Vision and Eye Health
Cataracts, Glaucoma, Myopia, Macular Degeneration, Floaters, Night Blindness and More
This article will cover eye health and vision issues. Topics discussed include cataracts, myopia, retinitis pigmentosa, night blindness, glaucoma, macular degeneration and more.
Cataracts
Among the factors that probably have a role in preventing cataracts: Thyroid, progesterone, pregnenolone, vitamin E, iodide, pyruvate. Increasing the carbon dioxide lowers the cell’s pH, and tends to resist swelling. Palmitic acid (a saturated fat that can be synthesized by our tissues) is normally oxidized by the lens. Calcium blockers experimentally prevent cataracts, suggesting that magnesium and thyroid (which also act to exclude calcium from cells) would have the same effect. -Ray Peat, PD
A “cataract” is thought to be the clouding of the eye lens, which is supposed to be clear. This clouding can lead to issues such as blurred or dim vision, night vision issues, sensitivity to light and so on.
Derived from Ancient Greek καταρράκτης meaning something like down rushing. Kata (cata) means down, just like how catastrophe literally means “downturn” in Greek.
According to Ray Peat, PhD exposure to excessive cortisol could lead to cataracts. Furthermore, he explained that chronic hypoglycemia could also contribute to this issue and that improving glucose metabolism would be essential for eye lens health. Furthermore, excessive exposure to UV light, excess estrogen, serotonin, acetylcholine and nitric oxide all seem to contribute to cataracts.
Also, uric acid, which at normal levels is a potent antioxidant, is thought to be protective against cataracts. Molybdenum is a nutrient, found in foods such as legumes, liver and oats, that is important for the normal production of uric acid. So if someone has cataracts and is low in uric acid, increasing their consumption of molybdenum could likely be helpful. Other than food sources, molybdenum supplements are available.
“Uric acid, which inhibits nitric oxide formation, is reduced in people with cataracts. The factors that prevent or promote other degenerative diseases are similarly protective or harmful for the lens.”
-Ray Peat, PhD
There is some indication that excessive acetylcholine in the lens can lead to cataracts. One cause of excessive acetylcholine could be the reduction of the enzyme needed to get rid of acetylcholine, which is cholinesterase. So, things that inhibit cholinesterase can lead to cataracts by causing an excess of acetylcholine. Pesticides can drastically increase acetylcholine levels. People living by farms, golf courses or other places that use a lot of pesticides may possibly be more at risk of cataracts because of this, and people who consume lots of produce treated with pesticides, herbicides and so on.
“The parasympathetic nerve transmitter acetylcholine is formed in the lens, as well as its receptor and the enzyme which destroys it, cholinesterase. Chemicals that inhibit cholinesterase, and drugs that mimic the action of acetylcholine on the receptor, cause cataracts. These drugs (Michon and Kinoshita, 1968; Harkonen and Tarkkanen, 1976) cause the lens to take up water, sodium, and calcium, and to lose potassium, and by increasing the cells' energy expenditure, they accelerate the consumption of glucose while blocking other metabolism. Since these are known effects of stimulation by acetylcholine, it's reasonable to assume that acetylcholine is involved in the natural formation of cataracts.” -Ray Peat, PhD
Increased nitric oxide (“NO”) can block cytochrome C oxidase, or complex IV of the electron transport chain which as a result would lead to impaired energy production. This impaired energy production can lead to cataracts. Methylene blue and red light are able to help counteract these negative effects of nitric oxide. Red light is naturally found in the early morning hours and the late evening hours, so essentially around sunrise and sunset. There are also many ways to create red light such as with the use of red light therapy panels and red light light bulbs.
“Red and orange wavelengths penetrate tissue very effectively, because of their weaker absorption by water, allowing them to react with pigments in the cell, such as cytochrome oxidase, which is activated (or re-activated) by red light, increasing the production of ATP. This effect counteracts the toxic effects of ultraviolet light, but there are probably other mechanisms involved in the many beneficial effects of red light.”
