What to Eat When You Have Macular Degeneration

You can prevent and slow down the progression of age-related macular degeneration (AMD) by eating a nutrient-dense diet. Your daily food intake should be rich in fruits and vegetables that contain green, orange, and yellow pigments, and foods that provide omega-3 fatty acids.

Maintaining a healthy weight, exercising, stopping smoking, and reducing your exposure to ultraviolet light is also recommended. Research suggests that diet and supplementing with certain vitamins and minerals are helpful. Find out how you can improve your eye health by eating a diet rich in certain foods.

Macular degeneration occurs when there is deterioration of the central portion of the retina (the macula), the inside back layer of the eye that records images we see which are sent to the brain from the eye via the optic nerve. It is the leading cause of vision loss and aging is the biggest risk factor, particularly for people 65 and older. Rarely, there is a genetic link and can occur in younger people.

Benefits

Eating a diet rich in fruits and vegetables has been well documented to reduce the risk of certain diseases such as heart disease, stroke, and cancer. Nutrients such as vitamins C and E, carotenoids (lutein, zeaxanthin, β-carotene), zinc, and omega-3 fatty acids (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]) have been thought to be important in vision health due to their antioxidant functions and anti-inflammatory properties.

While some of the research regarding the benefits of certain nutrients for preventing and slowing the progression of AMD are mixed, there is no harm in eating foods that contain these nutrients. For example, for most people adding berries, nuts, squash, carrots, kale, and fatty fish is advantageous.

Age-related macular degeneration is caused, in part, to oxidative stress in the retina as well as exposure to UV light. Lutein and zeaxanthin (two carotenoids) have the ability to filter short-wavelength light associated with photochemical damage and act as antioxidants. Studies have shown that diets highest in lutein and zeaxanthin are associated with a lower risk of AMD.

According to the Linus Pauling Institute, "Dietary lutein and zeaxanthin are selectively taken up into the macula of the eye, where they absorb up to 90% of blue light and help maintain optimal visual function." Some evidence also suggests that the consumption of about 6 milligrams (mg) per day of lutein and zeaxanthin from fruit and vegetables (compared with less than 2 mg/day) may decrease the risk of advanced AMD.

Lutein and zeaxanthin are found in green leafy vegetables, and yellow and orange pigment foods such as spinach, kale, turnip greens, dandelion greens, mustard greens, collards, Brussels sprouts, winter squash, summer squash, and pumpkin. One cup of cooked frozen spinach contains about 29.8 mg of lutein and zeaxanthin.

Antioxidants, such as vitamins A, E, and C, are known to combat oxidative stress by destroying free radicals. While most of the research regarding these vitamins discusses the benefits of supplementation, incorporating more of these foods into the diet would not be harmful. According to a review, "Current evidence shows that all AMD patients should be given indications to increase the consumption of green leafy vegetables and to eat fatty fish, at least twice a week."

A Cochrane review of 19 studies showed that people with AMD may experience some delay in progression of the disease with multivitamin antioxidant vitamin and mineral supplementation.

Most evidence in the Cochrane review came from The Age-Related Eye Disease Study (AREDS) which was funded by and The National Eye Institute. This study was dedicated to analyzing the effects of AMD when using supplements in people ages 55-80 years old. The study was designed to determine risk factors, prevention strategies, and ways to delay progression for macular degeneration and cataracts. Results showed that a supplement combinations of beta-carotene, vitamin C, vitamin E, zinc, and copper can reduce the risk of developing advanced age-related macular degeneration by about 25% in those patients who have earlier but not significant forms of the disease.

The follow-up study, Age-Related Eye Disease Study 2 (ARDES2), determined that supplementing with lutein and zeaxanthin can help to reduce disease progression. Researchers created specific formularies for these supplements and caution those people who have smoked or currently smoke from supplementing with beta-carotene which can increase the risk of lung cancer.

