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Nutrition for Diabetic Retinopathy

diabetic retinopathy nutrition - fruits and vegetablesDid you know that proper nutrition and exercise can help prevent diabetic retinopathy?1  Diabetic retinopathy (DR) is a potentially blinding complication of diabetes that damages the eye’s retina; it is a leading cause of vision loss in the world. About 10% of Americans have diabetes. One in three people with diabetes has symptoms of diabetic retinopathy. Of these, a further one-third have vision-threatening DR, including diabetic macular edema. And yet, the condition can potentially be preventable.

If You Are Diabetic

If you are diabetic, it is essential that you pay attention to lifestyle and nutrition to reduce the risk of developing diabetic retinopathy. Exercising, not smoking, eating a healthy diet with varied vegetables and fruits, getting enough sleep, and managing stress are all ingredients in a healthy vision recipe. Learn more about the Mediterranean Diet.

Diabetic Retinopathy Symptoms

Americans generally lack basic knowledge about the symptoms of diabetic retinopathy. A 2020 survey found less than half of patients knew that blurry central vision is a symptom. Only about a third of surveyed patients knew that spots or floaters can also be a symptom.

It is possible to have diabetic retinopathy for a long time before you realize it. The symptoms can be difficult to detect. In many cases, diabetic patients do not notice the symptoms of Diabetic Retinopathy until the retina has been quite damaged and their sight has been compromised.

Symptoms of diabetic retinopathy and its complications may include:

      • Blurry or distorted vision caused by high glucose levels
      • Difficulty reading and other close work
      • Eye pain
      • Impaired color vision
      • Increased number of eye floaters
      • Partial, fluctuating, or total vision loss or what feels like a permanent shadow cast across your field of vision
      • Reactive hypoglycemia (low blood sugar, or insulin resistance), is a symptom of pre-diabetes.

Risk Factors

      • Disease duration: the longer you have diabetes, the greater the risk of developing diabetic retinopathy
      • Poor control of blood sugar levels over time
      • Reactive hypoglycemia, when blood sugar levels spike too high after people regularly consume sugars and refined carbohydrates. Examples of these foods are sweetened beverages, bread, pasta, rice, and white potatoes.
      • Hypertension (high blood pressure)
      • Kidney disease
      • High cholesterol levels
      • Pregnancy

Doctors and scientists consider Diabetic Retinopathy to be a microvascular disorder, caused primarily by the deterioration of tiny capillaries in the retina. However, in recent years, some scientists have also recognized DR as a neurodegenerative condition.2 Diabetics should get a comprehensive dilated eye exam at least once a year. With timely treatment, many people with advanced diabetic retinopathy can be saved from going blind.

Good Nutrition Reduces Risk of Diabetic Retinopathy

Nutrition can have a profound impact on diabetic outcomes, including retinopathy.

Vitamins

Vitamins C, D, E. In a cross-sectional study and meta-analysis of 517 diabetics (25.17% had DR) low levels of circulating vitamins C, D, and E were found in the diabetic retinopathy patients compared to those without DR.3 4 Even though vitamin A is commonly held to be essential for diabetic retinopathy, this study found no association between low vitamin A and DR.5  Only high levels of vitamin C were linked to lower incidence of DR.6

B Vitamins, C, and E. In a clinical trial, 185 Type 2 diabetics were given supplementary nutrition – B vitamins, C, and E – along with their diabetic medications. They demonstrated slower rates of diabetic retinopathy development compared to patients given only the medication.7

B vitamins. Low B6 levels are linked to high homocysteine levels. High homocysteine is linked to glaucoma, diabetic retinopathy, and optic neuropathy, as well as cardiovascular and brain functioning problems. Because this condition is a complication of diabetes, the fact that B6 levels are decreased in diabetic patients makes it of interest in diabetic retinopathy.8

Vitamin B7 (biotin) supports the synthesis of fatty acids. B7 is an important part of the metabolism of glucose, decreasing insulin resistance. Therefore, it may be helpful for diabetes complications.9 It is noted that B7 levels are low in diabetics, but the mechanics are unclear.

