BETA CAROTENE, VITAMIN C, VITAMIN E.

A study led by researchers from Erasmus Medical Centre in Rotterdam, the Netherlands, followed a group of more than 4,000 people to see how diet affected the risk of developing macular degeneration. After eight years, the scientists compared the diets of people who developed the condition with the diets of those who did not. The results were encouraging: People who ate a diet rich in beta carotene, vitamin C, vitamin E, and zinc had a 35 percent reduced risk of developing macular degeneration compared with people who ate an average diet. And those who ate worse-than-normal diets, with low levels of those nutrients, actually had a 20 percent increased increased risk of disease. I highly recommend that anyone with a family history of macular degeneration follow the food plan for high-antioxidant, high-zinc foods to reduce their risk. For an easy way to get a large dose of all the nutrients, try one of my Smooth-SEE recipes (Chapter 11). risk of disease. I highly recommend that anyone with a family history of macular degeneration follow the food plan for high-antioxidant, high-zinc foods to reduce their risk. For an easy way to get a large dose of all the nutrients, try one of my Smooth-SEE recipes (Chapter 11).

BEST FOODS FOR BETA CAROTENE: Sweet potatoes, carrots, kale, winter squash (especially b.u.t.ternut), turnip greens, pumpkin, mustard greens, cantaloupe, red bell pepper, apricots, Chinese cabbage, spinach, lettuce (romaine, green leaf, red leaf, b.u.t.terhead), collard greens, Swiss chard, watercress, grapefruit, watermelon, cherries, mangos, red ripe tomatoes, guava, asparagus, red cabbage Sweet potatoes, carrots, kale, winter squash (especially b.u.t.ternut), turnip greens, pumpkin, mustard greens, cantaloupe, red bell pepper, apricots, Chinese cabbage, spinach, lettuce (romaine, green leaf, red leaf, b.u.t.terhead), collard greens, Swiss chard, watercress, grapefruit, watermelon, cherries, mangos, red ripe tomatoes, guava, asparagus, red cabbage BEST FOODS FOR VITAMIN C: Guava, bell peppers (red, yellow, green), orange juice, hot chile peppers, grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons, broccoli Guava, bell peppers (red, yellow, green), orange juice, hot chile peppers, grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons, broccoli, kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, grapefruit (pink, red), white potatoes (with skin), mustard greens, cherry tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, tomatoes, raspberries, Chinese cabbage, blackberries, green tomatoes, cabbage, watermelon, tangerines, lemon juice, okra, lychees, summer squash (all varieties), persimmons kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, grapefruit (pink, red), white potatoes (with skin), mustard greens, cherry tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, tomatoes, raspberries, Chinese cabbage, blackberries, green tomatoes, cabbage, watermelon, tangerines, lemon juice, okra, lychees, summer squash (all varieties), persimmons BEST FOODS FOR VITAMIN E: Wheat germ oil, fortified whole grain cereals, sunflower seeds, almonds, hazelnuts, peanut b.u.t.ter, wheat germ, avocado, pine nuts, tomato paste, flaxseed oil, red bell pepper, canola oil, kiwis, peanuts, olive oil, mangos, turnip greens, Brazil nuts, asparagus, peaches, papaya, radicchio, collard greens, broccoli, Swiss chard, spinach Wheat germ oil, fortified whole grain cereals, sunflower seeds, almonds, hazelnuts, peanut b.u.t.ter, wheat germ, avocado, pine nuts, tomato paste, flaxseed oil, red bell pepper, canola oil, kiwis, peanuts, olive oil, mangos, turnip greens, Brazil nuts, asparagus, peaches, papaya, radicchio, collard greens, broccoli, Swiss chard, spinach

FAQSMy doctor suggested that I cut down on sugary foods to try to prevent cataracts. I've never heard that before-is it good advice?