The studies suggest that the supplement formulations may help people who have intermediate AMD in one eye or both eyes, and people who have late AMD in only one eye. It should be noted that AREDS supplements are provided in much higher concentrations than the recommended daily intake. Certain supplements such as vitamin E and beta-carotene can be harmful at high doses. Therefore it is always important to discuss supplementation with a medical professional and consider increasing intake of foods rich in these nutrients first.

In addition, research suggests that adhering to a Mediterranean style of eating was associated with a reduced risk of progression to advanced AMD, which may be modified by genetic susceptibility. A Mediterranean style of eating includes plenty of fruits, vegetables, legumes, whole grains, potatoes, nuts, seeds, fatty fish and limited amounts of meat, poultry, sugars, processed foods, and dairy. It incorporates foods that are rich in the vitamins and minerals that have been linked to reduced risk and progression of AMD, therefore, it makes sense that following this eating plan would be beneficial. A Mediterranean style of eating has also been linked to a decrease in heart disease, improvement in glycemic control as well as reduced risk of obesity.

How It Works

There are no special rules or schedules to follow when adopting this eating style, rather, consider this a lifestyle change. Eating a Mediterranean-style diet rich in fruits, vegetables, whole grains, nuts, seeds and fatty fish has been associated with a decreased risk of diabetes, obesity, and heart disease.

Duration

This type of eating style is meant to last for the long term. You can adopt it at any point in life, before or after you might develop signs of macular degeneration.

What to Eat

Consuming a variety of fruits and vegetables daily is important, particularly those that are rich in vitamin C, E, β-Carotene, zinc, lutein and zeaxanthin. Fatty fish, nuts, seeds, oil (such as olive oil), lean protein, whole grains, legumes, and moderate amounts of poultry and dairy are also included.

Fruits and vegetables: A variety of fruits and vegetables is important for overall health. The specific fruits and vegetables listed are particularly high in vitamin C, as well as β-Carotene, lutein and zeaxanthin. Aim to include one fruit or vegetable at each meal. Another idea is to focus on making half of your plate vegetables at most meals. Base your meals around your vegetables and consider your grains, starches, and protein sources the side dish. Fruits and vegetables also contain filling fiber, which can increase feelings of satiety and pull cholesterol out of the body.

Nuts and seeds: Studies have shown that consuming nuts regularly can help improve diet quality due to their amounts of monounsaturated and polyunsaturated fats, as well as protein, fiber, vitamins, minerals, and bioactive compounds with antioxidant potential. In addition, many studies have shown nut intake to benefit health outcomes, such as preventing and/or treating some chronic disease related risk factors, like glycemic and lipid metabolism, oxidative stress, and inflammation. Add some chopped nuts to your oatmeal or salad, or grab a handful and pair it with a piece of fruit. You can even get creative and use it as a protein topper—simply grind up your favorite nut and use it as you would bread crumbs.

Legumes: Legumes are an excellent source of fiber, protein and contain some zinc. They are a very important part of the Mediterranean diet and can be a valuable source of vegetarian protein. Add some to soups and salad or your favorite whole grain. You can even opt to make some hummus for dipping vegetables and whole grain pita.

Whole grains: Whole grains are packed with vitamins, minerals, and antioxidants. They are rich in B vitamins, vitamin E, magnesium, iron, and fiber. Making most of your grains whole and consuming them daily can help to increase feeling of fullness and prevent large swings in blood sugar which can affect energy levels. The great thing about whole grains is that they are versatile and there are so many to choose from. Swap your cereal in the morning for whole grain oats, add some cooked quinoa to your salad, snack on whole grain popcorn, and serve some tabbouleh for dinner (which is made from bulgur).

Fish: Fish is a lean source of protein and an excellent source of omega-3 fatty acids. Omega-3 fatty acids are fats that need to be consumed through the diet. They are important components of the membranes that surround each cell in your body. DHA, a type of omega-3 fatty acid, is especially high in retina (eye), brain, and sperm cells.