Vitamin B9 (folate) and folic acid levels are linked to DR. The severity is associated with lower folic acid and red cell folate levels. A significant difference was observed between diabetic retinopathy patients who also have abnormal blood vessel growth (proliferative).10

Vitamin B12 deficiency could be a risk factor for DR.11 A meta-analysis of nutrition studies that considered ethnicity found a link between low vitamin B12 levels and DR risk in East Asian, South Asian and mixed populations, but not in Caucasian populations.12

Along with folic acid and B6, B12 is responsible for converting homocysteine to cysteine. Low levels of B12 are linked to high levels of homocysteine. High homocysteine levels are associated with diabetic retinopathy.

Vitamin D deficiency is seen in patients with diabetic retinopathy.13 Although the deficiency may be mild, vitamin D plays an important role through its effects on the immune system, and by reducing abnormal blood vessel growth in the retina.14

Lutein is more than merely a filter for the sun’s UV radiation. It modulates immune responses as well as inflammation, including inflammation in the eye, such as that manifested in diabetic retinopathy.

Along with zeaxanthin and other important carotenoids, lutein plays a central role in protecting the retina against oxidative stress, inflammation, and neurodegenerative damage.15

Bilberry

Bilberry increases macular thickness in both DR and macular degeneration.16 improves light sensitivity,17 This fruit also slows blood-retinal barrier disintegration.18

Researchers report that berry extracts and anthocyanins inhibit enzymes that convert starch to sugars (alpha-amylase and alpha-glucosidase) in the gut. Ultimately, this slows the rate of glucose entering the bloodstream. For this reason, they are important in helping to manage diabetes and diabetic retinopathy by using nutrition.19 20

Resveratrol

Resveratrol, a potent antioxidant, has significant impact against inflammatory disorders such as diabetes21 with good potential in the management of type 2 diabetes. This antioxidant has the ability to improve blood sugar balance and lower insulin resistance in diabetes.22 Via multiple molecular pathways resveratrol tends to reduce microvascular and other deformities in the retina.23

Glutathione

Glutathione (GSH) is one of the super antioxidants that neutralizes the full range of free radicals. In healthy people, GSH is the most abundant antioxidant in the cell. Patients with uncontrolled type 2 diabetes are unable to adequately synthesize glutathione because of a lack of natural precursors in the body.24 Supplementing with amino acids (cysteine, glutamate, and glycine), which are GSH precursors, supports GSH synthesis and reduces oxidative damage and inflammation.25 Glutathione is best taken in reduced form as it is not otherwise easily absorbable.

Curcumin

Curcumin’s anti-inflammatory effects make it a possible therapeutic agent for diabetic retinopathy. 26 Curcumin slows blood vessel leakage by inhibiting CAMKII, a biochemical process.27 Curcumin also slows the death of the islet cells that produce insulin in diabetics by retarding the creation of islet free radicals.28

Rutin

Rutin may reduce levels of fasting glucose and thus may protect against high levels of blood sugar.29 In this capacity, it may prove valuable in preventing the development of diabetes into diabetic retinopathy.

Alpha lipoic acid

Alpha-lipoic acid is known as a “universal” antioxidant because it helps regenerate levels of vitamin E, C, CoQ10 and glutathione in the body. It is an important antioxidant as a therapeutic agent in diabetes and diabetes complications.30

Other nutrients

A 2020 review of the literature discusses the research on various vitamins, minerals, and nutraceuticals to supplement conventional medications against diabetes complications such as diabetic retinopathy.  The paper identifies lutein, zeaxanthin, vitamin C, vitamin D, vitamin E, zinc, copper, alpha-lipoic acid, n-acetylcysteine, complexes of B1, B2, B6, L-methylfolate, and methyl-B12 as being particularly useful.31

Lifestyle

Diabetic nutrition and diet. Maintain normal blood sugar levels by eating a diabetic diet that is high in nutrition, and low in sugar and refined carbohydrates. Avoid all fried foods and keep fast foods down to a minimum. Eat lots of green leafy vegetables and colored fruits, especially berries.