Cutting back on sugary foods is always a good idea. Whether it will help prevent cataracts is a hot research topic right now. Some scientists from Tufts University a.n.a.lyzed data from AREDS and discovered that eating lots of low-quality carbohydrates increased the risk of cataracts by up to 50 percent. Low-quality carbohydrates are defined as sugary foods, white rice, and anything made with refined white flour, including crackers, breads, rolls, m.u.f.fins, pasta, and other baked goods. The theory is that these foods quickly raise blood sugars to very high levels and that there's a c.u.mulative effect. In other words, the more low quality carbs you eat, the more you expose the lens of your eye to potentially dangerous levels of sugar. So if you want another fabulous reason to eat healthier foods-including more fruits, vegetables, and high-quality carbohydrates, such as whole grain food and brown rice-there it is.

ZINC.

AREDS and the Rotterdam study confirmed zinc's role in eye health. Zinc is found in the retina, and helps the functioning of enzymes responsible for eye health. In people with macular degeneration, levels of zinc in the retina can be very low, so eating zinc-rich foods is a logical first step for preventing and treating macular degeneration.

BEST FOODS FOR ZINC: Oysters, lean beef, crab, ostrich, pork tenderloin, peanut b.u.t.ter, wheat germ, turkey, veal, pumpkin seeds, chicken, chickpeas (garbanzo beans), fat-free yogurt, fortified whole grain cereals, pine nuts, cashews, sunflower seeds, lima beans, lentils, pecans, cheese (fat-free, reduced-fat), fat-free milk, almonds, walnuts, peanuts, black-eyed peas, green peas Oysters, lean beef, crab, ostrich, pork tenderloin, peanut b.u.t.ter, wheat germ, turkey, veal, pumpkin seeds, chicken, chickpeas (garbanzo beans), fat-free yogurt, fortified whole grain cereals, pine nuts, cashews, sunflower seeds, lima beans, lentils, pecans, cheese (fat-free, reduced-fat), fat-free milk, almonds, walnuts, peanuts, black-eyed peas, green peas LUTEIN AND ZEAXANTHIN.

Lutein and zeaxanthin are a matched pair of antioxidants-almost without exception, foods that contain one also contain the other. And they are found in high concentrations in the tissue of the macula. Because they absorb 40 to 90 percent of blue light intensity, these nutrients act like sunscreen for your eyes. Studies have shown that eating foods rich in lutein and zeaxanthin can increase increase the pigment density in the macula-and greater pigment density means better retina protection, and a lower risk of macular degeneration. At least one study has confirmed that eating foods with high amounts of these antioxidants seems to reduce the risk of developing macular degeneration. the pigment density in the macula-and greater pigment density means better retina protection, and a lower risk of macular degeneration. At least one study has confirmed that eating foods with high amounts of these antioxidants seems to reduce the risk of developing macular degeneration.

BEST FOODS FOR LUTEIN AND ZEAXANTHIN: Kale, spinach, turnip greens, mustard greens, Swiss chard, radicchio, collard greens, summer squash (all varieties), watercress, Kale, spinach, turnip greens, mustard greens, Swiss chard, radicchio, collard greens, summer squash (all varieties), watercress, green peas, persimmons, Brussels sprouts, broccoli, pumpkin, corn, lettuce (b.u.t.terhead, Boston, Bibb, romaine), asparagus, green beans, okra, artichokes, green bell peppers, scallions, carrots green peas, persimmons, Brussels sprouts, broccoli, pumpkin, corn, lettuce (b.u.t.terhead, Boston, Bibb, romaine), asparagus, green beans, okra, artichokes, green bell peppers, scallions, carrots

FAQSLet's say I try changing my diet to help my macular degeneration, when should I start to see results?

It varies from person to person. Some people might see a dramatic change after just one month, while others may only notice subtle changes, and still others may have to wait for their next ophthalmologist appointment when they are surprised to discover that they do better on the eye exam. But don't lose faith-all those eye-healthy vitamins and minerals are also helping to keep the rest of you healthy, too!

