Vitamin supplements and dry eye

[Raj]

Here's an abstract from an interesting study that looked at large N cohort in a middle to older group of patients, most of whom were between 55 and 75. Interestingly, the single largest predictor of dry eye was history of arthritis, which is associated with Sjogren's. Both are autoimmune conditions.

Here 's a list of significant predictors of dry eye in this sample.

1. History of Arthritis
2. Smoking status
3. caffeine use
4. history of thyroid disease
5. history of gout
6. total to high-density lipoprotein cholesterol ratio
7. diabetes
8. multivitamin use.

The take-home message is: Stop smoking and stop caffeine consumption.

Nonsignificant factors:

body mass; blood pressure; white blood cell count; hematocrit; history of osteoporosis, stroke, or cardiovascular disease; history of allergies; use of antihistamines, parasympathetics, antidepressants, diuretics, antiemetics, or other drying drugs; alcohol consumption; time spent outdoors; maculopathy; central cataract; and lens surgery.

Raj
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Arch Ophthalmol. 2000 Sep;118(9):1264-8. Related Articles, Links


Prevalence of and risk factors for dry eye syndrome.

Moss SE, Klein R, Klein BE.

Dept of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 N Walnut St, 460 WARF, Madison, WI 53705-2397, USA. moss@epi.ophth.wisc.edu

OBJECTIVE: To examine risk factors for the prevalence of dry eye syndrome in a population-based cohort. METHODS: The prevalence of dry eye was determined by history at the second examination (1993-1995) of the Beaver Dam Eye Study cohort (N = 3722). RESULTS: The cohort was aged 48 to 91 years (mean +/- SD, 65 +/- 10 years) and 43% male. The overall prevalence of dry eye was 14.4%. Prevalence varied from 8.4% in subjects younger than 60 years to 19. 0% in those older than 80 years (P<.001 for test of trend). Age-adjusted prevalence in men was 11.4% compared with 16.7% in women (P<.001). After controlling for age and sex, the following factors were independently and significantly associated with dry eye in a logistic model: history of arthritis (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.56-2.33), smoking status (past, OR, 1.22; 95% CI, 0.97-1.52; current, OR, 1.82; 95% CI, 1.36-2.46), caffeine use (OR, 0.75; 95% CI, 0.61-0.91), history of thyroid disease (OR, 1.41; 95% CI, 1.09-1.84), history of gout (OR, 1.42; 95% CI, 1.02-1.96), total to high-density lipoprotein cholesterol ratio (OR, for 1 unit, 0.93; 95% CI, 0.88-0.99), diabetes (OR, 1.38; 95% CI, 1.03-1.86), and multivitamin use (past, OR, 1.35; 95% CI, 1. 01-1.81; current, OR, 1.41; 95% CI, 1.09-1.82). Nonsignificant variables included body mass; blood pressure; white blood cell count; hematocrit; history of osteoporosis, stroke, or cardiovascular disease; history of allergies; use of antihistamines, parasympathetics, antidepressants, diuretics, antiemetics, or other drying drugs; alcohol consumption; time spent outdoors; maculopathy; central cataract; and lens surgery. CONCLUSION: The results suggest several factors, such as smoking, caffeine use, and multivitamin use, could be studied for preventive or therapeutic efficacy. Arch Ophthalmol. 2000;118:1264-1268

[jcorbett]

multivitamins??

Are they saying taking multi-vitamins is BAD for you??

[Raj]

Interesting question. Good or bad for you is kind of a total judgment. They're just saying that multivitamin use can make your eyes drier. Many drugs do, and it appears that multivitamins, while good for you overall, do contribute to dry eye.

The abstract doesn't say whether the investigators looked into a dose-dependent relationship, in which, for example, 1 multivitamin a day might not affect dry eye, but 2 or more do. Impossible to know. Maybe the study says something more detailed, and maybe it doesn't. Maybe you lose 1 second off your tear break up time for every multivitamin you consume. Don't know.

We all probably know people who chuck down 10 different vitamins at breakfast. If you're one of those people and have dry eye, it's could be making it more severe. That much is certain. If you have a low or instantaneous tear break up time and you're consuming tons of vitamins, I think I'd cut back and see what happens.

