Diabetic Retinopathy natural treatment using nutritional supplements and herbal remedies by Ray Sahelian, M.D.
March 15 2014

Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere. People with a type of eye damage known as retinopathy are more likely to die of heart disease than those without it,. In adults with type 2 diabetes, diabetic retinopathy is associated with an increased risk of dying. The presence and severity of DN is associated with erectile dysfunction.

Diabetic Retinopathy Treatment
There are several natural therapeutic options. However research is very early and we still don't know for sure which supplements will help, in what dosages, and in what combinations. Ask you doctor to review this article every few months for additional information. Please use only one supplement at a time until you learn how it works for you by itself before combining them. The supplements that have been studied include:

Alpha Lipoic acid is a potent antioxidant but I do not see the need to take more than 50 mg every other day.
Benfotiamine has been evaluated in diabetic retinopathy with positive results.
CoQ10 or Coenzyme Q10
     Int J Ophthalmol. October 2013. Plasma coenzyme Q10 levels in type 2 diabetic patients with retinopathy. The ratio of ubiquinol-10/ubiquinone-10 is found lower in patients with PDRP. High levels of plasma ubiquinol-10/ubiquinone-10 ratio indicate the protective effect on diabetic retinopathy.
Fish oils are helpful in improving blood flow and vision enhancement.
Garlic is a potent blood vessel dilator and could be of benefit.
Ginkgo biloba may be helpful since it helps with blood flow and thins the blood.
Isoflavone supplements such as genistein.

You may also consider lutein and other carotenoids, and Eyesight Rx.

Medical treatment
Middle East Afr J Ophthalmol. 2013 Oct-Dec. Systemic medical management of diabetic retinopathy. Diabetic retinopathy (DR) affects the vision by way of proliferative disease that results in vitreous hemorrhage and traction retinal detachment or by way of diabetic maculopathy (DME). The present-day management of diabetic retinopathy revolves around screening the diabetics for evidence of retinopathy and treating the retinopathy with laser photocoagulation. DME is treated with laser photocoagulation and/or intra- vitreal injection of anti-vascular endothelial growth factor (VEGF) agents or steroids. Laser remains the mainstay of treatment and is potentially destructive. Systemic management aims at preventing or delaying the onset of retinopathy; reversing the early retinopathy; or delaying the progression of established retinopathy. Evidence from multiple studies has confirmed the protective role of rigid control of blood glucose and blood pressure. The evidence for lipid control versus maculopathy was less definitive. However, the use of fenofibrates (originally used for lowering serum lipids) has shown a benefit on both proliferative disease and maculopathy outside their lipid-lowering effect. Other drugs being tried are the Protein Kinase C (PKC) inhibitors, other peroxisome proliferator-activated receptors (PPAR) agonists, Forsoklin (which binds GLUT 1 receptor), minocycline (for its anti inflammatory effect), and Celecoxib (Cox-2 inhibitor).

Symptoms
Diabetic retinopathy often has no early warning signs or symptoms. It is a good idea to have a comprehensive dilated eye exam once a year.

Research
Isoflavone supplements exert hormonal and antioxidant effects in postmenopausal Korean women with diabetic retinopathy.
J Med Food. 2005.
There is growing evidence that soy isoflavones exert hormonal and antioxidant effects in postmenopausal women. In the present study, 12 postmenopausal Korean women with diabetic retinopathy consumed 2 g of genistein combined polysaccharides (GCP), containing 120 mg of genistein and 57 mg of daidzein, daily for 12 weeks. Blood was collected prior to and after 12 weeks of GCP supplementation for analysis of fasting blood glucose, insulin, lipid profiles, sex hormone-binding globulin (SHBG), estradiol, testosterone, free testosterone, and osteocalcin and activities of glutathione peroxidase (GSH-Px), catalase, and paraoxonase. After GCP supplementation, blood glucose, insulin, total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein cholesterols did not change significantly. However, there were significant increases in SHBG and testosterone and a decrease in estradiol. Free testosterone levels were not significantly affected by GCP supplementation. After supplementation, osteocalcin decreased, but the difference was not statistically significant. Although activities of catalase and paraoxonase were unchanged, GSH-Px activity was increased significantly. These findings suggest that GCP supplementation may change the levels of some hormones and improve antioxidant status in postmenopausal Korean women with diabetic retinopathy.