Fats: Olive oil is a staple on the Mediterranean diet and is rich in monounsaturated fat. Monounsaturated fatty acids are thought to reduce LDL cholesterol (bad cholesterol) while raising HDL cholesterol (the good kind). Extra virgin olive oil is particularly high in phenolic compounds which are strong antioxidants and free radical scavengers. You don't need a ton of oil to cook. A little goes a long way. Add a tablespoon to a pan and saute some vegetables or drizzle some over root vegetables to be roasted. Olive oil is a great oil for salad dressing, too.

Herbs and spices: Herbs and spices add a ton of flavor, texture, color, and micronutrients to meals for little calories and fat. For an added bonus, they look great and smell amazing. Add them to grain dishes, salads, eggs, fish, vegetables. You can use fresh or dried.

Recommended Timing

There is no recommended timing for meals and snacks, but most people looking to adopt a healthy way of eating find that eating three balanced meals and one to two snacks daily works best.

Cooking Tips

Using olive oil as a primary cooking oil may be a good idea in slowing down the progression of AMD. Although the research is mixed, olive oil was studied in the ALIENOR (Antioxydants, LIpides Essentiels, Nutrition et maladies OculaiRes) study. Data from 654 subjects French participants aged 72.7 years on average found there was a decreased risk of late AMD among olive oil users. Researchers speculate that the protection comes from phenolic compounds including oleocanthal, hydroxytyrosol, and oleuropein which have strong antioxidant and anti-inflammatory properties

One of the drawbacks is that it may not be generalizable to everyone since the population studied were isolated. However, olive oil has other health benefits to consider. Olive oil is also rich in monounsaturated fatty acids and is the oil used in the Mediterranean diet which has been associated with positive effects on AMD.

You can use olive oil to drizzle on salads, roast vegetables, lightly saute, and marinate protein and fish.

Steaming, roasting, sauteing, and grilling vegetables with herbs and spices can make any meal taste delicious. Add them to your whole grains and legumes for a meatless meal or serve them on the side of your protein source.

When cooking fish, aim to bake, broil, grill, steam, or poach. Avoid deep-frying or using lots of fats.

Modifications

The great news about this eating plan is that it is versatile and adaptable. Because there is an emphasis on fruit, vegetables, whole grains, and healthy fats, this diet can easily become vegetarian or vegan.

For aging adults: As we age our appetites can decrease and therefore it may sound like a daunting task to ingest multiple servings of fruits and vegetables daily. This can be due to a variety of factors, such as taste changes, medication side effects, issues with teeth, limited access to food, no desire to cook, and lack of interest in food. A great way to maximize servings of vegetables and fruits is to make smoothies. You can opt to use frozen or fresh fruits to make your smoothies. Oftentimes using frozen fruits and vegetables limits waste and can be more economical.

Vegetarians/vegans: This type of eating plan can easily adapt to a vegetarian or vegan eating plan. Planning meals around fruits, vegetables, whole grains, legumes, nuts, and seeds can assure that you are getting enough protein, fiber, B12, vitamins, and minerals. Sometimes people following a vegan diet may need to consider calcium, vitamin D, and B12 supplementation. If you are considering switching to this eating style discuss it with your healthcare provider or dietitian to ensure you are optimizing your nutrition and receiving ample amounts of vitamins and minerals.

Gluten allergy: If you have celiac disease or have been diagnosed gluten intolerant, you can still follow this diet by choosing gluten-free grains and eating foods that are naturally gluten-free.

Digestive trouble: This type of eating plan will be very high in fiber. If you are new to eating this way, increase your intake of fruits, vegetables, whole grains, nuts, and seeds slowly and be sure to drink lots of water. Increasing fiber gradually can reduce the risk of developing uncomfortable gas and bloating.

Considerations

For some people with early stages of AMD, your healthcare provider may recommend taking specific supplements and vitamins. According to the American Macular Degeneration Foundation, specific quantities of vitamins and supplements may be recommended for people to prevent or slow down the progression of AMD. It is not recommended to start these supplements on your own, but discuss it with your healthcare provider to see if it will work for you.

