Electron Rustlers

Let me preface this page by explaining how I passed chemistry: I did not understand a word the teacher said. He was so far out in left field I was never going to find him. I say it was bad teaching but maybe I was not being very bright.

Two of my friends sat behind me designing race cars. Never listened to a word of the lecture. After being confused for 45 minutes, I would turn around to the guys and they would clear everything up in 45 seconds.

I was terrified to try physics. That was the end of me and the hard sciences.

Moral of the story? You probably should not listen to me try to explain oxidative stress.  You have been warned so I am forging ahead.

I keep running into titles like The Role of Oxidative Stress in AMD. Great. It is important. What the hey is it?

Revisiting my horrible experience in chemistry my junior year, I vaguely remember learning atoms have electrons that spin around the nucleus in shells. Shells are orbits and for simplicity sake we will say they go out from the nucleus in concentric circles. (They really don’t but cut me a break. Two kids drawing race cars saved my chem grade.)

Each of the shells has an ideal number of electrons that orbit there. Although a shell is generally OK without the ideal number, it still tries to have that number. Sometimes it loses some electrons. Sometimes it steals some electrons and sometimes it shares some electrons with another atom that is also longing for its ideal number.

This desire to be ‘whole’ and to fill its outer shell with the ideal number of electrons is what is called being reactive. Often being reactive is a great thing for an atom. It gets to hook up with other atoms and make all sorts of crazy new molecules.

However there are times reactivity is not a good thing. Sometimes an atom may do some ‘electron rustling’ and steal from a neighbor. That atom is now out of kilter and it does some electron rustling of its own. Before you know it, there is a full-blown range war going on in your atoms. There is no peace in the valley!  This is oxidative stress.

Oxidative stress, just like a range war, can leave a lot of destruction in its wake. With all that electron rustling happening, things get damaged and broken. This is some of what is happening in our eyes.

You cannot totally eliminate oxidative stress but there are ways to restore the peace. Enter antioxidants.

Antioxidants have electrons to give to that first electron rustler. They allow that atom to be ‘complete’ by donating some electrons to fill its outer shell. If that atom has its needs satisfied early, it won’t feel the need to go rustle. Range war – errrrrrr, oxidative stress – averted.

Vitamins C and E are antioxidants. Also vitamin A. [Lin/Linda here: if you have Stargardt’s Disease, you do NOT want any extra vitamin A. Click here to read more about why that is.] Eating red, orange and yellow fruits and veggies can be very good for you. You can also get antioxidants in supplements. However, like all good things, they should be indulged in with moderation.

So that is my take on oxidative stress. I hope the guys would be proud of me.

Click here for another explanation of oxidative stress by Dr. Andrew Weil.

Continue reading “Electron Rustlers”

Highlight: Why are you taking that?

June 24, 2016

I have published information about the AREDS/AREDS2 supplements in the past.  In the Facebook group, we’ve discussed the studies and the pros and cons of taking the supplements. Here’s the text of an article that I hope will clarify some of the concerns that have been expressed by eye professional.  The link to the article is at the end of this post.


A long-time patient presented for an exam the other day. This is a patient that I look forward to seeing, as we have some common interests that we chat about during his exam. He remarked that he really enjoyed coming for his exam, because he felt secure in the advice I give him. However, he also stated he has recently experienced an unsettled feeling in having to find a new primary care provider due to insurance changes.

Here’s a bit of history on this patient: He is in his mid-50s, myopic, but otherwise enjoys normal ocular health. He has a family history of age-related macular degeneration, with both his mother and maternal aunt having undergone anti-VEGF injections for wet AMD. Several years ago I measured his macular pigment optical density and found it to be very low. I prescribed a triple carotenoid supplement (lutein, zeaxanthin and mesozeaxanthin), his pigment level is now well within normal range, and he reports taking this supplement without fail. In reviewing his medications, I noticed an addition, an Age-Related Eye Disease Study 2 formula. Knowing I had not prescribed this, I asked him why he was taking it.

“Well, I was at the drugstore and saw the box. It said that it was the No. 1 doctor-recommended brand, and the only clinically proven formula, so I thought I would take this along with what you prescribed. It is only a vitamin right?”

Only a vitamin… So this patient who has stated he trusts what I recommend for his eyes has fallen prey to misleading advertising on a product label at his local pharmacy.

I asked him a few questions.

GM: Did the label state that there is no clinically proven benefit to taking the AREDS2 formula for patients without AMD or even those with mild disease, only a moderate benefit for those with intermediate to severe disease?

Patient: Well, no, it did not say that.

GM: Did the label tell you that taking large doses of zinc have been linked to the development of Alzheimer’s disease and prostate cancer?

Patient: No, the label did not say that either.

GM: Did the label state that other studies have found that vitamins C and E have no effect on the development of AMD?

Patient: No.

GM: Did the label state that high doses of vitamin E have been associated with increased risk of heart failure?

Patient: No.

GM: Did the label state that if you have the wrong genetics, the high dosage of zinc might accelerate progression of AMD?

Patient: No.

GM: Do you think I would prescribe this for you?

Patient: No, definitely not. I am throwing away the bottle when I get home!

Interestingly, 2 days after this encounter I read an announcement regarding the release of an AREDS2 formula plus a multivitamin. It was stated that the reason for the combination formula was due to the fact that 90% of participants in the AREDS2 trial that took an AREDS supplement also took a multivitamin (which in itself may have skewed the results of the trial). The piece also stated that consumer feedback and data showed that more than 50% of people older than 50 use a multivitamin.

Unfortunately, supplements do not face the same FDA scrutiny as drugs do. Consider what is seen in TV ads for drugs. The announcer lists a litany of possible side effects that the drug being advertised may have, all the while showing images of the supposed patient taking the drug playing with their grandkids or walking along a beach. Now imagine if a commercial for an AREDS formula vitamin had to do the same. Patients would likely think twice while in the drug store vitamin aisle about self-prescribing. And perhaps maybe they would ask for advice from their eye care provider.

References:

The Age-Related Eye Disease Study 2 Research Group. JAMA.2013;309(19):2005-2015. doi:10.1001/jama.2013.4997.

Awh CC, et al. Ophthalmology. 2015;122(1):162-169; doi: 10.1016/j.ophtha.2014.07.049.

Christen WG, et al. Ophthalmology. 2012;119(8):1642-1649; doi: 10.1016/j.ophtha.2012.01.053.

Leitzmann MF, et al. J Natl Cancer Inst. 2003; 95:1004-1007.\


The article above is from: http://www.healio.com/optometry/nutrition/news/blogs/%7Bcc9498b0-051f-44c9-948d-dac572140054%7D/gary-l-morgan-od/blog-why-are-you-taking-that