A NUTRIENT-RICH PRIMARY CARE PRACTICE

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EyePromise AREDS 2 Plus with a Multivitamin from Zeavision helps reduce the amount of pills a patient may need to take each day.
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Distribution of macular pigments constituent carotenoids presented in scale onto a photograph of a healthy human retina. Copyright 2016 Nolan/Kuchling/Nöbel

Nutritional support for visual disorders is a rapidly growing area of eyecare. Here’s how your practice can offer the best of both traditional and complementary vision care.

While conventional medications certainly have their place, many practices choose to integrate nutraceuticals to support their treatments. Many patients prefer the use of natural, effective and less invasive intervention whenever possible. Offering or recommending nutritional supplements shows that you are being respectful to your patients, listening to their health concerns and taking them seriously while also using good medical judgment.

FINDING REPUTABLE COMPANIES
When reviewing products by companies that specialize in supplements for vision needs, they should have a valid scientific rationale available  as well as a website that puts science first before price and marketing. For instance, Biosyntrx””manufacturer of Eye and Body Complete””provides articles on the company website to educate the public on lifestyle and nutrition choices for ocular health.

Avoid companies that promote making “millions of dollars” when selling their products. Your goals should be directed toward patient health and well-being; the income will follow.

WHAT TO LOOK FOR IN A NUTRACEUTICAL
A full-spectrum supplement should be designed to slow the progression of chronic degenerative disease, including all diseases of the eye. There should be efficacious amounts of properly balanced fat-soluble vitamins, particularly in relation to the latest vitamin A and vitamin D research. Vitamin A should be in the retinol form, not beta-carotene. It should contain potent amounts of the full-spectrum of B vitamins for the proper maintenance of homocysteine, specifically B6, B12 and folic acid. There should also be 400 IUs of the complete spectrum of Vitamin E with a balanced mixture of both natural d-alpha tocopherol (not “d-l”) and mixed tocopherol oils containing gamma and delta tocopherols and tocotrienols.

4 MISCONCEPTIONS
ABOUT SUPPLEMENTS:

1. They are completely safe. While that is mostly true, they can be abused and cause dangerous effects if not taken appropriately, just like any over-the-counter item.
2. They are ineffective. The effectiveness of nutrients is much more subtle and long-term than it is with drugs, but they are effective nevertheless.
3. They are all the same. Not true, especially when a multiple vitamin is considered. The type, form and amount of each nutrient can make a major difference in how it works.
4. More is better. This is the most common misconception; just because a certain amount is effective, it does not mean that ten times that amount is
ten times more effective!

Supplemental iron has been linked to heart disease, so those you choose should be iron-free. It should also contain carotenoids that both prevent free-radical damage as well as neutralize the effects of previous oxidative damage. The three carotenoids (the only three elements in the macular pigment) needed are lutein, zeaxanthin and meso-zeaxanthin to assure proper xanthophyll transport to the retina and refurbish the macular pigment.
MacuHealth LMZ3 contains all three ingredients. The supplement should also contain the spectrum of minerals in their most bioavailable form to ensure proper cellular bioelectrical and enzymatic response.

Your patients don’t want to be taking pills all day, so look for as much nutrition as you can in fewer pills. To reduce the amount of pills your patients take each day, Bausch + Lomb now offers a 2-in-1 formula, PreserVision AREDS 2 Formula + Multivitamin. The supplement combines the AREDS2 study formula with other essential vitamins and minerals. EyePromise from ZeaVision also offers AREDS 2 Plus with a Multivitamin in its line of nutraceuticals specifically designed for ocular health.

Another thing to consider is the form of the pill. Hard-pressed pills are typically found to not break down effectively in the body. A capsule or gel-cap is preferable. Liquids and sprays are also an effective way to absorb nutritional supplements. Nordic Naturals takes it a step further and uses triglyceride formulations in its Omega-3 supplements, such as ProDHA Eye, which the company believes is more bioavailable than an ethyl ester formulation. When ethyl ester fish oil is taken with fatty foods in the diet, it gets absorbed very well, so it comes down to patient preference.

ASSESSING A PATIENT’S
NUTRIENT INTAKE

You can get a good sense of a patient’s basic diet just by asking a few general questions:
1. How many servings of fruits and vegetables do you eat on a daily basis? (Note: one serving is ¼ cup.) Also be aware that people will ALWAYS over estimate this amount The CDC recommends 9-13 servings per day!
2. How many times a week do you eat fish (and what kind)? We now realize that fatty fish (sardines, herring, salmon, tuna, etc.) at least three times a week are the best for Omega-3 intake.
3. Do you eat baked goods? These contain simple sugars and “bad” carbs, which is worse than eating “bad” cholesterol! Substituting good carbohydrates in vegetables is better.
4. Do you take a full spectrum multiple vitamin/mineral supplement? While we think that eating a “balanced” diet should supply an adequate vitamin intake, it rarely happens, so a supplement is usually required.
5. Do you limit the portion of food that you eat at each meal? Most people eat until the plate or box is empty. Limiting portions can promote better, more nutrient-dense food choices.

SELLING PATIENTS ON SUPPLEMENTS
Your office protocol for approaching the patient should be done in a caring manner. First, you should diagnose the condition and carefully explain the options to the patient. Then, if you are recommending a supplement, hand the patient a brochure that fully explains the product. If they decide to purchase it right away, you should have it available to dispense as a convenience to the patient. If they want to consider it later, simply alert your office staff (via a routing slip) that you have discussed this product with the patient. They can follow up with the patient to see if they’d like to make the purchase at the initial visit or at a later time. Either way, the patient knows that it is available and something that can assist in their treatment. A two-week follow up phone call asking about the status of the nutrient recommendation can increase compliance by up to 50% in many cases. This also demonstrates your commitment to the welfare of your patients.

 

Learning about nutrition can be a life-long proposition but can be extremely beneficial to you and your patients. While we are not biochemists or nutritionists, we should learn some of the basics of nutrition to make intelligent decisions about what to recommend to our patients. If we don’t, someone else will.

Jeffrey Anshel, OD, FAAO, is founding president of the Ocular Nutrition Society and is in private practice in Encinitas, CA. Anshel also serves on the advisory board for Optometric Office.

 

WHERE TO FIND IT:
Bausch + Lomb
800.828.9030 | bausch.com

Biosyntrx, Inc.
800.688.6815 | biosyntrx.com

MacuHealth
866-530-3222 | macuhealth.com

Nordic Naturals
800.662.2544 | nordicnaturals.com

ZeaVision LLC
866.833.2800 | zeavision.com

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