Improved haemorrheological properties by Ginkgo biloba extract (Egb 761) in type 2 diabetes mellitus complicated with retinopathy.
Clin Nutr. 2004.
Abnormal haemorrheological property changes in erythrocyte deformability, plasma and blood viscosity, and blood viscoelasticity may play very important roles in the development of microangiopathies in diabetes mellitus (DM). In this study, we demonstrate the improvement in abnormal haemorrheological parameters in DM with ingestion of Ginkgo biloba extract 761. Haemorrheological parameters before and 3 months after Ginkgo biloba oral ingestion were determined in 25 type 2 DM patients with retinopathy. These parameters included lipid peroxidation stress of erythrocytes, erythrocyte deformability, plasma and blood viscosity, blood viscoelasticity, and retinal capillary blood flow velocity. After taking Ginkgo biloba orally for 3 months, the blood viscosity was significantly reduced at different shear rates. Viscoelasticity was significantly reduced in diabetic patients. The level of erythrocyte malondialdehyde (MDA) was reduced by 30%; however, the deformability of erythrocyte was increased by 20%. And lastly, retinal capillary blood flow rate was increase. In this preliminary clinical study, 3 months of oral administration of Ginkgo biloba significantly reduced MDA levels of erythrocytes membranes, decreased fibrinogen levels, promoted erythrocytes deformability, and improved blood viscosity and viscoelasticity, which may facilitate blood perfusion. Furthermore, Ginkgo biloba effectively improved retinal capillary blood flow rate in type 2 diabetic patients with retinopathy.

Molecular Mechanism
The Juvenile Diabetes Research Foundation (JDRF), has announced that a new study that identifies a molecular link connecting high blood sugar inside cells to the initiation of diabetic retinopathy. This finding, reported in the January 27 issue of Cell, explains how methylglyoxal, a glucose-derived molecule that is overproduced in cells damaged by hyperglycemia, turns on a gene called angiopoietin-2, which plays a central role in the loss of small blood vessels in the retina. In diabetic retinopathy, this loss of small blood vessels causes low oxygen delivery to parts of the retina, which then compensates by stimulating new blood vessel growth. It is the growth of these new vessels that causes intraretinal bleeding and other problems in the diabetic eye that can eventually lead to blindness. In diabetic patients only certain cells -- those that cannot prevent their internal glucose levels from rising -- are damaged by hyperglycemia. Dr. Brownlee and his team discovered that a consequence of high glucose inside a cell is the overproduction of the free radical superoxide. This overproduction causes an increase in the glucose-derived molecule MG, which then turns on the angiopoietin-2 gene by directly attaching to an inhibitor of this gene and disabling it, thus resulting in blood vessel damage. Methylglyoxal is clearly an important, yet under-examined, molecule that is implicated in the disease process of two major diabetic complications: retinopathy and renal failure.

Questions
Q. Dear Dr. I am 59 years old and have diabetic retinopathy. I am so mad I didn't take care of myself sooner, but now I exercise daily and have gotten my diabetes under control. I am not on insulin. I can see and drive, but I want very much to nourish my eyes , especially the retina, so they can get better and healthy as they used to be. I really want to heal them. I am a firm believer of Chinese herbs and feel that they will help me a great deal. but I do not know which herbs to take. Can you please tell me which herbs are good to help my eyes. I keep looking for herbs that heal diabetic retinopathy.
   A. There are several supplements that are starting to be evaluated for diabetic retinopathy and they are listed at the top of the page.