General nutrition: As compared to the USDA MyPlate recommendations this type of eating plan will meet dietary guidelines for calories, fat, carbohydrates, fiber, and protein. For those people who eat smaller amounts of dairy or decide to go vegan, learning how to optimize calcium needs will be important. Choose non-dairy milk and yogurt that is fortified with calcium, lots of green leafy vegetables, almonds, and tofu. If your needs are still not met you may need to consider supplementation. Another nutrient that may warrant consideration is vitamin D. If you are not eating egg yolks, fatty fish like salmon, and dairy or other foods that are fortified with vitamin D, such as cow's milk alternatives and cereal, you may not be reaching your vitamin D needs.

Sustainability and practicality in the real world: This is a very sustainable and practical approach to eating. No foods are off-limits and there is an emphasis on whole foods. When it comes to food preparation, the possibilities are endless. There are countless fruits, vegetables, whole grains, and legumes to choose from. If you are going out to eat or going on a trip you will be able to apply these concepts and find menu items to choose from.

Safety: If you are thinking about starting supplements, always contact your healthcare provider to make sure there are no drug/nutrient interactions or any other adverse effects for taking larger doses of vitamins. As for the diet, it should be perfectly safe for most people.

Flexibility: Considering there are no real food groups that are considered off-limits, this type of eating plan is very flexible. You can choose from all different types of fruits, vegetables, whole grain, legumes, nuts, seeds, fish, moderate amounts of dairy, and lean protein.

Support and community: There may not be dietary support groups for people with macular degeneration, however, the National Eye Institute and American Macular Degeneration Foundation are great resources that provide all kinds of support and education, including nutrition.

Cost: This diet shouldn't break the bank, especially if you choose to purchase fruits and vegetables that are in season or frozen varieties. Frozen fruits and vegetables are just as good as fresh because they are frozen at peak freshness which ensures maximum amounts of vitamins and minerals. Fish can be costly. However, if you shop locally you can reduce the cost.

Energy and general health: Reducing your intake of processed foods and added sugar, while increasing fiber and nutrient-rich vegetables should improve your overall well-being and health. These types of foods help to increase energy by reducing large blood sugar fluctuations.

Contraindications

Eating a wide variety of nutrient-dense foods is important and healthy for most people. However, if you are someone who takes blood-thinning medication, also known as anti-coagulant drugs, you should monitor your intake of green leafy vegetables as these are rich in vitamin K and can affect the way your medication works.

In addition, if you are considering beginning supplementation, always consult with your healthcare provider first. High doses of certain vitamins, such as vitamin E, can be problematic.

Lastly, if you smoke or recently quit, it is not recommended to supplement with large doses of beta-carotene, as this can increase the risk of lung cancer in some.

Macular Degeneration Diet vs. Mediterranean Diet

There is no specific diet for AMD, rather suggested foods that are helpful and suggestions for supplementation. However, research has also shown that a Mediterranean style of eating can also help to slow down the progression of AMD. This makes sense since the concepts are aligned. Both eating styles encourage ample amounts of fruits, vegetables, nuts, seeds, fatty fish, olive oil, and limited amounts of sugar, white flour, and processed foods. It might actually be easier in certain ways to follow the Mediterranean diet since it is well documented and there are plenty of resources to give you examples of food lists, recipes, and other tips.

Summary

While there is no specific diet for age-related macular degeneration, research suggests that eating a diet rich in anti-inflammatory and anti-oxidant rich foods such as fruits, vegetables, whole grains, nuts, seeds, fatty fish, and oils, is associated with decreasing risk and progression.

There are no strict rules, guidelines, or time tables, which make it very easy to follow and flexible. This type of eating style can be adapted for certain dietary restrictions and preferences. In addition, you do not have to purchase pre-made packaged foods which can be costly. And there are no "forbidden foods."

However, there is an emphasis on reducing intake of processed foods, sugar, fatty meats, and fried fare. If you find that searching for foods that are rich in vitamin C, E, zinc, and fatty acids are confusing, simply adopt a version of the Mediterranean eating style. And in certain instances, consult with your healthcare provider if you think supplementation may be right for you.