OMEGA-3 FATTY ACIDS.

Retinal pigment cells contain a type of omega-3 called docosahexaenoic acid (DHA), which helps protect light receptor cells in the eye from damage by sunlight and free radicals. In 2006, scientists speculated that fish oil and other sources of omega-3 fatty acids could be natural protection against age-related macular degeneration. If you want to take advantage of this research, I recommend eating two to three servings of fatty fish each week, and strive to incorporate the other omega-rich foods into your daily diet, too.

BEST FOODS FOR OMEGA-3 FATTY ACIDS: Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans BONUS POINTS.

- Get regular eye exams. It is important to get a regular comprehensive checkup by an optometrist or ophthalmologist-at least once a year if you're over age 60. Be sure that the exam includes eye dilation so that any change in your lens or retina can be spotted easily and early. It is important to get a regular comprehensive checkup by an optometrist or ophthalmologist-at least once a year if you're over age 60. Be sure that the exam includes eye dilation so that any change in your lens or retina can be spotted easily and early.

- Protect your eyes from the sun. One of the top causes of cataracts is radiation from the sun. Take steps to protect your eyes by wearing sungla.s.ses and a hat with a brim whenever you are out in bright daylight. One of the top causes of cataracts is radiation from the sun. Take steps to protect your eyes by wearing sungla.s.ses and a hat with a brim whenever you are out in bright daylight.

- Stop smoking. Smoking increases your risk of both cataracts and macular degeneration, in part because it creates free radicals, and in part because smoking decreases the amount of oxygen to the eye. Smoking increases your risk of both cataracts and macular degeneration, in part because it creates free radicals, and in part because smoking decreases the amount of oxygen to the eye.

- If you smoke, don't drink alcohol or take beta carotene supplements. I strongly encourage you to stop smoking, but if you haven't yet quit entirely, you have a couple other guidelines. Although alcohol alone doesn't increase the risk for cataracts, smokers who drink alcohol have a greater risk than smokers who don't drink. And beta carotene supplements may increase the risk of lung cancer in smokers, so that's a dangerous combination. I strongly encourage you to stop smoking, but if you haven't yet quit entirely, you have a couple other guidelines. Although alcohol alone doesn't increase the risk for cataracts, smokers who drink alcohol have a greater risk than smokers who don't drink. And beta carotene supplements may increase the risk of lung cancer in smokers, so that's a dangerous combination.

- Maintain a healthy weight. People with early-stage macular degeneration who are also overweight have double the risk of moving on to the advanced stage, so losing weight may help keep the disease from progressing. Plus, people who are overweight have a greater risk of developing type 2 diabetes, which increases the risk of cataracts. (See Weight Loss on Chapter 3 for more information.) People with early-stage macular degeneration who are also overweight have double the risk of moving on to the advanced stage, so losing weight may help keep the disease from progressing. Plus, people who are overweight have a greater risk of developing type 2 diabetes, which increases the risk of cataracts. (See Weight Loss on Chapter 3 for more information.) - Avoid eating foods high in saturated and trans fats. b.u.t.ter, stick margarine, cream, whole milk, ice cream, lard, cheese, beef fat, products made with hydrogenated oil, and other damaging fats can cause a buildup of plaque in blood vessels which can choke off blood flow-including blood flow to the eye. Any decrease in oxygen can harm the eye and promote tissue damage. b.u.t.ter, stick margarine, cream, whole milk, ice cream, lard, cheese, beef fat, products made with hydrogenated oil, and other damaging fats can cause a buildup of plaque in blood vessels which can choke off blood flow-including blood flow to the eye. Any decrease in oxygen can harm the eye and promote tissue damage.

SUPPLEMENTS.

FOR CATARACTS.