“Since the water in cataracts is in a less ordered state than in the transparent lens, the re-ordering effect of red light could be valuable, and if the effects are the same as in their experiments with cancer cells, the increased volume of the re-ordered water would cause a movement of water out of the cataract, as it does in cancer cells in their experiment. And the known restorative effect of red light on oxidative production of ATP would almost certainly be helpful.”
“Besides the direct excitatory effects of acetylcholine, the increase of intracellular calcium and decrease of magnesium (Agarwal, et al., 2012) caused by it promote the synthesis of nitric oxide (which, for example, blocks the function of cytochrome oxidase, reducing the production of ATP), and the interference with glucose metabolism in itself is cataractogenic (Greiner, et al., 1981).”
“Ultraviolet light powerfully stimulates the formation of nitric oxide (Chaudhry, et al., 1993), and is one of the known causes of cataracts. Since the cornea is more directly exposed than the lens to the ultraviolet rays of sunlight, the effects of injury can be seen more quickly. Exposure of the cornea to ultraviolet light causes swelling, reduced transparency, and the formation of nitric oxide, which enters the aqueous humor (Cejka, et al., 2012; Cejkova, et al., 2005). Swelling in itself, regardless of the cause, decreases the transparency of the cornea (Stevenson, et al., 1983); anything interfering with its energy metabolism causes swelling.”
“Among the popular medical treatments that are likely to contribute to the development of cataract are glucocorticoids, and drugs that increase serotonin (Dietze and Tilgner, 1973; Korsakova and Sergeeva, 2010), and drugs that increase nitric oxide. Free fatty acids are toxic to the lens, which contains the enzymes for synthesizing prostaglandins and related promoters of inflammation; the products of lipid peroxidation are increased in people with cataracts. Endotoxin from the intestine increases the formation of nitric oxide, so it's essential to minimize intestinal inflammation.”
-Ray Peat, PhD
Ray Peat, PhD often wrote about the various health-promoting effects of having adequate CO2 (carbon dioxide) levels in the body. One of the reasons that Ray Peat suggested that people eat carbohydrates (as opposed to being low-carb or keto) was that when we utilize (or oxidize) glucose/carbohydrates well, we produce more CO2 and retain more CO2. This is also a major reason why Ray consistently wrote about the importance of maintaining a good metabolism/metabolic rate via good thyroid function because active thyroid hormone (T3) is crucial for energy production and thus CO2 production, and adequate retention.
People who cannot oxidize glucose well and cannot create enough energy will be lower in CO2 as they produce less of it, and expel more of it. Find out how to utilize glucose well by reading the article I wrote on the topic. There are many ways to increase CO2 levels, and one supplement that can likely help would be thiamine (vitamin B1). When CO2 is low, lactic acid/lactate seems to rise, which in and of itself is harmful. If someone cannot utilize glucose well, their CO2 will drop and lactic acid will increase.
This discussion on CO2 is very relevant for cataracts, as Ray wrote about how increasing carbon dioxide levels can be a great way to combat the pathology. Another way to increase carbon dioxide levels is to simply live at a high altitude, and this is why Ray often wrote about how living at a high altitude could be very protective in general, and for cataracts prevention.
An assortment of quotes from Ray Peat PhD on the role of CO2, alltitude and cataracts.
Found from his two newsletters on the topic:
Cataracts: water, energy, light, and aging
The transparency of life: Cataracts as a model of age-related disease
“High altitude very strongly protects against cataracts (Brilliant, et al., 1983). Low oxygen tension itself protects the lens's clarity (Akoyev, et al., 2009), possibly by the protective effect of increased carbon dioxide against glycation of protein amino groups.”
“High altitude is inversely related to cataracts, despite the known role of sunlight in causing cataracts; this is a strong confirmation of the protective role of carbon dioxide.”
“The decrease of carbon dioxide that generally accompanies increased lactic acid, corresponds to increased intracellular pH. Carbon dioxide binds to many types of protein, for example by forming carbamino groups, changing the protein conformation, as well as its electrical properties, such as its isoelectric point. With increased pH, cell proteins become more strongly ionized, tending to separate, allowing water to enter the spaces, in the same way a gel swells in an alkaline solution.”
