Andrew Huberman - Supplements for Eye Health

In this article we’ll be looking at the supplements discussed for eye health during Huberman’s interview with Dr. Jeffrey Goldberg.

In particular they mention supplements that may benefit macular degeneration and glaucoma.

Table of Contents

Before we discuss the supplements, let’s first zoom out a bit and look at the interconnection between vision and nutrition…

How Vision Works and Why Nutrition Is Important

Human vision depends on the retina. The retina is a light-sensitive tissue lining the back of the eye. It contains special cells called photoreceptors that detect light. ¹

There are two main types of photoreceptors – rods and cones. Rods help us see in low light, while cones help us see colors and details. ²

When light enters the eye and hits the photoreceptors, it starts a series of chemical reactions. These reactions create electrical signals that travel from the photoreceptors, through the optic nerve, to the visual cortex of the brain.³

The brain interprets these electrical signals to form the images we see. So, our ability to see relies on this complex process, turning light into signals the brain can understand.

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Phototransduction requires certain key molecules and nutrients:

Vitamin A – Converts light into electrical signals in rods. Vitamin A deficiency impairs night vision and adaptation to darkness.⁴
Lutein and Zeaxanthin – Carotenoids that filter blue light and quench free radicals in the eye. They help prevent light damage.⁵
DHA – An omega-3 fatty acid found in retinal cell membranes. It maintains the fluidity of photoreceptor membranes.⁶

Without adequate intake of these molecules, vision can be impaired.

As we age, photoreceptors and retinal cells accumulate damage from light exposure, oxidative stress, and metabolic byproducts.⁷ This can slowly degrade visual acuity and contribute to eye diseases like macular degeneration.

Getting sufficient nutrition provides the building blocks to maintain and repair these delicate eye tissues.

Supplements for Macular Degeneration

Age-related macular degeneration (AMD) is a leading cause of vision loss and blindness in older adults over the age of 50.⁸

In macular degeneration, the macula (part of the eye responsible for high-resolution vision) begins to degrade and leads to blurry or distorted central vision.⁹

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The Age-Related Eye Disease Studies (AREDS and AREDS2) were two major clinical trials investigating whether certain nutritional supplements could slow the progression of AMD or not.

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The original AREDS trial, published in 2001, found that a supplement containing vitamin C, vitamin E, beta-carotene, zinc, and copper reduced the risk of progressed AMD by 25% over 5 years.¹⁰

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The AREDS2 trial, published in 2013, tested adding the carotenoids lutein, zeaxanthin, and/or omega-3 fatty acids EPA and DHA to the original AREDS formula.

For context on these; lutein and zeaxanthin are concentrated in the macula and are important components of the retina. Then DHA is a major structural component of the retina, and EPA may support retinal function.

Nutrient	AREDS (1) formula	AREDS2 formula
Vitamin C	500 mg	500 mg
Vitamin E	400 IU	400 IU
Beta-carotene	15 mg	–
Copper	2 mg	2 mg
Lutein	–	10 mg
Zeaxanthin	–	2 mg
Zinc	80 mg	25 mg
*Taken daily

Comparison table between the initial AREDS supplement formula with the improved AREDS2.

The AREDS2 trial found that adding lutein (10 mg) and zeaxanthin (2 mg) to the AREDS formula further reduced the risk of progressed AMD by an additional 10% in individuals with moderate to severe AMD.¹¹

It’s worth clarifying that the study only found statistically significant data to support these supplements slowing progression in those with moderate to severe AMD, not early or mild AMD.

Adding EPA (650 mg) and DHA (350 mg) did not show any additional protective effect.

However, in the podcast, Dr. Goldberg notes that even though the study didn’t show a statistically significant improvement for those with early/moderate macular degeneration, he still recommends the AREDS2 formula to patients at his clinic with early/moderate AMD if they can afford it.

The formula may provide some degree of protection even if the effect size was not large enough to be statistically significant in the study.

Dr. Goldberg recommends getting these nutrients from a nutritious diet or supplements.

