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A Comprehensive Program of Glaucoma Dietary Supplements
What follows is my personal approach to glaucoma supplementation. I have arrived at this approach after decades of intense personal study (on top of my education in biochemistry).
In addition to sharing my ideas and general approach, I have included a list of supplements. The list serves several purposes. First, it is a comprehensive list of all (or almost all) of the dietary supplements that are relevant to glaucoma. Second, for each superfood, herb or nutrient I have picked the best specific product I can find. For most products I have already included a few sentences summarizing the benefits and why I take it -- with a focus on its benefits for glaucoma and/or general vision health. (For any remaining products where I have not yet written that summary you can find similar info on the product pages at the FitEyes eStore. For each product I have included a link directly to its product page.)
My nutrient intake philosophy is "Foods first!" I also believe in "first, do no harm." In the past I have taken supplements that I later learned were of dubious benefit. (One example is beta carotene.) I learned to appreciate "first, do no harm" on the basis of having possibly done harm to myself.
While I favor the safe, natural, food-based approach, glaucoma can be a serious disease and those who ignore the important role of nutraceuticals and pharmaceuticals may be risking their vision. We have to find a delicate balance between being careful and conservative and missing out on important new advances. So my program is also comprehensive and pragmatic. I've been in the nutrition field long enough to appreciate that views are often defended with the fervor of religious wars. I'm not afraid to take a position myself, but I try not to let any particular ideology limit me. I'm most interested in real world results and my recommendations cross several boundaries.
In order of priority, here is how I rank the different sources of nutrients (or chemicals) that we can consume.
- Superfoods consumed as real meals (not simply smoothies, etc.)
- Superfood supplements incorporated into meals or taken on their own
- Food-based supplements (including full spectrum herbs)
- Moderately isolated or fractionized nutrients
The idea is that we want to use pharmaceuticals as a last option. Pharmaceuticals do have a place, but their use should ideally be limited and/or short term. However, when I recommend a supplement program for a specific individual I put their specific needs above this general philosophy. While I myself take very few nutraceuticals, I have recommended a program featuring more nutraceuticals to some FitEyes members based on their specific needs. But as I mentioned, this document is not a recommendation for you -- it is my own overall approach. (If you want a personal recommendation, please see information at the bottom.)
What many people do not realize is that the "health food industry" has virtually been taken over by a pharmaceutical philosophy -- the philosophy of isolating so-called active ingredients, making these isolated active ingredients as strong as possible, designing patented or proprietary versions of them, targeting them for actions that manipulate our biochemistry for narrow goals rather than support the body's natural healing, etc. All of this is a profit-driven drug-like approach and it is driving almost all dietary supplement development today. I do not think it is a healthy trend.
Therefore, I distinguish between natural supplements and nutraceuticals. And I also try to restrict my use of nutraceuticals in an intelligent way. However, like pharmaceuticals, nutraceuticals have a place. I do not rule out either pharmaceuticals or nutraceuticals on the basis of ideology. But I respect their potential for serious side effects.
And there are many cases where there is a natural option available that has zero downside. In those cases, I almost always advocate for the option that is closer to the top of my list above (i.e., superfoods first and pharmaceuticals last). But when there is a clear advantage to moving down the list (toward nutraceuticals or pharmaceuticals) I do that. Sometimes the more natural choice is not available or not as efficacious.
However, in reviewing this list I hope you realize that many, many times, the more natural choice is both available and at least as efficacious -- sometimes more so. Often the more natural choice is the better choice for our health in every way.
As you read through the entire program below, keep in mind that I am not taking all of these supplements all the time. I do use my berry concoction twice a day every day. And I use the superfoods all the time as well. But, for example, I am not taking carnitine right now even though top glaucoma experts, including Dr. Robert Ritch, recommend it to their patients. I list it because it is an important nutraceutical for glaucoma and many FitEyes members use it and have given strong testimonials in favor of it (and other nutraceuticals on this list). In the comprehensive information below I will share the nutraceuticals I personally take as well as those recommended by top glaucoma specialists.
My program, as listed here, is comprehensive. Implementing this is a matter of selecting a subset of this full program. As I said above, I focus on all the things toward the top of my priority list above and I use only a few things from categories 5 and 6. However, someone could build their own ideal supplement program entirely from my list of nutraceuticals below. I have certainly included every nutraceutical recommended by top glaucoma experts. In many cases I have found higher quality nutraceuticals than these experts recommend (simply on the basis of doing product research). In other cases I have found the best values (for example, Healthy Origins CoQ10 or NOW Foods Magtein). A valid subset of my program could certainly focus on categories 5 and 6.