“The two biggest studies of altitude and cataracts (involving 12,217 patients in one study, and 30,565 lifelong residents in a national survey in Nepal) showed a negative correlation between altitude and the incidence of cataract. At high altitude, cataracts appeared at a later age. In Nepal, an increase of a few thousand feet in elevation decreased the incidence of cataracts by 2.7 times. At the same time, it was found that exposure to sunlight increased the incidence of cataracts, and since the intensity of ultraviolet radiation is increased with altitude, this makes the decreased incidence of cataracts even more important.”
“All of the typical causes of cataracts, aging, poisons, and radiation, decrease the formation of carbon dioxide, and tend to increase the formation of lactic acid. Lactic acid excess is typically found in eyes with cataracts.”
“Besides living at a high elevation or breathing extra carbon dioxide, the most certain way to increase the amount of carbon dioxide in the eye, and to prevent an excess of lactic acid, is to make sure that your thyroid function is adequate.”
“One man who took thyroid, USP, and vitamin E told me that his cataracts had regressed, but I haven’t known other people who tried this.”
“If a person already has distinct cataracts, it might be worthwhile to experiment with a relatively high degree of hypercapnia, for example, breathing a 5% mixture of CO2 in air.”
“Thyroid hormone is essential for maintaining adequate carbon dioxide production, for minimizing lactic acid, cortisol and prolactin, for regulating calcium and magnesium, for avoiding hypotonicity of the body fluids, and for improving the ratio of palmitic acid to linoleic acid.”
In addition to increasing the production and retention of carbon dioxide to combat the progression of cataracts, Ray Peat mentioned many other beneficial approaches. For example, he discussed how progesterone, caffeine/coffee and aspirin can all be very protective.
“Aspirin's known anticataract effect apparently involves a similar protection of crystallin against glycation, but aspirin has several other protective effects, including prevention of protein cross-linking, and the inhibition of the synthesis of nitric oxide and prostaglandins and other disruptive materials (Crabbe, 1998; Beachy, et al., 1987; Lonchampt, et al., 1983).”
“Progesterone's inhibition of nitric oxide production is probably protective for the lens, paralleling its effects in other organs. Inhibitors of nitric oxide, such as aminoguanidine, are protective. Anticholinergics, including atropine, inhibit over-hydration of the lens and prevent cataracts caused by excessive cholinergic stimulation (e.g., Kaufman, et al., 1977).”
“Caffeine, in animal experiments, prevents cataracts. Uric acid, which inhibits nitric oxide formation, is reduced in people with cataracts. The factors that prevent or promote other degenerative diseases are similarly protective or harmful for the lens.”
-Ray Peat, PhD
Excess levels of estrogen and prolactin seem to play a role in cataract formation. For example, when a woman cannot produce enough progesterone (this can be caused by many factors, such as a diet low in vitamin A, or a thyroid deficiency) then the estrogen levels can essentially go “unchecked” leading to an estrogen overload situation, which can potentially lead to complications such as cataracts. Furthermore, this excess unchecked estrogen can lead to an increase in prolactin, as estrogen increases prolactin production, and this increase in prolactin can also possibly increase the chance of developing cataracts.
Excessive serotonin is also thought to play a role in cataract formation. This means it may be a bad idea to try and “boost” serotonin levels with drugs, supplements and even some foods. For example, SSRI drugs are probably a bad idea for people who have cataracts or who are scared of developing them.
Estrogen, which tends to produce edema and hypotonic body fluids, also increases prolactin production. Prolactin is involved in water and electrolyte regulation, and it has been found to accelerate the development of experimental cataracts. (M. C. Ng, et al, 1987.) These hormones are associated with the calcification of soft tissues, and cataracts contain very high levels of calcium. (Avarachan and Rawal, 1987; Hightower and Reddy, 1982.)