Q.  I wanted to tell you that the way I found out about you and the wonderful information and education that you provide, was by typing in a question in my search engine. The response was a link to your site that provided me with the information I was looking for. My question or what I had asked was regarding any nutritional or supplements that a diabetic could take that would help them with the condition that I have of; Proliferative Retinopathy. What I found has been very helpful. I just thought that there must be a substance or supplement, or nutrient that might aid in the dissipation, or in the dissolving of the blood which lingers in the vitreous fluid. I figured blood, being a protein and all, there must be something that might help in the absorbtion of this blood through your metabolism or something, rather than having a vitrectomy or some other surgical procedure. Of course I have a retina specialist who has been controlling the bleeding and I am thankful to have my vision. However, I was just wondering if there was anything else that could be of an aid that I could do myself, nutritionally or naturally. I know about Vitrase, which is being tested, and is used only on those that have a really bad first bleed. I know someone who was in the trial testing for Vitrase, who had a bad bleed, was injected with the vitrase into the eye and the blood totally dissolved within a few days. I don't think it has been fully approved by the FDA. What I read in one of your articles on this topic was that there were several supplements that might be helpful with retinopathy. My nutritionist had also recommended one of them for neuropathy. I have always been conscious of herbs and supplements since I was in my early twenties; I am currently 55, and have carefully read about and have many books and herb and supplement bibles. I never take anything unless I'm sure of the effects and dosage. and if there are any adverse reactions due to any of the diabetes medications that I take. The supplements that you discussed were: Alpha Lipoic Acid (one suggested by my nutritionist), Amino Acid supplement, (I have a combined one) Astralagus, Spirulina, Magnesium and Ginko Biloba. I also take an omega fish oil supplement and a B12. I do not take these each day, more like 3 times a week and only the recommended dosage at a time. I also take a multi vitamin about 3 times a week and alternate it between the days I take the other supplements. I'm saying all of this to say that prior to my taking these supplements, I had a bleed in both of my eyes in January, 2007 which impaired my vision making it difficult for me to see clearly, temporarily. The problem was that I was getting ready to fly to California to attend my cousins funeral. It limitted my vision but not totally, which is how it usually is, but it took quite a long time for the blood to clear. I have had about at lease 3,500 to 4,500 laser hits in my left eye and more recently, because I haven't had as much bleeding in my right eye, and since my return from CA in January, about 2,500 in my right eye. I can see, but while I am waiting for the blood to become reabsorbed and or dissipate, it previously took quite a long time; weeks, months, a year. Even then, some of the bleeding never totally clears away and it gets dried. Since I usually can see pretty well after the fog lifts (the bleed), and my Dr. can still see the back of my eye, I haven't had to have a vitrectomy as yet, although it of course has not been ruled out. However, since I have been taking the above supplements, that I read about in your articles, the blood when I do have a retinal bleed seems to dissolve much, much quicker than prior to my taking the supplements. I don't take the Ginkgo and Spirulina as often because I read that Ginkgo increases circulation in capillaries and Spirulina works somewhat like an aspirin in that it may act as a blood thinner which may or may not be a good thing, but I still take them and it seems to be working really great. I wanted to ask if you will have any other articles on diabetic proliferative retinopathy; should I be concerned about the Ginkgo and Spirulina, or are there more benefits from taking them to retinopathy than what I'm understanding, would this cause more bleeding by taking them; are there any other findings regarding this condition or breakthroughs; will or has vitrase be approved by FDA in the future and will it be used for all patients in this way to dissolve all retinal bleeding; (I feel as though Dr.'s that perform vitrectomies my not want this advancement); are there any other supplements that you can recommend and is it alright to continue taking the ones I am taking; and why don't they have a substance that can be ingested or injected that can dissolve blood protein, and are they doing any other research to this effect that will be used as soon as possible to help to preserve vision; some researchers feel as though equal or such products have been instrumental in causing retinopathy (I have stopped taking this substitute for fear that it is true and that it is detrimental to health); what about stevia is it a nutritionally sound supplement and would it have any affects on diabetic vision. It is difficult to obtain many answers, and Dr's only will discuss but so much with their patients. They seem to get upset when you ask these relevant and extremely important questions; it is very frustrating. Thank you so very much again for all of your phenominal information. You have provided me with the most amazing information regarding this and all other nutritional and informative medical facts. I am truly greatful please keep up the wonderful service you have provided and afforded us. Please excuse any typos or misspelled words.. I would so appreciate any further information you may provide. I so look forward to reading your newsletters and as soon as I can.
   A. There has not been formal and extensive research done with supplements and retinopathy, but some early clues point to the benefit of these dietary and nutritional supplements options. Eat a wide variety of fresh fruits and vegetables, consume cold water fish such as salmon, take fish oil pills, drink fresh vegetable juices, walk daily and exercise in order to improve sleep at night, and consider small amounts of various supplements such as lipoic acid, carotenoids, various antioxidants, goji berry and other berries, and a good multivitamin. Small amounts of ginkgo biloba could also be helpful.