I have organized my recommendations into these groups based on the guiding principles described above.
- My berry concoction - "every
glaucoma patient should consume berries every day" ~ Dr. Greger
- My superfood-based super nutrient program (much of this is
incorporated into my food)
- David's food-based supplement recommendations (leaves out some
common glaucoma nutraceuticals)
- The ophthalmologist-recommended nutraceutical program (extra supplements not in David's program, but possibly essential for many people)
My idea is that every glaucoma patient should use the "berry concoction" every day. This is beyond question.
And every glaucoma patient should use most of the superfood-based super nutrient program daily. (There is room for variation in the specific product recommendations based on personal preferences or needs.)
Next, most of us should use many of the natural supplements in my food-based supplement recommendations. If we wish, we could fine tune this. For example if someone has normal tension glaucoma, they probably don't need Forskolin for its potential IOP reducing actions (but an NTG patient with poor circulation might include Forskolin for its heart-contraction-boosting quality). And a person interested in Ayurveda might want to fine tune the herbs based on body type. But most of the items on this list are of importance for most glaucoma patients. The supplements are also mostly food-based, so there is a higher degree of safety compared to nutraceuticals.
Finally, there is the nutraceutical list. Many of the nutraceutical decisions will be personal and will depend on one's own state of health, state of vision, rate of glaucoma progression and many other factors. If your vision is good and stable, your overall health is good and you have no specific issues, you might choose just a few of the nutraceuticals.
I should mention that I put isolated vitamins or minerals in the nutraceutical category. Some people might disagree with that categorization, but if you truly understand my approach you will see why I do it. It fits the way most of these supplements are actually used in glaucoma management. However, if used simply to make up for dietary deficiencies, I would not categorize vitamins and minerals as nutraceuticals. For example, a good case can be made for supplementing with boron because the average diet supplies 1 mg per day, but we require 3 to 6 mg daily to reduce calcium loss and support joint and bone health.
On the other hand, those of us with glaucoma progression or specific health issues will almost certainly want to consider more of the nutraceuticals (and, of course, consult with your doctor). While I do try to minimize the nutraceuticals, I am even more interested in minimizing pharmaceuticals. Therefore, if taking more nutraceuticals allows me to reduce or eliminate a pharmaceutical, I will do it. I can envision many glaucoma patients consuming the entire nutraceutical list. If that is what it takes to slow or stop glaucoma progression, it is certainly worth it.
There is almost no redundancy or needless duplication in my list. You could take every item on all of my lists below and not be wasting your resources. In contrast, when I review the supplements lists most people are taking, I see a lot of redundancy or needless duplication -- even potentially dangerous duplication. Many people take way too many synthetic B-complex vitamins or too much isolated beta-carotene (which shows up in many vision formulas, for example) or too much isolated DHA. My program eliminates these problems. If there is any "redundancy" it is in the form of superfoods such as berries, and rather than being a problem, this is a benefit in my program.
The main downside to my program is that you may end up using more separate products. But the price to using "formulation" products (such as vision formulas, multivitamins or other formulas) include all these drawbacks and more:
- no formulation product contains everything, so you still end up using multiple products
- the formulation products are what lead to redundancy of nutrients and potentially dangerous levels of consumption of a few highly marketed ingredients that are in almost all formulas
- the formulation products never contain the best quality ingredients for all their ingredients. There is always some compromise in quality. Often, the quality of every single ingredient is compromised.
- the formulation products almost never provide sufficient potency of key ingredients to match the clinical results seen in the studies.
My program avoids all those problems, even when including all the nutraceuticals. In over 30 years of being involved in the dietary supplement industry and searching for ideal ways to obtain all the nutrients, I have never found any program that would achieve the kinds of goals most glaucoma patients wish to achieve while relying largely on formulation supplements. Often, as soon as you introduce even one of these products the problems start. However, in the interest of putting practicality ahead of pure ideology, I do make exceptions to this rule. For example, I often use Antioxidant Extreme by HealthForce (a good product) and I sometimes use one of the Mitochondrial-focused products by Life Extension. (I can explain when/why I would do that.) But when I do that, I have to carefully re-examine the full program for redundancy or excessive intake levels. In the end, it is more work to use the formulation products correctly. And if you don't have convenience, using these products makes absolutely no sense.
While a program based on a lot of separate products may not initially seems as convenient or simple, my experience is that it becomes both more convenient and simpler -- as well as being much more flexible and efficacious. When does it become this? In exactly the circumstances where we would obtain the benefits we seek. In other words, if you are not serious about achieving real results from your supplements, then just do whatever seems easy or convenient. But the second you demand real results, a program based on a lot of separate products becomes more convenient, simpler, more flexible and much more efficacious. That's my experience.