Raj

[dianat]

Sounds kinda like suffering horrible allergies...runny nose, etc, and then finding out you're severely allergic to Kleenex...

[Gaye]

Multi-vitamins

Really, if so, I am in big trouble too!

[Rebecca Petris]

If you have a low or instantaneous tear break up time and you're consuming tons of vitamins, I think I'd cut back and see what happens.

Maybe replace some of them with flaxseed or fish oil....

[Gaye]

Vitamins and dry eye

Do you think that would also mean calcium supplements?

[Rebecca Petris]

I think I would like to see a more detailed study before drawing any conclusions about multivitamin use. It seems to me that this kind of sweeping study is a great first step at identifying which things, broadly speaking, appear to have a statistically significant relationship to dry eye incidence but not necessarily pinning down what any of it means for a specific factor.

For any specific vitamins, suggest looking up potential side effects on Medline. Gaye, here is the page on Calcium. (Scroll down to the very bottom.) Dry mouth is listed as a possible sign of overdose.

With ALL vitamins, one should be careful not to take more than the recommended dose unless under a doctor's advice, in case of toxicity.

[Lucy]

see your doctor

To take a broad statement such as "multivitamins" causing this n' that.....and tailor it to our own needs can be a mistake.

Most of us are here because of eye problems and therefore must see eye medical professionals quite often. How about asking them or your GP for information on this? My GP is very updated on holistic stuff and vitamins. If I stop taking "something" because I read about it in a report somewhere (without consulting him first), I'm not being compliant.

My doctor is big on glucosamine. He was recommending it even before all this stuff advertised on tv. He had me taking it long before it was the "thing to do." I had arthritis problems quite early. Now, everybody makes glucosamine. Almost like the big flood of dry eye over the counter remedies over the past 4 or 5 years.

ASK YOUR OWN DOCTOR. That's what you pay him big bucks for!

To Gaye: You are taking calcium for a reason, and you need to ask your doctor next time you see him whether you should stop or not. I take calcium too.

[Gaye]

Vitamins

Thanks everyone - I love the input and the info - sometimes a lot to take into account, but incredibly enlightening. Glad I found this site!

[Scout]

Are they saying taking multi-vitamins is BAD for you??

Thyroid disease is one of the risk factors for dry eye.

A relatively new warning label on thyroid replacement medication is now: Wait 4 hours before taking vitamin supplements.

More specifically, calcium supplements and anything containing iron will interfere with absorption of the medication.

I had been taking thyroid replacement medication for probably 5 years before I heard about the calcium supplement problem. I didn't learn this from my doctor or my pharmacist. I learned it on the Internet.

I only found out last year [from my pharmacist] that iron supplements also are a problem.

My doctor [I saw him last week] was not aware of this.

So, check with your doctors . . . but don't forget the Internet.
Like . . .
Drug Digest [A source for information about the side effects of medications and vitamins and herbal supplements--plus interactions].

Scout

This thread certainly has taken a turn . . . maybe our Site Admin can split it into two threads ?

[Rebecca Petris]

Good suggestion re thread split... have followed it. In case anyone is looking for the "rest" of the thread, see thread titled Sjogren's Syndrome.

A relatively new warning label on thyroid replacement medication is now: Wait 4 hours before taking vitamin supplements.

Fascinating. As always you are an amazing source of info, Scout.

Dumb question maybe but do you happen to know whether this applies to armour thyroid too or just the synthetics?

I learn so much from these discussions every week! Throw a few of the right people in a room together and it's amazing how the info flows.

[Scout]

Dumb question maybe but do you happen to know whether this applies to armour thyroid too or just the synthetics?

Yep.

Check it out:

Drug Digest Information on Armour Thyroid

What drug(s) may interact with desiccated thyroid?
•amiodarone
•antacids
•calcium supplements, like Tums® and many others
•carbamazepine
•cholestyramine
•colestipol
•digoxin
•female hormones, including contraceptive or birth control pills
•ketamine
•medicines for colds and breathing difficulties
•medicines for diabetes
•medicines for mental depression
•medicines or herbals used to decrease weight or appetite
•phenobarbital or other barbiturate medications
•phenytoin
•prednisone or other corticosteroids
•rifabutin
•rifampin
•soy isoflavones
•sucralfate
•theophylline
•warfarin

