Home Health Eye Conditions Diabetic Retinopathy

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Natural Prevention for Diabetic Retinopathy

Risk Factors
How Can Turmeric Help?
Evidence of Benefit

Can turmeric and its natural vitamins and nutrients help prevent or treat diabetic retinopathy? With progress lagging in conventional treatments, some researchers are looking to herbal remedies for safe and more effective alternatives. The search for solutions is especially urgent since the number of people with the condition is growing quickly. Studies suggest turmeric compounds could help delay the onset or progression of this common diabetic eye disease. ^{(viii.73-75, 86)}

What Is Diabetic Retinopathy?

Diabetic retinopathy is the most common eye condition associated with diabetes. It's also the leading cause of blindness in American adults. The other two eye diseases associated with diabetes are cataracts and glaucoma. ^{(viii.78, 81)}

Figure VIII.1: The Eye

Chronic, progressive damage to the small blood vessels of the eye leads to diabetic retinopathy. Without treatment, damage promotes development of fragile blood vessels on the surface of the retina. In a process called diabetic macular edema, leaking blood from these weak capillaries and blockage by hard deposits on the retina then causes vision loss. ^{(viii.78, 81)}

Risk Factors for Diabetic Retinopathy

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Not everyone with diabetes will have diabetic retinopathy, but many do. What increases the risk of developing diabetic retinopathy? Experts say the following are some of the factors that make it more likely: ^(viii.86)

Length of time a person has diabetes (almost 60% developing it after 10 years and 97% after 25 years).
Chronic high blood sugar levels.
High blood pressure.
Unhealthy cholesterol levels.

All these factors increase free radicals and oxidative damage to the retina, which is already prone to damage because it is: ^(viii.81)

Made of a lot of polyunsaturated fatty acids, which easily form free radicals when stressed.
Chronically exposed to light that excite free radicals.
Highly metabolic and in need of lots of oxygen and blood.

How Can Turmeric Help Diabetic Retinopathy?

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Research shows that turmeric and its compounds can help alleviate the effects of diabetes and cardiovascular conditions. ^(viii.34)

Turmeric compounds also work in many of the same ways researchers say conventional therapy for diabetic retinopathy works, including:

