Transcript training manual - Nordic Naturals

Ocular Specific Nutrients
 Introducing: Ultimate DHA Eye


Synergistic nutrients for ocular health
Protects the eyes from oxidative damage and damaging light
 Fish Oil Supports Ocular Health





Visual development
Healthy vision
Natural solution for dry eyes
Healthy blood flow
Antioxidant lipid mediator
 Lutein and Zeaxanthin Support Ocular Health


Macular degeneration
Prevent Age-Related Eye Diseases (AREDs)
 Ultimate DHA Eye – Practical Considerations




Fish oil
Lutein
Zeaxanthin
Fish oil is safe
 Quality Counts

Quality counts
2
Temp-A.ppt 7/16/2015 2
Introducing Ultimate DHA Eye
Nordic Naturals Ultimate DHA Eye
 Condition specific blend of research-based nutrients for
ocular health
 Prevents age-related oxidative damage to eyes
 Fish oil portion = concentrated DHA formula (50% DHA)

Research shows that DHA is specifically
indicated for supporting ocular health
 Lutein and Zeaxantin


Naturally occurring carotenoids
(also known as xanthophylls)
Protects from oxidative stress
and high-energy light
 Ultimate DHA Eye; 2 soft gels daily




DHA 788 mg
EPA 158 mg
Lutein 20 mg
Zeaxanthin 4 mg
4
Temp-A.ppt 7/16/2015 4
Fish Oil
for Ocular Health
Fish Oil and Ocular Tissue
Evidence-based benefits
 Supports




Visual development
Healthy vision
Hydration and moisture
Blood flow to ocular tissue
 Prevents


Oxidative damage and inflammation
associated with Age-Related Eye Disease
Macular degeneration,
Retinal degeneration, Cataracts
6
Temp-A.ppt 7/16/2015 6
Omega-3 Fatty Acids – EPA+DHA
Fish oil is the best source of omega-3 fatty acids
 Docosahexaenoic Acid (DHA)
 Visual development
 Structural lipid in retinal photoreceptor
and synaptic membranes
 Protects from light, oxygen, and
age-associated damage to the eyes
 Eicosapentaenoic Acid (EPA)
 Anti-inflammatory
 Reduces inflammation of lacrimal gland,
meibomian gland, and ocular surface,
which are associated with symptoms of
Dry Eye Syndrome (DES)
7
Temp-A.ppt 7/16/2015 7
Fish Oil Supports Visual Development
DHA
 Required for development of neural
and retinal membranes
 Accumulates rapidly in the brain and retina
during gestation and early postnatal life1
 DHA supplementation results in higher
visual acuity in infants born preterm2
 DHA and ARA—supplementation of
infant formula supports visual acuity
and IQ maturation3,4
1. Am J Clin Nutr 2006;83:1452S–1457S.
2. Am J Clin Nutr 2006;83:1458S–1466S.
3. Early Hum Dev 2007;83:279–84.
4. Pediatrics 2003;112:e177–83.
8
Temp-A.ppt 7/16/2015 8
Fish Oil Supports Healthy Vision
Omega-3s are important structural components for
retinal photoreceptors and cortical gray matter
 The essential omega-3 fatty acids attain
their highest concentration in the human
photoreceptors
 The integrity of retinal pigment epithelial
(RPE) cells is critical for photoreceptor
cell survival and vision
 DHA is the precursor of neuroprotectin
D1, which directly protects RPE cells
Neurotrophins enhance retinal pigment epithelial cell survival through neuroprotectin D1 signaling.
Proc Natl Acad Sci USA 2007;104:13152–7.
9
Temp-A.ppt 7/16/2015 9
Fish Oil – The Natural Solution for Dry Eyes
 Over 10 million Americans suffer chronic
persistent inflammation of the ocular tissue
that results in burning and redness
 Dry Eye Syndrome (DES) is characterized
as an inflammatory condition of the ocular
tissue
 Fish oil supports the body’s natural
anti-inflammatory response
 Women’s Health Study
(a cross sectional study of 32,470 women)
Women who consumed higher amounts of EPA and
DHA had significant reduction in the occurrence of
Dry Eye Syndrome (DES)
 Women who ate five servings of fish had 68%
reduced risk of DES compared to those who ate
one serving
Relation between
dietary n6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr

10
Temp-A.ppt 7/16/2015 10
2005; 82:887–893.
Fish Oil Improves Blood Flow
 Healthy blood vessels and circulation are key to good eye health

Eye health depends on the integrity of fine vessels that supply blood to the area
 Fish oil promotes healthy blood flow

In a review of 36 studies (2002) and a review of 31 studies (1993)
 Measurable improvements of blood flow were seen
The Omega-3 fatty acids EPA and DHA increase systemic
arterial compliance in humans. Am J Clin Nutr 2002;76: 326–330.
11
Temp-A.ppt 7/16/2015 11
Fish Oil Prevents Oxidative Damage
 DHA converted into lipid mediator that is
responsible for protecting ocular cells
from oxidative stress