Avoid sugar and refined carbohydrates

Sweeteners of all kinds contribute to inflammation. Sugar is one of the most acidic foods, and excess sugar in one’s diet is considered a leading contributor to disease, such as type 2 diabetes, cardiovascular disease, high blood pressure (hypertension), dementia, and cancer. Numerous research studies have linked a number of these health conditions to eye diseases, such as cataracts, glaucoma, and diabetic retinopathy.32

Do not eat fried foods

Fried foods provide almost no nutritional value and present digestive challenges. This is especially true of foods containing trans-fatty acids, which can also cause diarrhea. Fried foods and foods containing trans-fatty acids substantially increase free radicals in the body that cause the breakdown of healthy cells.

Excess intake of fried foods is tied to increased risk of diabetes and heart disease. One study found that people who ate fried food at least once per week had a greater risk of type 2 diabetes and heart disease, and the risk increased as the frequency of fried food consumption increased. On a per-calorie basis, trans fats appear to increase the risk of chronic heart disease more than any other micronutrient. In one study, the participants who ate fried foods 4–6 times per week had a 39% increased risk of type 2 diabetes, and those who ate fried foods seven or more times per week had a 55% increased risk.33

The Vision Diet is a healthy diet for both the eyes and body consisting mainly of plant-based foods. Non-vegetarians would add small portions of organic animal products, such as free-range, grass-fed meats. A healthy diet should be combined with exercise, and maintenance of proper weight. This lifestyle reduces the incidence of a range of health conditions, including chronic diseases, heart disease,34 type II diabetes,35 cancer, obesity, and osteoporosis.36

Healthy gut microbiota. Researchers are beginning to understand the role of gut bacteria in prevention, development, and treatment of diseases. We know that diabetes and its complications are characterized by chronic inflammation in the body. Therefore, many studies focus on the anti-inflammatory effects of certain bacteria such as Faecalibacterium in patients with diabetic nephropathy, diabetic neuropathy, cerebrovascular disease, or coronary artery disease.37

Best Juice Recipe for Diabetic Retinopathy

Prepare fresh juice using a juicer. Include a selection from this list of ingredients: asparagus, beets, cabbage, carrots, celery, chlorophyll, garlic, ginger, Jerusalem artichokes, leeks, parsley, pumpkin, raspberries, and spinach. Do not add too much sweet fruit, due to its high sugar content.

Exercise

Regular exercise is known to be effective in combating insulin resistance.38 While aerobic exercise is very helpful, resistance exercise (with weight or force) is even better.39 At the very least, try to have a 30-60 minute brisk daily walk.

Control Blood Sugar

Take medication as needed to manage blood sugar levels.

Suggested Supplements

Viteyes Optic Nerve Support Formula – 90 tablets – good combination of nutrients for retinal and overall body support. Contains antioxidants to help neutralize free radicals. This formula is included in the packages below.

Glycemic Guard™ – included in packages below.

Resveratrol (Trans) w/Quercetin 60 vegcaps – included in packages below.

ACG Glutathione EXTRA STRENGTH Spray 2oz. This is a readily-absorbable reduced form of glutathione.

Advanced Eye & Vision Support Formula (whole food) 60 vcaps – our eye foundation formula for overall vision support. This formula is a whole food, organic, GMO free formula.

Advanced Eye & Vision Support + Revision Formula – The package includes Revision, which is a wild-crafted herbal tincture that innervates the Liver Meridian. In Traditional Chinese Medicine, the liver meridian promotes healthy energy flow and circulation in the eyes and body overall. Thus, it is the main meridian supporting healthy vision.

Microcurrent Stimulation supports nourishment and healing to the back of the eyes.

Optase Allegro (allergy) Dry Eyedrops. A fast-acting, preservative- and drug-free eyedrop that provides a first line of defense against allergy-related dry eyes.

Any of the products in the packages below can be ordered separately as well.

