Cataracts

What Are Cataracts?

[dropcap]C[/dropcap]ataract is a clouding of the normally clear lens in an affected eye characterized by blurred vision and progressive blindness due to loss of the len’s ability to focus light rays on the retina. Cataracts can occur in either or both eyes.

Q: How does a cataract form?

A: The lens is a transparent, colorless, oval-like structure of the eye made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light coming through the pupil to pass through it to reach the retina where it is recorded. Once an image reaches the retina, it is changed into nerve signals that are sent to the brain.¹

In each eye, the lens is enclosed in a capsule that is held in place directly behind the pupil by the ciliary body and the suspensory ligaments. The lens consists primarily of lens fibers that at the periphery are soft, forming the cortis lentis, and in the center are of a harder consistency, forming the nucleus lentis. Beneath the capsule on the front surface is a layer of cells, the lens epithelium. The shape of the lens is changed by the ciliary muscle to focus light rays onto the retina.²

A cataract begins to form when some of the protein clumps together and starts to cloud a small area of the lens. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.³

A cataract is diagnosed by an ophthalmologist, who is a medical doctor specializing in the treatment of eye conditions. The eye examination involves viewing the anterior (front) of the eye by means of a slit lamp microscope. This instrument allows detailed observation of the lens and its supporting structures.

What Are Cataracts In Celiac Disease and/or Gluten Sensitivity?

• Relationship between cataracts and celiac disease. Cataracts are a serious complication in celiac disease.
• Relationship between cataracts and nutritional deficiencies. Cataracts are a feature of vitamin A deficiency, long standing hypocalcemia (low blood calcium level), magnesium deficiency and antioxidant insufficiency involving vitamin C and vitamin E, two powerful antioxidants. The lens is the eye structure most susceptible to oxidative damage.⁴
• Relationship between cataracts  and diabetes in celiac disease. Cataracts can form in diabetes, which is an associated disorder of celiac disease. Diabetes mellitus is associated with a 5-fold higher prevalence of cataracts.⁵ The transient nature of the diabetic cataract is related to changes in lens hydration. Biochemical changes that occur as a result of rapid changes in blood sugar cause the lens fibers to swell, forming a cataract. Patients presenting with this condition have been shown to stabilize within 3 months.⁶

How Prevalent Are Cataracts In Celiac Disease and/or Gluten Sensitivity?

Cataracts have increased frequency in patients with celiac disease⁷, and can be the presenting feature of celiac disease.⁸,⁹

A Dutch study investigating prevalence of deficiencies in 80 newly diagnosed patients found that 7.5% of patients showed deficient levels vitamin A.¹⁰

What Are The Symptoms Of Cataracts?

Cataracts are marked by these symptoms:

• Distorted vision, especially at night or in very bright light, that progressively leads to blindness.
• Cloudy vision.
• Halos may be seen when looking at lights.
• Shadows of light images may be seen giving the effect of double vision. For example, the moon would seem to have a twin.
• Painless condition.
• Also, the clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina but makes it difficult to identify blues and purples.³

How Do Cataracts Develop In Celiac Disease and/or Gluten Sensitivity?

Cataracts result from chronic nutrient deficiencies of vitamin A, vitamin C, vitamin E, calcium, magnesium, and protein and to antioxidant insufficiency due to malabsorption in celiac disease.

• Nutrient deficiency mechanisms.

• Cataract during the early stage of hypocalcemia (low blood calcium) is caused by membrane damage with low calcium level in the aqueous humor and sodium content increase in the lens.¹¹  The aqueous humor is the watery liquid within the cavity in front of the lens.
• Magnesium deficiency in the lens accelerates the progression of lens opacification because of the resulting imbalanced ion exchange that alters the structure needed to keep the lens transparent. That is, decreased levels of magnesium (Mg2+) and potassium (K+) allow a harmful increase in levels of calcium (Ca2+) and sodium (Na+).¹² 
• In patients with cataract, significant inverse associations were found for vitamin C, vitamin A, and the vitamin A precursors: zeaxanthin, lutein, lycopene, α- and β-carotene, and β-cryptoxanthin.¹³ This means the lower the nutrient, the worse the risk of cataract formation.
• Protein deficiency is associated with increased risk of cataract. Low protein intake may induce deficiencies of specific amino acids that are needed to maintain the health of the lens, or other nutritional deficiencies, particularly niacin, thiamin, and riboflavin.¹⁴

• Free radical mechanism – unstable molecules that damage cells.