If you are concerned about cataracts and want to consider supplements in addition to in addition to the food fixes, my only recommendation is for: the food fixes, my only recommendation is for: - Multivitamin. It is important to get the necessary amounts of the cataract-fighting B vitamins, along with a basic amount of vitamin C and E. Look for a standard multivitamin that contains 100 percent of vitamins C and E. Too much vitamin C from supplemental doses might actually increase the risk of cataracts...and too much vitamin E from supplemental doses might increase the risk of macular degeneration. Supplements with "mega" doses of any vitamin or mineral are not recommended. It is important to get the necessary amounts of the cataract-fighting B vitamins, along with a basic amount of vitamin C and E. Look for a standard multivitamin that contains 100 percent of vitamins C and E. Too much vitamin C from supplemental doses might actually increase the risk of cataracts...and too much vitamin E from supplemental doses might increase the risk of macular degeneration. Supplements with "mega" doses of any vitamin or mineral are not recommended.

FOR MACULAR DEGENERATION ONLY.

For people who have been diagnosed with macular degeneration, the following supplements may help slow progression of the disease. Among the best studied are daily dosages of the following supplements: I RECOMMEND THAT EVERYONE TAKE.

- Multivitamin that provides only only 100% DV for Vitamin E. 100% DV for Vitamin E.

AND SPEAK WITH YOUR DOCTOR ABOUT THESE.

ADDITIONAL SUPPLEMENTS.

- 500 milligrams vitamin C.

- 15 milligrams beta carotene. Smokers shouldn't take beta carotene because it may increase the risk of cancer (in smokers only).

- 80 milligrams zinc, with 2 milligrams copper to balance out the effect of such high levels of zinc, which can depress the immune system and block copper's availability in the body.

JOY'S 4-STEP PROGRAM FOR CATARACTS AND MACULAR DEGENERATION Follow this program if you have macular degeneration or cataracts, or a family history of these diseases.

STEP 1...START WITH THE BASICS These are the first things you should do to address eye problems: - See an optometrist or ophthalmologist for a comprehensive eye exam. If you are over age 60, have an exam every two years. If you notice any vision changes, see a doctor immediately-don't wait for your next appointment.

- If you have macular degeneration, talk with your physician about whether you are a good candidate to take the AREDS supplements, and whether you need to avoid zinc or beta carotene.

- If you smoke, quit.

- Protect your eyes from the sun by wearing a brimmed hat and sungla.s.ses whenever possible.

STEP 2...YOUR ULTIMATE GROCERY LIST A nutrition plan is only as good as the foods that you choose. This list contains foods with high levels of nutrients that contribute to eye health, plus some foods used as ingredients in the meal plans and recipes. You don't have to purchase every item...but these foods should make up the bulk of what you eat for the week. If you find yourself getting bored, try adding a food from the list that's new to you. My practice is full of people who are pa.s.sionate fans of foods they've only recently started eating.

FRUIT.

Apples (especially Red Delicious, Granny Smith, Gala)ApricotsBerries (blackberries, blueberries, raspberries, strawberries)CantaloupeCherriesClementinesCranberries, fresh and dried (and juice)Grapefruit (and juice)GuavaKiwiLemonsLimesLycheesMangosOranges (and juice)PapayaPeachesPersimmonsPineapplePlums (especially black)PrunesTangerinesWatermelon

VEGETABLES.

Artichoke heartsAsparagusAvocadoBeans (red, kidney, pinto, black, garbanzo, lima)BroccoliBrussels sproutsCabbage (including Chinese, red)CarrotsCauliflowerCeleryChickpeas (garbanzo beans)Collard greensCornGreen beansKaleKohlrabiLentilsLettuce (romaine, green leaf, red leaf, b.u.t.terhead, Boston, Bibb)Mushrooms (including portobello, white)Mustard greensOkraOnionsPeas (green, sugar snap)Peas, black-eyedPeppers (hot; yellow/red/green bell)Potatoes, sweetPotatoes, white (including russet)PumpkinRadicchioRutabaga.s.scallionsSeaweedSnow pea.s.soybeans (edamame)SpinachSquash, summer (all varieties)Squash, winter (especially b.u.t.ternut)Swiss chardTomatoes (including green tomatoes, red ripe tomatoes, cherry tomatoes, and tomato paste)Turnip greensWatercress

SEAFOOD.