Estrogen is strongly associated with free radical processes, calcium mobilization, and acetylcholine release, all of which are involved in the process of excitoxicity. Alvarez, et al., (1996) have shown a possible involvement of acetylcholine in calcium mobilization in the lens.
Serotonin is another regulatory substance strongly associated with prolactin and estrogen, and it also can be involved in disrupting the metabolism of the lens. This is one of the potential dangers in using supplemental tryptophan. (Candia, et al., 1980.)
-Ray Peat, PhD
Orthomolecular medicine doctors such as Dr. Abbram Hoffer, have written about how certain nutrients can be very helpful when it comes to treating cataracts. Some of these nutrients were vitamin C, taurine, zinc, histidine, riboflavin and selenium. These vitamins, minerals and amino acids all seem to be helpful for people trying to prevent, treat and even potentially reverse cataracts.
One reason for the selenium suggestion was that selenium is needed for glutathione reductase. Taurine was recommended due to its role in preserving retina health. Furthermore, taurine in combination with zinc has been shown to inhibit the development of cataracts, plus taurine deficiency accompanies retinitis pigmentosa. Histidine was suggested as diets missing histidine can produce cataracts in as little as three weeks based on experimental animal studies. Riboflavin is another nutrient that has been shown to be potentially helpful in combating cataracts, one possible reason is that riboflavin is very important for the production of FAD, which is crucial for optimal energy production.
“The Healing Nutrients Within” Third edition.
One quick note on Retinitis Pigmentosa, as it was mentioned above that taurine defeicnecy can lead to this condition, there was a study showign that Goji berries can help with this conditon. The study showed that after a year of supplemneting with goji berries, there was improvment in visual acuity and macular thinnning.
General Eye Health, Myopia, Macular Degeneration, Floaters
One quick general note on improving eyesight and the health of the eyes in general is to consume enough vitamin A. Remember, the active form of vitamin A is literally called “retinol” a word derived from “retina”! Vitamin A will be discussed in more detail in the night blindness section of this article.
The popular supplements melatonin, tryptophan, fish oils, St. John's wort, and the various omega -3 oils, all increase the risk of retinal light damage and macular degeneration. Serotonin uptake-inhibiting antidepressants are suspected to be able to cause it. -Ray Peat PhD
As will be discussed in some more detail shortly, light exposure can be very helpful for combating some conditions such as myopia. However, it seems that too much ultraviolet light can be detrimental to other conditions, such as cataracts and macular degeneration. Ray Peat wrote about how too much light exposure to the eyes could lead to issues, especially when combined with a diet high in polyunsaturated fats (PUFAs) such as canola oil, vegetable oil, sunflower oil and margarine. Furthermore, when one has too much melatonin and prolactin bright light is more likely to cause issues with the eyes. Furthermore, excess iron, or “iron overload” also makes blue light more dangerous to the eyes.
One helpful supplement one can utilize would be vitamin E. Vitamin E can help protect against the dangers of excess PUFAs and iron, among other things such as excessive prostaglandins and other eicosanoids that can harm the eyes. Since cytochrome C oxidase is so important for good vision, eating a diet rich in copper will most likely be very helpful, and getting enough red light exposure. Copper is rich in seafood, especially oysters and shrimp, it is high in animal livers such as beef liver, and there is a good amount of copper in mushrooms and chocolate.
“Degeneration of the retina is the main cause of blindness in old people. Retinal injury is caused by ordinary light, when the eyes are sensitized by melatonin, prolactin, and polyunsaturated fats. Bright light isn't harmful to the retina, even when it is continuous, if the retina isn't sensitized.”
“Processes similar to those that damage the over-sensitized retina can occur in other cells, as a result of stress. The substances that sensitize the retina to light-damage, can also increase the incidence of new or metastatic cancers.”
“Iron supplements and the use of supplemental oxygen, especially with a vitamin E deficiency exacerbated by excessive unsaturated fats in the diet, are still commonly used exactly when they can do the most damage.”