Key dietary sources include:

Lutein/Zeaxanthin: kale, spinach, collard greens, corn, eggs
Vitamin C: oranges, grapefruit, tomatoes, red peppers
Vitamin E: sunflower seeds, almonds, spinach
Zinc: oysters, meat, legumes, seeds
DHA/EPA: salmon, sardines, mackerel

Some examples of supplements that provide a similar formulation to that used in the AREDS2 study include:

In addition to the targeted supplements suggested by the AREDS trials, there are also some general strategies that may help support eye health:

Avoid smoking – Smoking significantly increases the risk of developing macular degeneration and other eye diseases.¹²

Control systemic diseases – Getting diabetes, high blood pressure, and high cholesterol under control can lower the risk of retinal complications from vascular damage.

Wear sunglasses – Sunglasses that block 99-100% of UVA/UVB rays can help reduce sun damage to the eyes and lower cataract risk.¹³

Supplements for Glaucoma

Glaucoma is a condition where the optic nerve in the eye is damaged. This damage is often caused by abnormally high pressure inside the eye.

Glaucoma can lead to vision loss and blindness if not treated.¹⁴ The high eye pressure presses on the optic nerve and damages it.

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Research has shown that decreased levels of the coenzyme nicotinamide adenine dinucleotide (NAD+) are present in animal models of glaucoma.¹⁵

NAD+ plays an important role in maintaining energy production and redox balance in cells throughout the body – the retinal ganglion cells included.¹⁶

Huberman mentions a couple of studies about the relationship between glaucoma and vitamin B3, which we’ll look at below:

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First, Huberman and Dr. Goldberg discuss an interesting mouse study by Williams and colleagues published in 2017.

The study showed that supplementing a high dose of nicotinamide (a form of vitamin B3) in the diet prevented 90% of optic nerve damage in a mouse model of glaucoma.¹⁷

The nicotinamide was able to preserve retinal ganglion cells and maintain their function.

They also talk about how this animal study led scientists to become interested in whether nicotinamide could also be beneficial for human glaucoma.

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Then, they go on to discuss a small randomized trial by Hui and team in 2020, which tested oral nicotinamide supplements in 57 patients with open angle glaucoma.

The patients received either 1500 mg of nicotinamide twice daily or a placebo capsule for 6 weeks.

The researchers found that the patients supplemented with nicotinamide had significantly better retinal function compared to placebo, based on electroretinography testing.¹⁸

Goldberg says this provides some early evidence that nicotinamide may be helpful for glaucoma.

The dose of nicotinamide used in the research studies was much higher than what could be obtained from normal dietary intake, at 1,500 – 3,000 mg per day.

Nicotinamide is available as an inexpensive, over-the-counter vitamin supplement. Dr. Jeffrey Goldberg and Huberman think it’s pretty safe based on scientific studies.

Examples of vitamin B3 supplements include:

Thorne, Niacinamide – 500 mg per capsule
Now Foods, Niacinamide – 500 mg capsules or 1,000 mg capsules
Source Naturals, Niacinamide, B-3 – 1,500 mg per tablet

It’s worth noting that vitamins can come in multiple forms, each with pros and cons. In this instance, vitamin B3 comes in two popular forms; nicotinamide, which we discussed above, and niacin.

Whilst they function similarly, they have some key differences.

In particular, niacin can cause flushing side effects like reddening of the skin, itching, or tingling. This is due to niacin causing dilation of blood vessels near the skin.

However, nicotinamide (the form used in the research studies) typically does not cause flushing and is considered non-flushing niacin.

For this reason, it’s suggested to take nicotinamide rather than niacin for potential benefits related to glaucoma – as niacin flushing can be very uncomfortable.

Vitamin B3 can also be found in a variety of dietary sources including:

Meat like chicken, beef, pork, and liver – Liver is particularly high in B3. A 3oz serving of cooked beef liver provides over half the recommended daily B3 intake.
Fish like tuna, salmon, and trout – A 3oz serving of tuna provides about a third of the recommended daily B3.
Grains like brown rice, barley, wheat germ – A half cup of cooked brown rice provides around 2 mg of B3.
Legumes including lentils, chickpeas, and peas – A half-cup serving of cooked lentils contains about 2.5mg of B3.

In addition to vitamin B3, there are some other nutritional strategies people with glaucoma can consider:

Get adequate magnesium – Magnesium supports healthy blood flow and may have neuroprotective properties.¹⁹ While it’s important for overall eye health, further research is needed to determine its specific role in protecting retinal ganglion cells and its potential implications for glaucoma prevention.