Protecting from oxidative damage is the
foundation to preventing visual and
cognitive decline
 DHA is most highly concentrated in
photoreceptors, brain, and retinal
synapses

DHA accounts for approximately 30–35% of the
total fatty acids found within the eye
 Fish oil – The best source of DHA
Rotstein NP, et al. Protective effect of docosahexaenoic acid on oxidative stress-induced apoptosis
of retina photoreceptors. Invest Ophthalmol Vis Sci 2003;44:2252–2259.
12
Temp-A.ppt 7/16/2015 12
Fish Oil Improves Overall Eye Health
 Obstacles to healthy eyes and visual longevity are





Incomplete visual development
Poor circulation to eye tissue
Inflammation
Dry eyes
Free radical damage to eye tissue
 Fish oil

Supports ocular development
 Improves circulation
 Supports the body’s natural anti-inflammatory response
 Supports the production of bioactive lipid mediators
that protect from free radical damage
Studer M, et al. Effect of Different Antilipidemic Agents and Diets on Mortalit, A Systematic Review.
Arch Intern Med 2005;165:725–730.
Durrington P, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased
triglycerides in simvastatin treated patients with coronary heart disease. Heart 2001;85(5):544–548.
13
Temp-A.ppt 7/16/2015 13
Lutein and Zeaxanthin
Lutein and Zeaxanthin
 Natural xanthophylls not synthesized by the human body that must be
consumed from the diet
 Fat-soluble nutrients that occur in the retina of the human eye
 Provide protective pigment that filters out harmful light
 Found in green leafy vegetables such as spinach and kale, and in egg yolks
and animal fat
 Proven benefits:



Individuals with a diet rich in lutein and zeaxanthin are more likely to have healthy vision than
people who do not
Daily supplementation of 10 mg of lutein for one year is associated with healthy eyes and vision
Increased dietary intake of, or supplementation with, lutein and zeaxanthin was found to result in
increased plasma levels, which were positively and significantly associated with macular pigment
optical density
Zhao L, Sweet BV. Lutein and zeaxanthin for macular degeneration. Am J Health Syst Pharm 2008;65:1232–8.
Richer S, et al. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic
age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry 2004. 75:216–230.
16
Temp-A.ppt 7/16/2015 16
Fish Oil + Lutein and Zeaxanthin
Possibly the next standard of care for Macular Degeneration and other
Age Related Eye Diseases (AREDs)
 2001: The National Eye Institute completed the
Age-Related Eye Disease Study (AREDS)

Zinc, vitamin C, vitamin E, and beta-carotene established as the
“Standard of Care” for age-related causes of vision loss
 2007: The National Eye Institute initiates AREDS II

Omega-3 fats (DHA and EPA), lutein, and zeaxanthin on
Age-Related Eye Diseases
 The results of ARED Study 1 and ARED Study 2
may result in a new “Standard of Care”
17
Temp-A.ppt 7/16/2015 17
AREDS II : Advancing Our Understanding
Researchers analyzed the dietary intake of participants in original AREDS trial
and chose the most promising nutrients for the AREDS II study
Results of AREDS
 Highest intake of DHA had a 50% lower risk of
advanced AMD
 Highest EPA had nearly the same 50% decrease in
their risk of developing advanced geographic atrophy
(a severe form of "dry" AMD)
 Highest intake of lutein and zeaxanthin had a 50%
lower risk of developing new AMD during the trial
compared to the control group
 For people with high intakes and elevated blood levels
of lutein and zeaxanthin, a decreased risk of both
neovascular (wet AMD) and dry AMD was observed
18
Temp-A.ppt 7/16/2015 18
ARED II : Advancing Our Understanding
 Randomized study of 4000 participants aged
55 to 80 who have Macular Degeneration in
one eye
 Participants will receive one of four
supplements:




Placebo
10 mg of lutein along with 2 mg of zeaxanthin,
1 g of DHA and EPA
Combination of lutein, zeaxanthin, DHA, and EPA
19
Temp-A.ppt 7/16/2015 19
Don’t Wait – Prevention Starts Today
 We won't know the results of AREDS II for a number of years
 In the meantime, it makes good sense to recommend to
patients