Table VIII.5: Turmeric Compounds Compared to Conventional Therapy Modes of Action for Diabetic Retinopathy
ACTION	PROPOSED/USED CONVENTIONAL TREATMENT/DRUGS	ACTIVE TURMERIC COMPOUNDS/FORM
Anti-inflammatory. Block inflammatory molecules: ^(viii.86) ↓ NF-κB. ↓ COX-2. ↓ TNF-α.	NSAIDs. ^(viii.86) Salicylate-based drugs. ^(viii.86) Steroids. ^(viii.86) Topical COX-2 inhibitors. ^(viii.86) Etanercept, a TNF-α trap. ^(viii.86) Infliximab, a TNF-α neutralizing antibody. ^(viii.86)	Alpha-linolenic acid ^(viii.4) ↓ NF-κB. ^(viii.10) Stimulates proteins important to healthy metabolism and cell energy. ^(viii.18-20) Alpha-terpineol ^(viii.22) ↓ NF-κB. ^(viii.23) Ar-turmerone ^(viii.22) ↓ COX-2. ^(viii.24) Borneol ^(viii.22) ↓ NF-κB. ^(viii.23) Caffeic acid ^{(viii.22, 26-27)} Curcumin ^(viii.22) ↓ NF-κB. ^(viii.75) ↓ COX-2. ^(viii.87) ↓ TNF-α. ^(viii.87) Eugenol ^(viii.22) ↓ COX-2. ^(viii.87) ↓ TNF-α. ^(viii.87) Ferulic acid ^{(viii.26, 39)} Fisetin ^(viii.40) ↓ NF-κB. ^(viii.41) Geraniol ^(viii.43) ↓ NF-κB. ^(viii.23) Limonene ^(viii.22) ↓ NF-κB. ^(viii.23) Magnesium ^{(viii.42, 44)} Niacin ^(viii.46) ↓ NF-κB. ^(viii.47) ↓ TNF-α. ^(viii.47) ↓ Free radicals. ^(viii.47) Quercetin ^(viii.40) ↓ COX-2. ^(viii.81) ↓ NF-κB. ^(viii.87) ↓ TNF-α. ^(viii.81) Protocatechuic acid ^(viii.39) ↓ TNF-α. ^(viii.88) Resveratrol ^(viii.50) ↓NF-κB. ^(viii.89) ↓ COX-2. ^(viii.89) Vitamin E ^(viii.46) ↓ COX-2. ^(viii.90) ↓ TNF-α. ^(viii.90) Whole turmeric extract ^(viii.63)
Inhibiting leukostasis & leakage: ^(viii.86) ↓ Cell Adhesion Molecules (CAMs). ↓ Integrin activity.	NSAIDs. ^(viii.86) Salicylate-based drugs. ^(viii.86) Steroids. ^(viii.86) Topical SAR 1118. ^(viii.86) Anti-CD49a neutralizing antibody. ^(viii.86)	Fisetin ^(viii.40) ↓ Cell Adhesion Molecules (CAMs). ^(viii.91) Curcumin ^(viii.22) ↓ Cell Adhesion Molecules (CAMs). ^(viii.71) Niacin ^(viii.46) ↓ Cell Adhesion Molecules (CAMs). ^(viii.47)
Blocking formation of AGEs. ^(viii.86)	Aspirin. ^(viii.92) LR-90 advanced glycation inhibitor. ^(viii.86) PPAR-γ stimulating drugs (e.g., rosiglitazone and troglitazone). ^(viii.93)•	Caffeic acid ^{(viii.22, 92)} Cinnamic acid ^{(viii.22, 92)} Ferulic acid ^{(viii.26, 92)} Myricetin ^{(viii.40, 94)} Quercetin ^(viii.40) ↓ AGEs. ^(viii.92) ↑ PPAR-γ. ^(viii.20) Resveratrol ^{(viii.50, 92)} Turmeric extract ^(viii.92) ↓ AGEs. ^(viii.92) ↑ PPAR-γ. ^(viii.25) Vitamin C ^{(viii.46, 92)} Vitamin E ^{(viii.46, 92)}
Reduce oxidative stress: ^(viii.86) Quench excess free radicals. Block NADPH oxidase (an enzyme that increases free radicals). Increase natural antioxidant levels.	Apocynin. ^(viii.86) Statins. ^(viii.86) Vitamin C and vitamin E. ^(viii.86)	Caffeic acid ^(viii.22) ↓ Free radicals in retina. ^(viii.95) Curcumin ^(viii.22) ↑ Natural antioxidants. ^{(viii.75, 96)} ↓ NADPH oxidase. ^(viii.96) ↓ Free radicals. ^(viii.96) Gamma-terpinene ^(viii.22) ↓ Free radicals. ^(viii.97) ↓ Peroxidation of lipids. ^(viii.97) Protocatechuic acid ^(viii.39) ↑ Natural antioxidants. ^(viii.88) ↓ Free radicals. ^(viii.88) Rho-coumaric acid (reduced oxidative stress). ^{(viii.22, 98)} Turmerin ^(viii.99) ↓ Free radicals. ^(viii.99) Whole turmeric extract ^(viii.63) ↑ Natural antioxidants. ^(viii.63)
Block renin-angiotensin system (RAS) that increases blood pressure, free radicals, and inflammation in blood vessels. ^{(viii.86, 100)}	Captopril ^(viii.86) Candesartan ^(viii.86) Enalapril ^(viii.86) Lisinopril ^(viii.101) Olmesartan ^(viii.86) Talsartan ^(viii.86) Telmisartan ^(viii.86)	Alpha-terpineol ^(viii.22) ACE inhibitor ^(viii.26) Gamma-terpinene ^(viii.22) ACE inhibitor. ^(viii.26) Niacin ^(viii.46) Blocks free radicals produced by RAS. ^(viii.47) Resveratrol ^(viii.50) Blocks effects of angiotensin II, a protein that constricts and can damage blood vessels. ^{(viii.100, 102)}
Reduce formation of excess, abnormal blood vessels (angiogenesis) that lead to diabetic macular edema: ^(viii.101) ↑ PPAR-γ, a protein important to metabolism and artery health, that can also help block the formation of abnormal blood vessels. ^(viii.103) ↓ Vascular endothelial growth factor (VEGF).	Intravitreal pegaptanib. ^(viii.101)	Ar-turmerone ^(viii.22) ↑ PPAR-γ. ^(viii.25) Caffeic acid ^(viii.22) ↓ VEGF. ^(viii.95) Curcumin ^(viii.22) ↑ PPAR-γ. ^{(viii.25, 104)} ↓ VEGF. ^(viii.75) Fisetin ^(viii.40) ↑ PPAR-γ. ^(viii.36) Quercetin ^(viii.40) ↑ PPAR-γ. ^(viii.20) ↓ VEGF receptor. (viii.81) Turmeric extract ↑ PPAR-γ. ^(viii.25)

Pre-Clinical and Clinical Evidence of Benefit

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Animal and clinical studies show the following potential benefits of turmeric compounds:

Table VIII.6: In Vivo Benefits of Turmeric Compounds for Diabetic Retinopathy
TURMERIC COMPOUND	HOW IT CAN HELP
Alpha-linolenic acid ^(viii.4) (an omega-3 fatty acid)	Anti-inflammatory effects in animal models of diabetic retinopathy. ^(viii.105) Stimulates proteins important to healthy metabolism and cell energy. ^(viii.18-20)
Ar-turmerone ^(viii.22)	Anti-inflammatory effects. ^(viii.24-25) Prevents formation of weak blood vessels in diabetic rats. ^(viii.24-25)
Caffeic acid ^(viii.22)	Anti-inflammatory and antioxidant effects in an animal study on retinopathy. ^(viii.95) Blocked abnormal blood vessel growth in retina in mice with retinopathy. ^(viii.95)
Curcumin ^(viii.22)	Anti-inflammatory and antioxidant effects. ^{(viii.61, 75, 81)} Blocks formation of weak blood vessels in diabetic rats. ^(viii.81) Inhibits thinning of retinal layers linked to diabetes and early retinopathy. ^(viii.106) Prevented destruction of retinal ganglion cells in diabetic rats. ^(viii.106) Restores natural antioxidant levels in diabetic rats. ^(viii.61) Antiglycation effects in diabetic rats. ^(viii.61) Lowers high blood sugar levels in diabetics. ^(viii.34) Significantly reduces oxidative stress on blood vessels in patients with type 2 diabetes. ^(viii.74) In a multiherbal eye drop that contained whole turmeric extract, curcumin was one of 8 compounds shown to successfully penetrate the cornea. Some of the other 8 compounds are also found in turmeric, including camphor, γ-terpinene, and quercetin. ^{(viii.22, 40, 46, 64)} Curcumin gel has been developed and safely tested in animals, causing no eye irritation. ^(viii.107)
Fisetin ^(viii.40)	Anti-inflammatory and antioxidant effects. ^(viii.41) Blocks formation of weak blood vessels in mice with high blood sugar. ^(viii.41)
Myricetin ^(viii.40)	Anti-inflammatory effects. ^(viii.45) In diabetic rats, myricetin strongly blocked formation of AGEs and death of pericyte cells in eyes (an early sign of diabetic retinopathy). ^(viii.94)
Niacin ^(viii.46)	Anti-inflammatory effects. ^(viii.47) Helps boost healthy HDL cholesterol levels in people with type 2 diabetes, and protects blood vessel function. ^(viii.108)
Protocatechuic acid ^(viii.39)	Antioxidant and anti-inflammatory effects. ^(viii.88) Reduced elevated blood sugar levels and stimulated insulin levels in diabetic mice. ^(viii.88) Lowered triglyceride levels in blood and organs. ^(viii.88)
Resveratrol ^(viii.50)	Anti-inflammatory and antioxidant activity in eye cells. ^(viii.81) Helped regulate blood sugar levels and reduce inflammatory AGE formation in diabetic rats. ^(viii.92) In preliminary human studies and case reports, resveratrol relaxes blood vessels and improves vision in diabetic retinopathy. ^(viii.61)
Quercetin ^(viii.40)	Anti-inflammatory and protects retina cells from free radicals. ^(viii.81) Increases healthy blood flow to eyes and blocks formation of defective capillaries in retina. ^(viii.81) Stimulates proteins that regulate a healthy metabolism. ^(viii.19-20)
Vitamin C ^(viii.46)	Antioxidant protection. ^(viii.30) Blocks activation of NF-κB inflammatory proteins. ^(viii.53) Some, but not all, population studies show a link between low plasma levels of vitamin C with higher incidence of diabetic retinopathy. ^(viii.109)
Vitamin E ^(viii.46)	Antioxidant protection. ^(viii.30) Blocks activation of NF-κB inflammatory proteins. ^(viii.53) Population studies don't show a link between vitamin E plasma levels and rate of diabetic retinopathy. However, a recently published small, randomized, controlled clinical trial suggest that vitamin E in combination with other antioxidants could help reduce free radical levels and preserve retina thickness in patients with diabetic retinopathy. ^{(viii.109-110)}
Whole turmeric extract	Anti-inflammatory and antioxidant effects in diabetic animal studies. ^{(viii.57, 63)} Promotes proteins that help prevent metabolic syndrome. ^(viii.25) Blocks development of abnormal blood vessels in animal studies. ^(viii.25) When combined with other herbs and spices (e.g., holy basil, black pepper) in multiherbal Diabecon supplements, helped reduce fasting and regular blood sugar levels in people with type 2 diabetes. ^(viii.111) Turmeric extract is one of the ingredients in a multiherbal eye-drop (Itone™), shown in animal studies to have significant anti-inflammatory effects. It also prevented formation of weak blood vessels. ^(viii.64) In a clinical study involving 137 patients with diabetic retinopathy, combining a TCM formula containing turmeric with conventional diabetes drugs slowed progression of the disease. Measurements taken over the course of the 2-year study showed that those treated with the turmeric formula had significantly better treatment outcomes than the patients treated with conventional drugs only. ^(viii.112)

Glycyrrhiza glabra, G. uralensis. ^(ii.15)

Black pepper is the dried, unripe seed of the woody Piper nigrum vine, white pepper is the dried ripe fruit with the outer part removed. ^(ii.15)

Holding cells together and helping them communicate. ^(iii.56)

Perivascular contractile cells around small blood vessels in the eye. ^(viii.81)

However, one of its metabolites (quercetin-3'-sulphate) was found to stimulate VEGF receptors. ^(viii.81)

Enzyme that produces angiotensin II. ^(viii.100)

Such as aspirin, sodium salicylate, and sulfasalazine. ^(viii.86)

Excess immune-system molecules that increase inflammation and damage blood vessels. ^(viii.86)

Such as aspirin, sodium salicylate, and sulfasalazine. ^(viii.86)

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