“Light and stress, especially with excess iron, damage the retina when the cells contain too much PUFA, since these fats react with light and free radicals. The nocturnal/stress hormones, especially prolactin and melatonin, make the retina more sensitive to light, and more easily damaged. (It's too much darkness that sets up the problem, since the eyes will adapt to excess light, but darkness increases their sensitivity.”
“Cytochrome oxidase is one of the enzymes damaged by stress and by blue light, and activated or restored by red light, thyroid, and progesterone. It's a copper enzyme, so it's likely to be damaged by excess iron. It is most active when it is associated with a mitochondrial lipid, cardiolipin, that contains saturated palmitic acid; the substitution of polyunsaturated fats lowers its activity. Mitochondrial function in general is poisoned by unsaturated fats, especially arachidonic acid and DHA.”
“Copper and magnesium deficiencies predispose to retinal damage. Red light is protective, blue light (or u.v.) is harmful, so wearing orange lenses would be helpful. Progesterone and pregnenolone, by reducing the stress reactions, should be helpful--in the eye diseases of infancy and old age, as they are in the respiratory distress syndromes.”
-Ray Peat PhD
Ray also mentioned how supplemental progesterone and pregnenolone could help with eye conditions by reducing stress reactions. These should also help by opposing excess estrogen and prolactin, both of which can worsen eye conditions. Furthermore, it seems like ocular progesterone administration can potentially be helpful for vision/eye conditions such as retinitis pigmentosa.
Myopia or “nearsightedness” is a vision condition where close objects look clear but objects far away appear blurry. There is some evidence showing that increasing one’s vitamin D levels could help with myopia. Furthermore, it seems that getting more sunlight exposure can also help prevent myopia. So, it seems like a good idea to get outside often in order to help prevent myopia, both for the light aspect and the increase in vitamin D that naturally follows light exposure.
Vitamin D deficiency may drive myopia, supplementing may prevent/treat it
Lack of light exposure may be the main cause of the myopia boom
Also, when it comes to myopia, I think it’s important that people look at far-off things, as opposed to only looking at very close-up things such as looking at a phone, computer or TV screen. Gazing at far-off clouds, mountain tops (if you’re lucky enough to live near mountains), and even looking at the tops of tall buildings occasionally can be helpful. The point is, that it’s important to look at things far away from time to time, instead of just looking at close-up things such as your phone, a book and so on.
One herb often touted to be useful for improving vision is Ginko Biloba.
There can be many causes of eye floaters, they are often attributed to parasites but they are not the only cause. One suggestion here would be to potentially try some anti-parasitic approaches to see if this will get rid of the floaters. Common anti-parasitic supplements are clove, wormwood, black walnut hull and even pumpkin seeds. There is a lot more to the discussion of parasitic infections and eye floaters, but I’ll leave that discussion for another day.
Night Blindness
Night blindness is essentially very poor vision at night or in dim light. When it comes to night blindness it’s important to consider a few common nutritional deficiencies linked to this issue.
The main nutritional deficiency that is linked to night blindness is a vitamin A, or retinol, deficiency. Many people think that eating a lot of carrots and other “carotinide-rich” foods will help their vision. This is only, at best, partly right, in my opinion. Carotenoids are “pre-vitamin A” which means they must be converted into the useable form of vitamin A, which is retinol. Many people, due to liver issues, genetics, hypothyroidism etc. can not effectively convert carotenoids into retinol, and thus only getting this “pre-vitamin A” from vegetables is not a good idea. It is much more effective to consume retinol, the best source of retinol is in organ meats such as beef or chicken liver. However, many people will never eat organ meats. I would urge people with vision issues to attempt to find a way to consume liver, such as liver sausages such as liverwurst or liver “jerky” which is far more palatable. Alas, even with these modifications many people simply cannot stomach organ meats. This is ok, as there are some other food sources of retinol such as egg yolks and dairy products such as whole milk, fatty cheese, butter and ghee. Moreover, you can also supplement with retinol palmitate.
