A Nutrient "Cocktail" to Protect Your Vision

Dynamic Trio: Acetyl L-Carnitine, Omega-3 Fish Oil, and CoQ10

A Nutrient ‘Cocktail’
to Protect Your Vision

Breakthrough study of age-related macular degeneration demonstrates the
benefits of combined acetyl-L-carnitine, omega-3 fatty acids, and coenzyme Q10
By Will Block

f you’ve never seen the Taj Mahal, you still have that to look forward to, along with many other wonderful experiences that life has to offer. Having now seen the rather unusual picture of it on this page, however, you can perhaps appreciate all the more what it means to actually see the Taj Mahal, or anything else. Just imagine what life would be like if everything looked like that picture.

Age-Related Macular Degeneration Destroys Central Vision

In the developed world, the most common cause of irreversible central vision loss in people over 55 is age-related macular degeneration (AMD), a disease that almost never occurs in young people. AMD is a slowly progressing neurodegenerative disease for which there are few treatment options and no cure. Its cause is unknown, but it occurs more commonly in white people, in people with a family history of it, in past or present smokers, and in people with a low dietary intake of antioxidants. It also appears to be more common in women, in people with fair skin, and in people with light-colored eyes.

Two parts of the name are obvious, but what does macular mean? In anatomy, a macula is any small, flat, circumscribed area that is perceptibly different in color from the surrounding tissue. There are different kinds of maculae, but the one we’re interested in is the macula lutea, or macula of the retina. It’s a small, yellowish, oval area on the retina, located at the central point of curvature at the back of the eye, where most of the light rays coming through the lens are focused.*


*Don’t confuse the macula with the optic disk, a few millimeters away. That’s the so-called blind spot, where all the individual nerve endings from across the retina converge to form the optic nerve that goes to your brain.


The macula is responsible for our central vision, upon which we rely for observing most things in our daily lives. At its center is a pinpoint depression called the fovea centralis, responsible for our most acute vision, which we need for discerning fine details of anything, such as the letters in the words you’re reading right now.

When Dry Is Better than Wet

Imagine a worst-case scenario in which your maculae, and with them your foveae, are essentially gone. You can no longer read or watch TV or drive a nail (let alone a car) or do many other things you once took for granted. You probably still have some blurry peripheral vision, though, so although you’re now legally blind, you’re not totally blind (the latter is possible, but rare, with AMD). Your quality of life, however, has taken an enormous hit.


Statistically significant improvements
were evident in all three measures of
visual function, and the fundus
photographs revealed a significant
shrinkage of the drusen.


AMD occurs in two forms: wet and dry. The wet form (the worst-case scenario) is called that because it entails the leakage of fluid or blood from newly formed, invasive blood vessels that develop beneath the macula. This condition develops rapidly (within days or weeks) and is highly destructive: although it accounts for only 10% of all cases of AMD, it’s responsible for 90% of the cases of legal blindness. The other form of AMD is called dry simply because it’s not wet. This form entails a thinning of the retina with the formation of small lesions under and around the macula, known as drusen. It develops slowly over a period of years, accounts for 90% of all cases, and is less destructive of vision than the wet form (but it’s bad enough).

Oxidative Damage Is Implicated . . .

Did you notice that one of the risk factors for AMD was a diet low in antioxidants? Since that’s the only risk factor, aside from smoking, that you can do anything about, your course of action is obvious. But which antioxidants are best? As always, the answer is that a broad spectrum of antioxidants—a multiantioxidant formulation—is best, because no condition is so simple that just one agent will suffice. That said, however, there are two antioxidants that are particularly valuable for maintaining healthy vision: the plant carotenoids lutein and zeaxanthin, which are found in many fruits and vegetables. These two compounds are the principal pigments in the macula, which owes its yellow color to them.*


*Regarding the value of supplemental lutein and zeaxanthin in helping to prevent AMD—and cataracts as well—see “Carotenoids Can Help Maintain Healthy Eyes” and “Protect and Improve Your Vision with Carotenoids” in the November 2002 and March 2003 issues, respectively.


. . . But So Is Mitochondrial Dysfunction

Although the prevailing wisdom has been that oxidative damage from free radicals plays a central role in the development of AMD, there is growing evidence that the disease may also have its roots in dysfunction of the mitochondria, the tiny cellular organelles that serve as “powerhouses” for the generation of chemical energy from our food. This would not be surprising, because mitochondria, being the principal source of free radicals in our bodies, are also the principal target for their destructive actions.