However, travel can present challenges when we are consuming a lot of supplements. I once traveled to South America with an extra suitcase filled almost entirely with supplements! Once of my supplements was Vitamin C powder (a white powder). And one of my stops was Bogotá, Colombia! Fortunately, the supplements did not present any problems, even to this destination and back (where white powder usually means something illegal). But traveling with supplements can be inconvenient at times. What I have found is that when I am using a food-based supplement program, the body does not object to missing certain supplements while on occasional vacations. With nutraceuticals, my experience is that they are more like prescription drugs. The body comes to depend on them and we don't want to haphazardly stop taking them.
Therefore, here is my recommendation. When it comes to the superfood powders and the superfood juice concentrates, if it is too inconvenient to travel with them and you don't travel that often, just leave them at home when you travel. If you travel more frequently, I can recommend capsules for use while you are traveling. But I still recommend the powders and juice concentrates when you are at home because these provide more for the money (and they are completely free of all capsule materials, fillers, tablet binding agents, excipients, etc.) (I always recommend Paradise Herbs products because all their capsules are completely free of all those other ingredients.) If you absolutely do not want powders or liquids at all, I can recommend things like Paradise Herbs green superfood (ORAC Energy Greens) in capsules and superfruits such as Acai, Mangosteen and Maqui berry in capsules. And since most of our nutraceuticals of interest are already in capsules, that part of the program doesn't need to change. Do take your nutraceuticals when you travel.
Because my overall program is food-based, it is not designed entirely around isolated nutrient dosages. For example, I do not believe it is enough to take X milligrams of reservatrol, Y milligrams of quercetin, Z units of vitamin D3 and so on down a list. While those values have meaning, they are not enough alone. That's one of the principles of a superfood program. We cannot replace eating an apple with taking a pill. Likewise, we cannot replace berries with a capsule of anthocyanidins and other isolated chemicals. And we cannot achieve optimal well-being simply by pursuing target values for blood chemistry or urine tests, especially when that pursuit primarily utilizes pharmaceuticals and nutraceuticals. This chemistry-driven approach certainly dominates segments of the "health" industry (such as life extension and bodybuilding). I have experience with both those segments going back decades.
I do not think you can replace tart cherries, olive oil, ghee, flax seed meal or any of the superfoods with a handful of pills.
Therefore, my overall supplement program is not designed around a list such as X milligrams of reservatrol, Y milligrams of quercetin, etc. But I do consider those kinds of dosages guidelines for the nutraceuticals. (However, in some cases the right dose is as much as you can afford. In other cases, nobody [including top scientists] knows the optimal dose.)
OK, here are my superfoods and supplements:
(With a consultation I will often include medicinal spices too.)
For more information that may help you decide which nutraceuticals to use, read the product info at each link above. And consider these resources:
Another reference point for some of these nutraceuticals are the minimum dosages Dr. Robert Ritch usually recommends to his patients as shown in David's notes below:
- R-alpha-lipoic acid 100 mg
- Bilberry 375 mg
- Carnitine 250 mg
- Citicoline 100 mg
- CoQ10 as Ubiquinol 50 mg
- Curcumin 800 mg
- Krill oil 500 mg
- Forskolin 250 mg
- Ginkgo biloba extract 120 mg
- Grape seed extract 100 mg
- Green tea catechins 100 mg
- N-acetyl-L cysteine 200 mg
- Pycnogenol 100 mg
- Quercetin 200 mg
20 mg (recommended: from 400 to 500mg of whole grape extract)
Of course, we can discuss each nutrient on the FitEyes discussion list in great detail. I'm happy to enter into any discussion there.
I will be revising, refining and improving my supplement recommendations over time. As new research comes out, as new feedback from the FitEyes community comes in, as new products come out, I will improve this list. This is version 1.2. The main new additions to my program in this version are Lion's Mane and a few new Paradise Herbs products.
My final reminder is to give highest priority to healthy lifestyle factors. Include time for meditating, exercising and sleeping well. If you have stress in your life, invest your time learning meditation. Supplements -- even those that claim to help with stress -- will not be as effective as a good meditation program for managing stress. If the supplement recommendations seem too complex or too complicated, I can do a telephone consultation as an educator. I cannot prescribe supplements to treat any specific medical conditions, but I can teach you more about the supplements, describe what each one does, mention related research, and generally discuss the various products with you. I can help make it less overwhelming. After the call, I will send you a personalized version of the list above with the subset of the supplements that are most relevant to your needs and goals.