Sugar Balance & Blood Vessel Support Package 1

Sugar Balance & Blood Vessel Support Package 2

Footnotes

  1. Bryl A, Mrugacz M, Falkowski M, Zorena K. (2022). The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy-A Review of the Literature. Nutrients. Mar 16;14(6):1252. ↩
  2. Ren X, Lu H, Wang N, Zhang C, Ji Y, et al. (2017). Thioredoxin is implicated in the anti apoptotic effects of grapeseed proanthocyanidin extract during hyperglycemia. Mol Med Rep. Nov;16(5):7731-7737. ↩
  3. Xiong R, Yuan Y, Zhu Z, Wu Y, Ha J, et al. (2022). Micronutrients and Diabetic Retinopathy: Evidence From The National Health and Nutrition Examination Survey and a Meta-analysis. Am J Ophthalmol. Jun;238:141-156. ↩
  4. Valdés-Ramos R, Guadarrama-López AL, Martínez-Carrillo BE, Benítez-Arciniega AD. (2015). Vitamins and type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2015;15(1):54-63. ↩
  5. Ibid. Xiong. (2022). ↩
  6. Ibid. Xiong. (2022). ↩
  7. Pramanik S, Banerjee K, Mondal LK. (2022). The Amelioration of Detrimental Biochemical Anomalies by Supplementing B, C, and E Vitamins in Subjects with Type 2 Diabetes Mellitus May Reduce the Rate of Development of Diabetic Retinopathy. J Diabetes Res. Sep 1;2022:3886710. ↩
  8. Ibid. Valdes-Ramos. (2015). ↩
  9. Shi C, Wang P, Airen S, Brown C, Liu Z, Townsend JH, Wang J, Jiang H. Nutritional and medical food therapies for diabetic retinopathy. Eye Vis (Lond). 2020 Jun 18;7:33. ↩
  10. Malaguarnera G, Gagliano C, Salomone S, Giordano M, Bucolo C, et al. (2015). Folate status in type 2 diabetic patients with and without retinopathy. Clin Ophthalmol. Aug 7;9:1437-42. ↩
  11. Satyanarayana A, Balakrishna N, Pitla S, Reddy PY, Mudili S, et al. (2011). Status of B-vitamins and homocysteine in diabetic retinopathy: association with vitamin-B12 deficiency and hyperhomocysteinemia. PLoS One. 2011;6(11):e26747. ↩
  12. Yang X, Hu R, Zhu Y, Wang Z, Hou Y, et al. (2023). Meta-analysis of Serum Vitamin B12 Levels and Diabetic Retinopathy in Type 2 Diabetes. Arch Med Res. Jan;54(1):64-73. ↩
  13. Afarid M, Ghattavi N, Johari M. (2020). Serum Levels of Vitamin D in Diabetic Patients With and Without Retinopathy. J Ophthalmic Vis Res. Apr 6;15(2):172-177. ↩
  14. Totolici G, Tiutiuca C, Jurja S, Tutunaru D, Pătrașcu AM. ( 2022). The role of vitamin D in the onset and progression of diabetic retinopathy. Rom J Ophthalmol. Jul-Sep;66(3):214-218. ↩
  15.  Neelam K, Goenadi CJ, Lun K, Yip CC, Au Eong KG. (2017). Putative protective role of lutein and zeaxanthin in diabetic retinopathy. Br J Ophthalmol. May;101(5):551-558. ↩
  16. Moshetova LK, Vorob’eva IV, Alekseev IB, Mikhaleva LG. (2015) Results of the use of antioxidant anangio-protective agents in type 2 diabetes patients with diabetic retinopathy and age-related macular degeneration. Vestn Oftalmol. May-Jun;131(3):34-44. ↩
  17. Ibid. Moshetova. (2015). ↩
  18. Kim J, Kim CS, Lee YM, Sohn E, Jo K, et al. (2015). Vaccinium myrtillus extract prevents or delays the onset of diabetes–induced blood-retinal barrier breakdown. Int J Food Sci Nutr. Mar;66(2):236-42. ↩
  19. Castro-Acosta ML, Lenihan-Geels GN, Corpe CP, Hall WL. (2016). Berries and anthocyanins: promising functional food ingredients with postprandial glycaemia-lowering effects. Proc Nutr Soc. Aug;75(3):342-55. ↩