To the extent that mitochondria are damaged by free radicals (or anything else), their various physiological functions will suffer, and so will we. Some scientists believe that AMD may be one manifestation of this problem. If that’s true, it suggests that another avenue of attack on AMD, besides antioxidants, may be via compounds that are known to enhance mitochondrial function. Such compounds have been dubbed “mitochondriotropic,” or mitotropic for short.1

Preliminary Study Shows Promise


The fundus of the human eye. Left: normal retina; the macula (with the reddish fovea at its center) is slightly left of center, and the optic disk is right of center. Right: the dry form of AMD, with drusen under the macula.
In the October 2004 issue of Life Enhancement, we published an article ( “Can Acetyl L-Carnitine and Lipoic Acid Slow the Aging Process?”) that discussed the oxidative and mitochondrial mechanisms of aging, which are probably linked. The article included a sidebar, “A Recipe for Better Vision,” that outlined the results of an Italian study on AMD, using a mixture of four mitotropic nutrients—acetyl-L-carnitine, omega-3 fatty acids, coenzyme Q10, and vitamin E.1

Compared with a control group receiving only vitamin E, the treatment group of 14 patients with early AMD (of the dry form) showed some improvement in visual functions, which persisted for the 2-year duration of the study. The researchers acknowledged, however, that at no time during this period were the improvements statistically significant. They commented on the need for a randomized, double-blind, placebo-controlled clinical trial with a larger group of patients so as to overcome the serious limitations of their preliminary study.

Follow-Up Study Gets Serious

It didn’t take long before the same Italian research group (now with collaborators in Hungary) published just such a study.2 This time they used a formulation consisting of three nutrients: each capsule contained 100 mg of acetyl-L-carnitine, 530 mg of omega-3 fatty acids, and 10 mg of coenzyme Q10 (vitamin E was not included). The researchers enrolled 106 male and female Caucasian patients, aged 55–70, who had early-stage AMD (of the dry form) in both eyes.

Three Powerhouse Nutrients

The common denominator among the three nutrients used in the study described in the accompanying article is their enhancement of mitochondrial function; hence the designation mitotropic for these substances. In addition to their apparent synergistic effect in helping to alleviate age-related macular degeneration (AMD), they offer numerous other health benefits. Let’s have a quick look at each one.

Acetyl-L-carnitine (ALC) is a nutrient that is converted, in our cells, to acetyl groups and L-carnitine molecules. Carnitine cannot easily enter our cells from the bloodstream—hence the use of ALC, which can enter easily, as a source of this compound. Carnitine is itself a delivery vehicle of great importance: it facilitates the transport of fatty acid molecules into the cells’ mitochondria, where they’re oxidized to produce chemical energy, and it facilitates the transport of fatty acids and their metabolites back out if they accumulate to excess.

Thus, by raising intracellular levels of carnitine, whose natural levels decline with age, ALC acts to boost energy metabolism. ALC has been shown to improve cognitive function in people with mild cognitive impairment or early Alzheimer’s disease, perhaps owing to improved energy metabolism in the brain. Its neuroprotective effect is also evident in diabetes, where there is evidence that it helps to inhibit various peripheral neuropathies. Contrary to some claims, ALC is not an antioxidant.

Omega-3 fatty acids, popularly known as omega-3 fish oils or just fish oils, are found mainly in coldwater fish. They’re a special type of polyunsaturated fatty acids (PUFAs), which are known for their beneficial effects on our health. The omega-3 acids—most notably DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid)—are especially valuable in this regard, in part because they’re important structural components of the lipid bilayer that constitutes our cell membranes. The brain, retina, and other neural tissues are particularly rich in these compounds, which are critical for their proper function.

The omega-3s help protect against various aspects of cardiovascular disease, mainly heart attack, arrhythmias, angina pectoris, stroke, and death. One factor in this protective action, probably, is their strong effect in reducing the levels of triglycerides (fats) in our blood. The omega-3s also provide protective effects against other diseases, including dementia, the metabolic syndrome, and perhaps cancer. Furthermore, they reduce all-cause mortality, i.e., the overall death rate from all causes.

Coenzyme Q10 (CoQ10) is one of the body’s most important antioxidants: it’s a key player in the so-called antioxidant network, in which five antioxidants act synergistically to maintain and enhance each other’s levels of activity (the other four are lipoic acid, vitamin C, vitamin E, and glutathione*). That role of CoQ10, however, is secondary to its principal function as a vital factor in cellular energy metabolism. It can be thought of as a molecular “spark plug” for the Krebs cycle, the series of energy-generating chemical reactions that occur in our cells’ mitochondria.


*Glutathione, the body’s most important antioxidant, is a tripeptide made from glycine, cysteine, and glutamic acid; it can’t be taken as a supplement because it’s destroyed by digestive juices.


CoQ10 is particularly abundant in the mitochondria of the hardest-working tissues of the body, notably the heart, brain, kidneys, and liver. Unfortunately, however, its levels decline markedly as we age. It is widely prescribed in Europe and Japan for patients with cardiovascular disease, especially congestive heart failure. There is also evidence showing that CoQ10 is helpful in treating isolated systolic hypertension, a type of high blood pressure that is common in the elderly.