AnchoviesCrabHerringMackerel (not king)Oysters (including Pacific)Salmon, wild (fresh, canned)SardinesTrout, rainbowTuna (canned light)

LEAN MEATS/EGGS.

Beef, leanChickenEggs (especially omega-3-fortified)Ham, leanLiverOstrichPork (lean cuts, including tenderloin)TurkeyVealVenison

NUTS AND SEEDS (PREFERABLY UNSALTED).

AlmondsBrazil nutsb.u.t.ternuts (white walnuts)CashewsFlaxseed, groundHazelnutsPeanut b.u.t.terPeanutsPecansPine nutsPumpkin seedsSunflower seedsWalnuts

WHOLE GRAINS.

Breads, whole wheat (including pita and crackers)Cereal, fortified whole grainCouscous, whole wheatPasta, whole wheatWheat germ

DAIRY.

Cheese (fat-free, reduced-fat)Cottage cheese (nonfat, 1% reduced-fat)Milk (fat-free, 1% reduced-fat)Yogurt (fat-free, low-fat)

MISCELLANEOUS.

Chili, canned vegetarian, low-fatCoffeeDressing, salad, reduced-fatGuacamoleHorseradish (prepared)HummusMargarine spread, soft tub trans fat-freeMayonnaise, reduced-fatNonstick cooking sprayOil, canolaOil, flaxseedOil, oliveOil, walnutParsley, freshPepper, blackSaltSoup, canned b.u.t.ternut squash, low-fatSoup, canned pumpkin, low-fatSoup, canned split pea, low-fatSugarTea (green, black)Vinegar, balsamic or red wineWorcestershire sauce

STEP 3...GOING ABOVE AND BEYOND If you want to do everything you can for eye health, here are some additional things you might try: - If you like, feel free to take a multivitamin with 100% DV for B vitamins and folic acid. Look for a supplement that contains no more than 100% DV of any nutrient, especially vitamins C and E.

- If you specifically have macular degeneration (not cataracts), consider supplements of vitamin C, beta carotene, and zinc with copper, in the dosages recommended on Chapter 11. At the very least, make sure your multivitamin provides 100% DV for beta carotene, zinc, and copper. If you smoke, cross beta carotene off your list. These are treatment-level dosages-if you do not have macular degeneration, do not take these supplements.

- Avoid eating foods high in saturated and trans fats, including b.u.t.ter, stick margarine, ice cream, whole milk, cheese, and products made with hydrogenated oils.

SUNGLa.s.sESYour choice of sungla.s.ses makes a fashion statement, but please don't let that statement include the words eye damage eye damage. Not all designer models protect the eyes. Don't be fooled into thinking that large or dark lenses necessarily protect against radiation. The American Academy of Ophthalmology recommends choosing sungla.s.ses that are certified to block 99 to 100 percent of UVA and UVB radiation. Gla.s.ses should fit well so they don't slide down your nose. If possible, look for models that wrap all the way around to your temples. Wear your sungla.s.ses every time you go outside, even on cloudy days-radiation is still there even if the sun is hidden. If you wear contact lenses with UV protection, it is still important to wear sungla.s.ses because contacts cover only a tiny portion of your eyes.

STEP 4...MEAL PLANS These sample menus include foods high in nutrients that have been shown to be protective against cataracts and macular degeneration, specifically antioxidants, beta carotene, vitamins C and E, zinc, B vitamins, and lutein.

