were taking a multivitamin supplement, whether they were in the actual treatment group or the placebo group.

The point of all of this review regarding the additional supplementation is that, even in the placebo group, around 70% of them were receiving a multivitamin, which was typically Centrum. And all groups did very poorly, in terms of progression. Remember that 28% of those who had category 3 or 4 AMD to begin with progressed to advanced AMD in 5 years, and that number was still 20%, even in the AREDS-formula group.

The AREDS 2 trial, published in 2013, sought to determine whether adding the carotenoids found in dark leafy green vegetables, lutein and zeaxanthin, long-chain omega-3 fatty acids (docosahexaenoic acid {DHA} or eicosapentaenoic acid {EPA}), or both might further reduce the risk of progression of AMD.45

The conclusion from the AREDS 2 study:

[The] Addition of lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation in primary analyses did not further reduce risk of progression to advanced AMD. However, because of potential increased incidence of lung cancer in former smokers, lutein + zeaxanthin could be an appropriate carotenoid substitute in the AREDS formulation.45

See References Here.

This is Part Three of an eight-part series.

Part 1: Are the Best Vitamins for Macular Degeneration Synthetic?

Part 2: The History of Vitamins

Part 4:  Coming soon

Part 5: Coming soon

Part 6: Coming soon

part 7:Coming soon

Part 8: Coming soon

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