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

Scout

[Kyle]

Wow, what an interesting conversation!
I am one of those people that "chucks down a ton of vitamins" at every meal. I've mentioned throughout this website that I have been seeing a nutrionist ever since I had my lasik surgery. I'm on everything!...flax seed, multivitamins, B, C, A, E, calcium, you name it...I'm taking it.
It kind of freaked me out when I first started reading this thread, but it's interesting to get everyone's perspective.
I totally agree with Lucy though..we all need to check with our individual docs to find out why we're taking what we're taking and if it's needed.
Here I am thinking I'm so healthy...wouldn't it be strange if I was actually making things worse!
Hey Gaye, it's nice to put a face with a name. Tell everyone in good ole Virginia Beach I said "Hello!"

[Raj]

Vitamin A supplements are almost certainly okay. Vitamins C and E look to be okay, given the research below. In general, oral antioxidents are probably okay (N-Acetyl-L-Cysteine is an antioxidant).

Now, check the abstract at bottom, which says compares a multi-vitamin group, a vitamin C only group, and a control group. The vitamin groups took a recommended daily allowance (i.e., they did not "chuck tons of vitamins"). The abstracts states that "The tear stability of both treated groups increased, however, the multi-vitamin and trace element group demonstrated the more consistent and individually predictable improvement."

So it would seem that there's literature to support that taking the recommended daily allowance of a multi-vitamin won't dry your eyes out.

However, these subjects didn't ALREADY have dry eye...they were normal subjects to begin with. Given the research supporting vitamin A's healthy benefit on the ocular surface, they should have run a Vitamin A only group.


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Med Sci Monit. 2004 May;10(5):CR213-7. Epub 2004 Apr 28. Related Articles, Links


Conjunctival and tear film changes after vitamin C and E administration in non-insulin dependent diabetes mellitus.

Peponis V, Bonovas S, Kapranou A, Peponi E, Filioussi K, Magkou C, Sitaras NM.

Department of Ophthalmology, Tzaneion General Hospital of Piraeus, and Department of Pharmacology, School of Medicine, University of Athens, Greece.

BACKGROUND: The purpose of our research was to investigate the effect of supplementation with vitamin C and E on ocular surface cytology specimens and related parameters in diabetic patients. MATERIAL/METHODS: 60 patients were enrolled in the study. The patients were given vitamin C (1000 mg/day) and vitamin E (400 IU/day) for 10 days. Conjunctival brush cytology specimens were obtained before and after treatment. Schirmer tests, break-up time and ocular ferning tests were also performed. RESULTS: Goblet cell densities were 50 cells/per field before and 59 cells/per field after supplementation (p=0.002). The stage of squamous metaplasia was 1.12+/-0.42 before and 0.88+/-0.41 after supplementation (p=0.011). The changes were accompanied with improved values for the Schirmer test (p<0.001), break up time (p=0.001), and ocular ferning (p<0.001). CONCLUSIONS: Diabetes mellitus is associated with increased oxidative stress. Our study suggests that supplementation with antioxidant vitamins C and E probably plays an important role in improving the ocular surface milieu.
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Acta Ophthalmol (Copenh). 1993 Dec;71(6):825-9. Related Articles, Links


The influence of vitamins and trace element supplements on the stability of the pre-corneal tear film.

Patel S, Plaskow J, Ferrier C.

Department of Vision Sciences, Glasgow Caledonian University, Scotland, U.K.

The tear stability af 60 normal healthy subjects was measured and repeated 10 days later. Using a double-blind protocol, during the interim period 2/3 of the subjects (the treatment groups) took a commercially available daily dietary supplement and the remaining 1/3 acted as controls. The recommended daily dose was applied to the treatment groups. 20 of the treatment group took a daily dietary supplement of a mixture consisting of vitamins (e.g. A, B1, B2, B6, E) and trace elements (e.g. calcium iron, manganese), the other 20 took purely vitamin C tablets. The tear stability of both treated groups increased, however, the multi-vitamin and trace element group demonstrated the more consistent and individually predictable improvement. Within this group, the characteristics of the regression line correlating the initial mean (x) and final mean (y) tear stabilities were, y = 5.94 + 1.02x. The tear stability of the control group individuals did not significantly change.