Every day, choose one one option for each of the three meals-breakfast, lunch, and dinner. Then, one or two times per day, choose from a variety of my suggested snacks. Approximate calories have been provided to help adjust for your personal weight management goals. If you find yourself hungry (and if weight is not an issue), feel free to increase the portion sizes for meals and snacks. Beverage calories are option for each of the three meals-breakfast, lunch, and dinner. Then, one or two times per day, choose from a variety of my suggested snacks. Approximate calories have been provided to help adjust for your personal weight management goals. If you find yourself hungry (and if weight is not an issue), feel free to increase the portion sizes for meals and snacks. Beverage calories are not not included. included.

BREAKFAST OPTIONS.

(Approximately 300 to 400 calories)

Cottage Cheese and Cantaloupe cantaloupe filled with 1 cup fat-free or 1% reduced-fat or cottage cheese and topped with 1 tablespoon sunflower seeds and 1 tablespoon slivered almonds (or chopped walnuts).

Cereal with Milk and Fruit 1 cup whole grain fortified cereal (any brand 120 calories or less per serving) with 1 cup fat-free or enriched/fortified soy milk, topped with 1 tablespoon wheat germ. Enjoy with pink grapefruit (or 1 orange).

Peanut b.u.t.ter Pita Whole wheat pita bread split and toasted, each half topped with 1 level tablespoon peanut b.u.t.ter.

Scrambled Eggs with Peppers, Mushrooms, and Onion Saute cup each sliced onion, mushrooms, and red or yellow peppers in a skillet coated with nonstick cooking spray (or 1 to 2 teaspoons canola oil) until soft. Beat 1 whole egg with 2 egg whites. Add to vegetables and cook, stirring, until eggs are cooked. Serve with 1 slice whole wheat bread, toasted, with optional 1 teaspoon soft tub, trans-fat-free margarine.

Yogurt with Chopped Mango and Berries 1 cup fat-free or low-fat vanilla yogurt mixed with chopped mango, cup berries, and 1 to 2 tablespoons wheat germ (or chopped walnuts, almonds, pecans, or sunflower seeds).

LUNCH OPTIONS.

(Approximately 400 to 500 calories)

Turkey Sandwich with Baby Carrots 4 ounces sliced turkey breast (or lean ham) and unlimited romaine lettuce and sliced tomato on 2 slices whole grain bread; add optional 2 thin slices avocado and/or 2 teaspoons reduced-fat mayonnaise. Enjoy with a large handful baby carrots.

Pumpkin Soup with Mixed Vegetables and Salad 3 cups pumpkin, b.u.t.ternut squash, or split-pea soup (canned, no cream or whole milk used in preparation). Enjoy with large mixed vegetable salad of unlimited leafy greens, tomato, pepper, onion, carrots, cuc.u.mber, mushrooms, etc., tossed with 1 teaspoon olive oil and unlimited vinegar or fresh lemon juice (or 2 tablespoons reduced-calorie salad dressing).

Grilled Chicken Salad 5 ounces skinless chicken breast on large bed of mixed greens (romaine lettuce, spinach, mustard greens, collard greens) and topped with cup cherry tomatoes, 1 chopped bell pepper (red, yellow, green), artichoke hearts, and cup chickpeas (garbanzo beans). Toss with 2 teaspoons olive oil and unlimited vinegar or fresh lemon juice.

Veggie Tuna Salad with Fresh Fruit 1 serving Veggie Tuna Salad. Enjoy with 150 calories of whole wheat pita bread or whole grain crackers and 1 orange or kiwi, or mango.

Spinach Omelet and Sweet Potato Beat 1 whole egg with 2 to 3 egg whites. Cook in heated skillet coated with nonstick cooking spray. When bottom is cooked, gently flip over. Top with unlimited spinach (raw or pre-sauteed) and optional 1 ounce reduced-fat cheese. Fold omelet over and cook until egg mixture is firm and cheese melts. Enjoy with a plain baked sweet potato (or 2 cups hearty vegetable soup).

DINNER OPTIONS.

(Approximately 500 to 600 calories)