Eat a diet rich in fruits and vegetables for antioxidant nutrients, especially
dark green leafy veggies which are good sources of lutein and zeaxanthin
Eat fish at least 2–3 times weekly for omega-3 fats
 We also need to understand most individuals
fail to comply with diet changes
 Solution = Ultimate DHA Eye
20
Temp-A.ppt 7/16/2015 20
Ultimate DHA Eye
Synergistic Nutrients
 Omega-3s and Carotenoids are found together in the eye
 In Vitro evidence shows they function synergistically
 “These results show for the first time the direct
neuroprotection of photoreceptors by xanthophylls and
suggest that zeaxanthin and lutein, along with DHA, are
important environmental influences that together promote
photoreceptor survival and differentiation.”
Chucair AJ, et al. Lutein and zeaxanthin protect photoreceptors from apoptosis induced by
oxidative stress: relation with docosahexaenoic acid. Invest Ophthalmol Vis Sci
2007;48:5168–77.
 Human Clinical Trials provide additional support
 Forty-nine women were randomly assigned to placebo,
DHA, lutein, or lutein + DHA supplement
 Conclusion: Lutein and DHA aid in prevention of
age-related macular degeneration
Johnson EJ, et al. The influence of supplemental lutein and docosahexaenoic acid on serum,
lipoproteins, and macular pigmentation. Am J Clin Nutr 2008;87:1521–9.
22
Temp-A.ppt 7/16/2015 22
Benefits Beyond the Eye
 The combined protective activity of omega-3 fats and xanthophylls
extends beyond ocular health
 The cognitive benefit of DHA and lutein in elder women was explored
in a double-blind, intervention trial of DHA and lutein supplementation
for eye health
 Subjects underwent cognitive tests measuring verbal fluency, memory,
processing speed and accuracy, and self-reports of mood at
randomization and upon completion of the trial
 Following supplementation:



Verbal fluency scores improved significantly
Memory scores and rate of learning improved significantly
There was a trend toward more efficient learning
 CONCLUSIONS: These exploratory findings suggest that DHA and
lutein supplementation may have cognitive benefits for older adults
Johnson EJ, et al. Cognitive findings of an exploratory trial of docosahexaenoic acid and lutein supplementation in older women.
Nutr Neurosci 2008;11:75–83.
23
Temp-A.ppt 7/16/2015 23
Ultimate DHA Eye
Nordic Naturals Ultimate DHA Eye
 AREDS 2 nutrients
 Prevents age-related oxidative damage to eyes
 Fish oil: concentrated DHA formula (50% DHA)

Provides 788 mg DHA
158 mg EPA
 Lutein

Provides 20 mg Lutein
 Zeaxanthin

Provides 4 mg Zeaxanthin
24
Temp-A.ppt 7/16/2015 24
Ultimate DHA Eye is Safe
 Research shows that pure fish oil supplements
are safe with generally no adverse effect


3+ grams of fish oil may be contraindicated with blood
thinning medications–best to monitor
It is generally recommended to stop taking
fish oil one week before major surgeries
 Purified fish oil supplements have significantly
less impurities than fish
 The FDA has ruled that up to 3 g of EPA + DHA is
safe to be included in the food supply of Americans
without fear of adverse events

Food and Drug Administration. Safety Reporting Requirements
for Human Drug and Biological Products.
 In 2004 The FDA confirmed the Joint Expert Committee
on Food Additives' ruling that lutein and zeaxanthin are
safe for human consumption

Maximum acceptable daily intake level is 2 mg per kg of body weight.
Hence, for a 160 lb person, that would mean an intake of approximately
145 mg of lutein/zeaxanthin.
25
Temp-A.ppt 7/16/2015 25
Quality Counts
Fish Oil Quality Counts
Choosing the right fish oil product for your patients is key
 Burping/fish smell due to rancid, poorly manufactured oil
 Fish oil can easily oxidize
 Must process in nitrogen environment
 Molecular distillation—removes PCBs and mercury
27
Temp-A.ppt 7/16/2015 27
Fish Oil Quality Standards are Voluntary
 In the United States there are no required manufacturing standards
 There are three voluntary guidelines for manufacturers to consider

Norwegian Medicinal Standards
 European Pharmacopoeia
 Council of Responsible Nutrition
Standards are related to limits for heavy metals, dioxins,
PCBs, and measurements of freshness
28
Temp-A.ppt 7/16/2015 28
Third-Party Testing
To verify quality, all finished product
should be independently tested for
 Purity – absence of environmental
toxins
 Potency – fatty acid content verified
 Freshness – measurement of oxidation
(rancidity)
29
Temp-A.ppt 7/16/2015 29
Summary
 Fish oil supports visual development, healthy
vision, blood flow, and anti-inflammatory activity
 Fish oil, Lutein, and Zeaxanthin work synergistically
to prevent oxidative damage and inflammation
associated with Age-Related Eye Diseases
(AREDs)
 Ultimate DHA Eye is safe
 Freshness, purity, and taste are key components of
a high quality product
 Nordic Naturals Ultimate DHA Eye is a condition
specific product ideal for protecting the eyes from
the damaging effects of aging
30
Temp-A.ppt 7/16/2015 30
FOR INTERNAL USE ONLY
Thank You!
Disclaimer: This information is provided by Nordic Naturals, Inc. for educational purposes only.
Current and peer-reviewed research is cited. It is not intended as medical advice of any kind.
The educational information in this document is not intended to diagnose, treat, or cure any disease,
nor has this document been reviewed or approved by the FDA.
31
Temp-A.ppt 7/16/2015 31