  20. Vorob’eva IV, Vorob’eva IV. (2015). Current data on the role of anthocyanosides and flavonoids in the treatment of eye diseases. Vestn Oftalmol. 2015 Sep-Oct;131(5):104-110. Russian. ↩
  21. Ahmad I, Hoda M. (2020). Attenuation of diabetic retinopathy and neuropathy by resveratrol: Review on its molecular mechanisms of action. Life Sci. Mar 15;245:117350. ↩
  22. Zhu X, Wu C, Qiu S, Yuan X, Li L. (2017). Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis. Nutr Metab (Lond). Sep 22;14:60. ↩
  23. Ibid. Ahmad. (2020). ↩
  24. Kwong-Han K, Zunaina E, Hanizasurana H, Che-Badariah AA, Che-Maraina CH. (2022). Comparison of catalase, glutathione peroxidase and malondialdehyde levels in tears among diabetic patients with and without diabetic retinopathy. J Diabetes Metab Disord. Mar 19;21(1):681-688. ↩
  25. Sekhar RV, McKay SV, Patel SG, Guthikonda AP Reddy VT, et al. (2011). Glutathione Synthesis Is Diminished in Patients With Uncontrolled Diabetes and Restored by Dietary Supplementation With Cysteine and Glycine. Diabetes Care. Jan; 34(1):162–167. ↩
  26. Yang J, Miao X, Yang FJ, Cao JF, Liu X. (2021). Therapeutic potential of curcumin in diabetic retinopathy (Review). Int J Mol Med. May;47(5):75. ↩
  27. Li J, Wang P, Ying J, Chen Z, Yu S. (2016). Curcumin Attenuates Retinal Vascular Leakage by Inhibiting Calcium/Calmodulin-Dependent Protein Kinase II Activity in Streptozotocin-Induced Diabetes. Cell Physiol Biochem. 2016;39(3):1196-208. ↩
  28. Meghana, K., Sanjeev, G., Ramesh, B. (2007). Curcumin prevents streptozotocin-induced islet damage by scavenging free radicals: a prophylactic and protective role. Eur J Pharmacol. Dec 22;577(1-3):183-91. ↩
  29. Ghorbani, A. (2017) Mechanisms of antidiabetic effects of flavonoid rutin. Biomed Pharmacother. Oct 7;96:305-312. ↩
  30. Jeffrey S, Samraj PI, Raj BS. (2021). The Role of Alpha-lipoic Acid Supplementation in the Prevention of Diabetes Complications: A Comprehensive Review of Clinical Trials. Curr Diabetes Rev. 2021;17(9):e011821190404. ↩
  31. Shi C, Wang P, Airen S, Brown C, Liu Z, et al. (2020). Nutritional and medical food therapies for diabetic retinopathy. Eye Vis (Lond). Jun 18;7:33. ↩
  32. Bryl A, Mrugacz M, Falkowski M, Zorena K. The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy-A Review of the Literature. Nutrients. 2022 Mar 16;14(6):1252. ↩
  33. Dow C, Mancini F, Rajaobelina K, Boutron-Ruault MC, Balkau B, et al. (2018). Diet and risk of diabetic retinopathy: a systematic review. Eur J Epidemiol. Feb;33(2):141-156. ↩
  34. Trautwein EA, McKay S. (2020). The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients. Sep 1;12(9):2671. ↩
  35. McMacken M, Shah S. (2017). A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. May;14(5):342-354. ↩
  36. Craig WJ, Mangels AR, Fresán U, Marsh K, Miles FL, et al. (2021). The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients. Nov 19;13(11):4144. ↩
  37. Iatcu CO, Steen A, Covasa M. (2021). Gut Microbiota and Complications of Type-2 Diabetes. Nutrients. Dec 30;14(1):166. ↩
  38. Sampath Kumar A, Maiya AG, Shastry BA, Vaishali K, Ravishankar N, et al. (2019). Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Ann Phys Rehabil Med. Mar;62(2):98-103. ↩
  39. Reddy R, Wittenberg A, Castle JR, El Youssef J, Winters-Stone K, Gillingham M, Jacobs PG. Effect of Aerobic and Resistance Exercise on Glycemic Control in Adults With Type 1 Diabetes. Can J Diabetes. 2019 Aug;43(6):406-414.e1. ↩