• Deficiency of powerful antioxidants vitamin C and vitamin E results in the inability to quench free radicals in the lens which is a major cause for cataract formation.¹⁵
• After exposure to oxidative stress which causes free radical formation, the redox set point of the single layer of the lens epithelial cells (but not the remainder of the lens) quickly changes, going from a strongly reducing to an opposing oxidizing environment. Almost concurrent with this change is extensive damage to DNA and membrane pump systems, followed by loss of epithelial cell viability (ability to live) and death by necrotic and apoptotic mechanisms. The data suggest that the epithelial cell layer is the initial site of attack by oxidative stress and that involvement of the lens fibers follows, leading to cortical cataract.¹⁶
• Magnesium deficiency enhances oxidative stress of the lens by increased production of free radicals and depletion of antioxidant defenses.¹⁷

Do Cataracts Respond To Gluten-Free Diet?

Yes. A gluten free diet containing adequate calcium, vitamin A, magnesium, protein and antioxidants that include vitamin C, β-carotene, lutein and zeaxanthin is preventive and limits further changes.¹⁸,¹⁹

6 Steps To Improve Cataract In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both eye and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.²⁰
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.²¹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.²¹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.²¹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.²¹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.²¹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.²¹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs cause deficiencies of Calcium,Vitamin A, Magnesium, Vitamin C, Vitamin E, and protein  that promote the formation of cataracts.

Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Calcium,Vitamin A.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Calcium,Vitamin A.
• Alka Seltzer®, Baking Soda deplete Magnesium, Protein.

ANTIBIOTICS disrupt intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete Vitamin C.
•  Tetracyclines deplete Calcium.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Calcium, Magnesium, Vitamin C.
• Aspirin and Salicylates deplete Calcium, Vitamin C.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Calcium.

ANTIVIRAL AGENTS

• Foscanet depletes Calcium, Magnesium. 

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin A, Vitamin E.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete  Magnesium.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Calcium, Magnesium, Vitamin C.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Calcium.

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin C, Magnesium.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin C, Magnesium.

WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.

• Zenicol (Orlistat®) depletes Vitamin A, Beta-carotene.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Vitamin C as prescribed.
• Chelated magnesium as prescribed but do not take at same time as calcium because they compete for absorption.
• Vitamin A as prescribed following blood test for status.
• Vitamin E as prescribed.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

Medical Research Findings On Cataracts In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

Sources:

1. Tabers Cyclopedic Medical Dictionary. 19th ed. FA Davis Company, Philadelphia, PA. [↩]
2. Tabers Cyclopedic Medical Dictionary.C 19th ed. FA Davis Company, Philadelphia, PA. [↩]
3. http://www.nei.nih.gov/health/cataract/cataract_facts [↩] [↩]
4. Agte V, Tarwadi K. The importance of nutrition in the prevention of ocular disease with special reference to cataract. Ophthalmic Res. 2010;44(3):166-72. doi: 10.1159/000316477. [↩]
5. Obrosova IG, Chung SS, Kador PF. Diabetic cataracts: mechanisms and management. Diabetes Metab Res Rev. 2010 Mar;26(3):172-80. doi: 10.1002/dmrr.1075. [↩]
6. Butler PA. Reversible cataracts in diabetes mellitus. J Am Optom Assoc. 1994 Aug;65(8):559-63. [↩]
7. Mollazadegan K, Kugelberg M, Lindblad BE, Ludvigsson JF. Increased risk of cataract among 28,000 patients with celiac disease. Am J Epidemiol. 2011 Jul 15;174(2):195-202. doi: 10.1093/aje/kwr069. [↩]
8. Raina UK, Goel N, Sud R, Thakar M, Ghosh B. Bilateral total cataract as the presenting feature of celiac disease. Int Ophthalmol. 2011 Feb;31(1):47-50. doi: 10.1007/s10792-010-9396-6. Epub 2010 Sep 21. [↩]
9. Sari R, Yildirim B, Sevinc A, Buyukberber S. Idiopathic hypoparathyroidism and celiac disease in two patients with previous history of cataract. Indian J Gastroenterol. 2000 Jan-Mar;19(1):31-2. [↩]
10. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975. [↩]
11. Takahashi H. Ca(2+)-ATPase activity in the hypocalcemic cataract. Nihon Ganka Gakkai Zasshi. 1994 Feb;98(2):142-9. [↩]
12. Nagai N, Fukuhata T, Ito Y. Effect of magnesium deficiency on intracellular ATP levels in human lens epithelial cells. Biol Pharm Bull. 2007 Jan;30(1):6-10. [↩]
13. Dherani M, Murthy GV, Gupta SK, Young IS, Maraini G, Camparini M, Price GM, John N, Chakravarthy U, Fletcher AE. Blood levels of vitamin C, carotenoids and retinol are inversely associated with cataract in a North Indian population. Invest Ophthalmol Vis Sci. 2008 Aug;49(8):3328-35. doi: 10.1167/iovs.07-1202. [↩]
14. Delcourt C, Dupuy AM, Carriere I, Lacroux A, Cristol JP; Pathologies Oculaires Liées à l’Age study group. Albumin and transthyretin as risk factors for cataract: the POLA study. Arch Ophthalmol. 2005 Feb;123(2):225-32. [↩]
15. Thiagarajan R, Manikandan R. Antioxidants and cataract. Free Radic Res. 2013 May;47(5):337-45. doi: 10.3109/10715762.2013.777155. [↩]
16. Spector A. Oxidative stress-induced cataract: mechanism of action. FASEB J. 1995 Sep;9(12):1173-82. [↩]
17. Agarwal R, Iezhitsa IN, Agarwal P, Spasov AA. Mechanisms of cataractogenesis in the presence of magnesium deficiency. Magnes Res. 2013 Jan-Feb;26(1):2-8. doi: 10.1684/mrh.2013.0336. [↩]
18. Agte V, Tarwadi K. The importance of nutrition in the prevention of ocular disease with special reference to cataract. Ophthalmic Res. 2010;44(3):166-72. doi: 10.1159/000316477. [↩]
19. Schalch W, Chylack LT. Antioxidant micronutrients and cataract. Review and comparison of the AREDS and REACT cataract studies. Ophthalmologe. 2003 Mar;100(3):181-9. [↩]
20. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
21. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
22. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975. [↩]
23. Mollazadegan K, Kugelberg M, Lindblad BE, Ludvigsson JF. Increased risk of cataract among 28,000 patients with celiac disease. Am J Epidemiol. 2011 Jul 15;174(2):195-202. doi: 10.1093/aje/kwr069. [↩]
24. Delcourt C, Dupuy AM, Carriere I, Lacroux A, Cristol JP; Pathologies Oculaires Liées à l’Age study group. Albumin and transthyretin as risk factors for cataract: the POLA study. Arch Ophthalmol. 2005 Feb;123(2):225-32. [↩]
25. Raina UK, Goel N, Sud R, Thakar M, Ghosh B. Bilateral total cataract as the presenting feature of celiac disease. Int Ophthalmol. 2011 Feb;31(1):47-50. doi: 10.1007/s10792-010-9396-6 [↩]
26. Nora DB, Fricke D, Becker J, Gomes Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report. I Arq Neuropsiquiatr. 2004 Mar;62(1):154-7. [↩]
27. Sari R, Yildirim B, Sevinc A, Buyukberber S. Idiopathic hypoparathyroidism and celiac disease in two patients with previous history of cataract. .Indian J Gastroenterol. 2000 Jan-Mar;19(1):31-2. [↩]