Huberman personally prefers the Threonate form of magnesium (also known as L-Threonate), but notes that Bisglycinate appears to work well too – as both can cross the blood-brain barrier.

Examples of reputable brands of L-Threonate include:

Product	Servings	Price	Cost per 100 mg*
DoubleWood – L-Threonate	25x 144mg	$25 with coupon	$0.69
Momentous – L-Threonate	30x 144mg	$34 with coupon	$0.78

* = elemental magnesium

Magnesium Glycinate is another good source of magnesium that is noticeably more affordable (see cost per 100 mg). Reputable brands include:

Product	Capsules	Price	Cost per 100 mg*
Double Wood – Magnesium Glycinate	180 x 60 mg	$17 with coupon	$0.15
NOW – Magnesium Glycinate	180 x 100 mg	$18 with coupon	$0.10

* = elemental magnesium

Increase omega-3s – The omega-3s EPA and DHA support optic nerve cell membrane structure and function.²⁰

For good fish oil options see my fish oil spreadsheet (link) where I’ve analyzed Omega-3 supplements with low levels of total oxidation and heavy metals. The latter are important to prevent spoiling and avoid toxicity.

Roundup

This wraps up the insightful discussion on supplements and nutrition for eye health between Andrew Huberman and Dr. Jeffrey Goldberg.

If you’ve questions or comments, please leave them below.

References

1
Patterning and Development of Photoreceptors in the Human Retina | Hussey et al. | 2022 | Front. Cell Dev. Biol.
2
Projection of rods and cones within human visual cortex | Hadjikhani & Tootell | 2000 | Human Brain Mapping
3
Visual Processing by Retina | Tessier-Lavigne | 2006 | Biology
4
Night vision in a case of vitamin A deficiency due to malabsorption | Perlman et al. | 1983 | British Journal of Ophthalmology
5
Carotenoids in the retina — A review of their possible role in preventing or limiting damage caused by light and oxygen | Schalch, W. | 1992 | Free Radicals and Aging
6
Retina and Omega-3 | Querques et al. | 2011 | Journal of Nutrition and Metabolism
7
Consequences of oxidative stress in age-related macular degeneration | Jarrett & Boulton | 2012 | Molecular Aspects of Medicine
8
Updates on the Epidemiology of Age-Related Macular Degeneration | Jonas et al. | 2017 | Asia-Pacific journal of Ophthalmology
9
Nutrition and Eye Health | Lawrenson & Downie | 2019 | Nutrients
10
A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8 | Age-Related Eye Disease Study Research Group | 2011 | JAMA Ophthalmology
11
The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1)| AREDS2 Research Group | 2012 | Ophthalmology
12
The Association Between Cigarette Smoking and Ocular Diseases | Solberg et al. | 1998 | Survey of Ophthalmology
13
Ultraviolet Radiation and Cataract | Balasubramanian | 2019 | Journal of Ocular Pharmacology and Therapeutics
14
Glaucoma and its treatment: A review | Lee & Higginbotham | 2005 | American Journal of Health-System Pharmacy
15
The Role of NAD+ and Nicotinamide (Vitamin B3) in Glaucoma: A Literature Review | Pietris | 2022 | Journal of Nutritional Science and Vitaminology
16
NAD+ metabolism and its roles in cellular processes during ageing | Covarrubias et al. | 2020 | Nature Reviews Molecular Cell Biology
17
Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice | Williams et al. | 2017 | Science
18
Improvement in inner retinal function in glaucoma with nicotinamide (vitamin B3) supplementation: A crossover randomized clinical trial | 2020 | Hui et al. | Clinical & Experimental Ophthalmology
19
The Role of Magnesium in the Pathogenesis and Treatment of Glaucoma | Ekici et al. | 2014 | International Scholarly Research Notices
20
Mechanisms of action of (n-3) fatty acids | Calder | 2012 | The journal of nutrition

Andrew Huberman – Supplements for Eye Health

How Vision Works and Why Nutrition Is Important

Supplements for Macular Degeneration

Supplements for Glaucoma

Roundup

Further Reading

References

Andrew Huberman – Supplements for Eye Health

How Vision Works and Why Nutrition Is Important

Supplements for Macular Degeneration

Supplements for Glaucoma

Roundup

Further Reading

References

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