For 12 months, the patients received two capsules per day of either the three-nutrient formulation or a placebo. Every 3 months, the researchers assessed their condition by means of visual function tests called visual field mean defect, visual acuity, and foveal sensitivity. In addition, they used an ophthalmoscope to photograph the fundus of each eye, i.e., the deepest portion of the retina, surrounding the macula. The objective here was to monitor the progress of the drusen.

A Medical First, from Three Nutrients

By the end of the 12-month period, statistically significant improvements were evident in all three measures of visual function compared with placebo, and the fundus photographs revealed a significant shrinkage of the drusen. In the group treated with the three-nutrient formulation, the drusen-covered area decreased by 15% in the more affected eye and by 23% in the less affected eye, while in the control group, these figures increased by 11% and 13%, respectively. The authors stated (the italics are theirs),

To our knowledge, this is the first clinical study that demonstrated a treatment-related improvement of visual functions in early AMD. … the results of this clinical trial suggest that treatment of early AMD with a combination of acetyl-L-carnitine, omega-3 fatty acids, and coenzyme Q10 may improve both visual functions and fundus alterations …

They went on to state that their findings, taken together with those from other studies pertaining to AMD, indicate that the beneficial effects of this “cocktail” of mitotropic nutrients are due to its improvement of mitochondrial function and its restoration of certain metabolic processes occurring in the retina. They emphasized the importance of early detection and early treatment of the disease—which is, of course, good advice with regard to any disease.

Be Thankful, and Prudent

The fact that you’re reading these words is a blessing—not because the words are such pearls of wisdom, but because it means you can see. Although that puts you in the vast majority of people, it’s wise to bear in mind that making the transition to the minority isn’t hard, and the process can sneak up on you while you’re, uh, not looking. So look around you, and think about it. And may you one day see the Taj Mahal in all its glory.

References

  1. Feher J, Papale A, Mannino G, Gualdi L, Balacco Gabrieli C. Mitotropic compounds for the treatment of age-related macular degeneration. Ophthalmologica 2003;217:351-7.
  2. Feher J, Kovacs B, Kovacs I, Schvöller M, Papale A, Balacco Gabrieli C. Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica 2005;219:154-66.

ALC vs. AGEs

A characteristic feature of some types of aging tissues, including the lenses of our eyes, is the presence of advanced glycation end products, or AGEs. These large molecular complexes are the result of unwanted chemical reactions between sugars, especially glucose, and various proteins, such as the crystallins in our lenses. AGEs foul up the cellular machinery of life. Their accelerated formation is characteristic of diabetes, a disease in which blood glucose levels are chronically high.

It’s no coincidence, therefore, that cataracts, which can be caused by the excessive formation of AGEs, are common in diabetics. Indeed, aging and diabetes are the two principal causes of cataracts. Because the amino acid carnitine and some of its derivatives are known to have beneficial effects on some aspects of diabetes, researchers in Georgia undertook a study of the effects of carnitine and acetyl-L-carnitine (ALC) on the glycation of lens crystallins.1 They also tested acetylsalicylic acid (aspirin), which had previously been shown to inhibit glycation and cataract formation in rats.

Using solutions of crystallins extracted from the lenses of slaughtered calves, the researchers measured the ability of the three chemical compounds to prevent glycation caused by exposure to glucose. In their experiments, carnitine had no preventive effect, but ALC and aspirin reduced the glycation by 42% and 63%, respectively. This was the first demonstration of the ability of ALC to protect lens crystallins from glycation and the damage caused by AGEs.

Reference

  1. Swamy-Mruthinti S, Carter AL. Acetyl-L-carnitine decreases glycation of lens proteins: in vitro studies. Exp Eye Res 1999;69:109-15.

Acetyl L-Carnitine, Omega-3 Fish Oils, and Coenzyme Q10 for Good Vision

For those who wish to preserve and protect their precious vision, a trio of ingredients, acting together, have been found in scientific studies to help maintain proper metabolic function in the eyes: Acetyl L-Carnitine, Omega-3 Fish Oils, and Coenzyme Q10. Each of these ingredients offers, in addition, a variety of other well-documented health benefits.

The recommended amounts of Acetyl L-Carnitine are 500 to 3000 mg/day, or as recommended by your healthcare professional.

The recommended serving of Omega-3 FIsh Oils is 300–600 mg EPA/DHA taken 3 times daily with meals, and optionally the same amount at bedtime, for a total of 900 to 2,400 EPA/DHA daily. The maximum amount is roughly equivalent to the total amount of omega-3 fatty acids in one serving (6 oz) of wild Chinook salmon.

The recommended amounts of Coenzyme Q10 are 90 to 300 mg daily, or less if in microencapsulated form, or as recommended by your healthcare professional.


Will Block is the publisher and editorial director of Life Enhancement magazine.

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