What you need to know before selling nutraceuticals

Many of your patients are interested in maintaining or improving their vision, but they may walk into your office with wrong information.

The most common misperception is that eating carrots is good for vision, but this is a myth, according to Jeffry D. Gerson, OD, FAAO, Optometry Times Editorial Advisory Board member. He suggests that the optometrist’s role includes educating patients on dietary habits and supplements for which scientific evidence indicates a benefit for overall health or eye health, such as potential value in the prevention or management of a particular eye disease.

Related: Why ODs should care about sugar          

The importance of diet

While encouraging optometrists to sell carefully selected nutraceuticals in their practices, he also reminded them that pills are not intended to meet all of an individual’s nutritional requirements.

“Nutritional supplements are just that; they’re something you add that may fill gaps in the diet,” says Dr. Gerson, who is in private practice in Kansas City, KS.          

“Healthy eyes belong to healthy people,” he says, and helping patients improve their diets is as essential as recommending supplements.         

The sad truth is that the typical American diet consists of far too many packaged and high-fat foods and too few fruits, vegetables, and healthy options such as fish-not the fried menu selections from fast food restaurants. As a result, obesity is becoming an epidemic.

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“If current trends continue, 86 percent of the population will be overweight or obese by 2030,” Dr. Gerson says, “and at this rate, 100 percent of the adult population will be affected by 2048.”          

Changing peoples’ eating habits is a challenge, and supplements can help make up for the nutrients lacking in the diet, Dr. Gerson says. And certain nutrients, such as lutein, zeaxanthin, vitamin D, and vitamin B12, may have a role in the management of age-related macular degeneration (AMD), diabetes, and diabetic retinopathy.

Next: Multivitamins and fairy dust formulations

Multivitamins and fairy dust formulations      

Many patients already take multivitamins or ocular vitamins. However, they may not be getting the benefits they assume come from these pills. Multivitamins are usually “fairy dust formulations,” according to Dr. Gerson, containing tiny amounts of many nutrients. Further, supplements may not actually contain what’s on the label, given that there is little regulatory oversight of these products.        

“If you think our patients aren’t buying something, they are,” he says. “We just need to make sure they’re buying the right things. Find out what products they take so you can give them proper guidance. Typical name brands won’t have high enough quantities of lutein and zeaxanthin, in particular, to make a difference.”

Next: Sell what you trust          

Sell what you trust

Without specific recommendations, patients who confront shelves of vitamins at the store are likely to choose the prettiest label or the cheapest price, which isn’t likely to do them much good.        

To ensure that patients choose supplements that are likely to address their particular ocular health needs, brush up on the literature on the role of various nutrients in the management AMD and diabetes, and find out what supplements contain the ingredients demonstrated to have potential value, Dr. Gerson says. They may be common, over-the-counter products that a patient could buy at any retailer or specialized products that you could stock in your office, sell from the practice website, or order for patients.      

Related: Misdiagnosing macular degeneration

“Control the distribution,” Dr. Gerson says.

Sell only products that are true to the label and brands that you trust. If you leave it up to patients to choose a supplement, treat it like a prescription and be very specific. Be proactive and influence patients to do the right thing.

Next: Magic potion or poison?

Magic potion or poison?

While new studies come out regularly with findings that may contradict the results of earlier work, there is evidence from a study published late last year in BMJ Open Diabetes Research and Care that lutein, zeaxanthin, lycopene, and beta carotene all had a tendency to prevent development of type 2 diabetes.¹ It is especially important to educate patients on the types and amounts of these nutrients to obtain from supplements if one or both of their parents have this condition, Dr. Gerson says. But don’t overlook dietary changes such as increased consumption of fruit and vegetables or following a Mediterranean diet.       

Vitamin B12 deficiency is highly prevalent in patients with diabetes, and patients may need to obtain more of this nutrient through diet and supplementation. Supplementation may be particularly important for patients who have been taking metformin for several years because it can affect B12 absorption, Dr. Gerson says. Screening for B12 deficiency will help determine the correct management.         

Lutein and zeaxanthin supplementation may also help address low macular pigmentation, a risk factor for diabetes and diabetic retinopathy.           

Two other products to consider for treatment of diabetic retinopathy are Pycnogenol (Horphag Research), a product made from the bark of the Pinus pinaster tree, and benfotiamine, which has been widely used in Europe, Dr. Gerson said.         

Lutein, zeaxanthin, and omega-3 fatty acids may be tremendously beneficial for certain patients at high risk of development or progression of AMD, although they seem to have much less an effect in studies when taken by a wide range of patients. Results of the Age-Related Eye Disease Study 2 (AREDS2) showed complex findings in which adding DHE/EPA or lutein/zeaxanthin to the original AREDS formulation, which included beta-carotene, had no additional effect on the risk of advanced AMD.² However, patients who took supplements containing lutein/zeaxanthin had a slight reduction in risk compared to those who had taken a supplement with beta-carotene. Further differences were found in other subgroups.          

Related: Addressing AREDS2 controversies

The benefit of fish oil supplements is unclear, as studies have reached different conclusions. “I wouldn’t rule it out yet,” Dr. Gerson says, adding that fish is a better source than a supplement.       

The verdict on whether zinc is a “magic potion or poison” is also still out. While zinc is a necessary nutrient, too much could be harmful, and evidence suggests that the risk-benefit profile may have a genetic component.          

“We can actually improve vision through the right diet and right supplementation,” Dr. Gerson says, but optometrists must offer evidence-based recommendations and products from reliable suppliers.

Reference

1. Sugiura M, Nakamura M, Ogawa K, et al. High-serum carotenoids associated with lower risk for developing type 2 diabetes among Japanese subjects: Mikkabi cohort study. BMJ Open Diab Res Care. 2015 Dec 1;3(1).

2. AREDS2 Research Group. Lutein/Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration. The Age-Related Eye Disease Study 2 (AREDS2) Controlled Randomized Clinical Trial. JAMA. 2013 May 15;309(19):2005-15.