Retinol also needs to be converted further into something called “retinoic acid” for certain functions. The most important things for the conversion of retinol into retinoic acid are one’s zinc and NAD (nicotinamide adenine dinucleotide) levels. Thus, for night vision issues it is very important for someone to be eating enough zinc, which is found in high amounts in oysters, red meat such as lamb, bison and beef, and seafood such as shellfish. There’s an ok amount of zinc in cheese, and zinc is best consumed from animal foods as opposed to nuts and seeds (even though pumpkin seeds are touted to be high in zinc). There is also the option to supplement with zinc, if someone wants to do this I would suggest zinc carnosine because this is a source of zinc while also having many other benefits such as helping with digestion issues like leaky gut.
Now, onto the topic of how to increase NAD. As mentioned previously, NAD levels are crucial for the conversion of retinol into retinoic acid. One quick way to increase NAD levels is simply to consume more vitamin B3, also known as niacin. The best vitamin B3 supplement to increase NAD levels in my opinion would be niacinamide (sometimes called nicotinamide) which has many other benefits other than increasing NAD. Other than supplementing with niacinamide, there are many other ways to increase NAD which I talk about in this article on how to utilize glucose well.
So, if someone consumes (via food or supplementation) enough vitamin A and zinc, and has enough NAD levels (by supplementing with niacinamide etc.) then their night vision will likely improve over time. The last nutrient I would like to mention for night blindness is molybdenum. This mineral is also shown to be helpful for combating night blindness, it is high in legumes, liver and oats and can be taken as a supplement as well. Taurine is also thought to be helpful when it comes to night blindness, and I like to use LifeBlud's taurine (discount code DEAN).
Glaucoma
Glaucoma is a type of condition that results from damage to the optic nerve. It is one of the leading causes of blindness in the elderly.
There is some evidence that glaucoma can be caused by an energy deficiency. In the blog posts by Georgi Dinkov linked below, he discusses the results from a study that showed that the addition of pyruvate and niacinamide improved the symptoms of glaucoma in patients. One possible reason for this is niacinamide and pyruvate's ability to improve glucose utilization and increase NAD levels. Overall, it seems like supplementing with niacinamide, a beneficial and easy-to-obtain supplement, might be a good idea for those dealing with glaucoma. As mentioned earlier, NAD is needed to convert retinol into retinoic acid, which also may be at play here. This is in addition to the fact that niacinamide and NAD are crucial for optimal energy production.
Niacinamide (vitamin B3) may also help with fibrotic eye disease.
Vitamin D is also helpful for glaucoma. This is especially true if someone has glaucoma symptoms as a result of an “autoimmune” response as vitamin D is very effective when it comes to combating autoimmunity. Find out more about autoimmune diseases in my article on the topic.
Blogposts
Studies:
https://karger.com/ore/article/64/1/116/259110/Vitamin-D-Levels-in-Young-Adult-Cataract-Patients
Summary list of useful supplements for eye health:
It seems like for most eye-related conditions the most beneficial supplements one could take would be:
Niacinamide
Vitamin E
Riboflavin
Selenium
Taurine
Histidine
Magnesium
Vitamin B1
Caffeine and coffee
Consuming enough molybdenum in food (or supplementing)
Consuming enough copper in food (maybe supplementing)
Vitamin A (ideally from food)
Vitamin D (sun exposure and supplementation)
Vitamin C
Zinc
Red light exposure
Progesterone and pregnenolone
Ginko Biloba
*None of this is medical advice. I am not a medical professional, always talk to your doctor*
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BTW: I am a frequent guest on the podcast “Stuff Your Doctor Should Know”.
Discount code DEAN works at:
Ona’s Naturals (progesterone oil, topical progesterone and pregnenolone creams)
LifeBlud (Magnesium products, Taurine, Theanine, B vitamins, Methylene Blue)
Health Natura (oral pregnenolone, Methylene Blue)
This! Whoa.
“Estrogen is strongly associated with free radical processes, calcium mobilization, and acetylcholine release, all of which are involved in the process of excitoxicity. Alvarez, et al., (1996) have shown a possible involvement of acetylcholine in calcium mobilization in the lens.”
Brilliant!!
As always, great work Constantine!!