My Family Doctor
A family practitioner for over 25 years, Dr. Hubbard knows the medical world inside and out. Frustrated by managed care and the lack of time doctors were able to spend educating patients, he launched James Hubbard's My Family Doctor: The Magazine That Makes Housecalls, a national magazine written by health care practitioners that is his answer to hurried doctor visits, conflicting medical studies, and complicated treatment options.
B Vitamins Prevent Macular Degeneration
Logic fails, then succeeds for leading cause of blindness
A recent JAMA study is fascinating for two reasons. It gives us hope for preventing a leading cause of blindness in the United States, but it’s also a great example of why, while the popular “association” studies give us valuable information, they never prove causation. You need more-focused studies for that.
First, the great news: A combination of B vitamins taken daily can prevent acute macular degeneration (AMD), a disease that severely affects the vision of 1.75 million aging Americans. (Another seven million have early disease.) Until now, the only two known alterable risks factors were our old standbys, smoking and obesity. Aging, being female, and heredity also play a role.
When logic is wrong—then right
Investigators first suspected B vitamins might affect AMD when a large women’s study showed an association of high homocysteine levels with heart disease and, by the way, AMD. High homocysteine levels are associated with B vitamin deficiencies, so increasing B vitamins should lower heart disease risk, right?
Wrong.
A randomized, placebo-controlled, double-blind study (the best kind) showed no difference in heart disease in those taking B vitamin versus placebo.
Then they took a large subset of these women—all of whom had no sign of AMD—and followed them over seven years. The ones who took the B vitamins had about 40% less AMD. They also measured a smaller subset of follow-up blood homocysteine levels, finding a decrease in the treatment group.
That is how studies are supposed to be done: start general, get suppositions, and then get specific.
By the way, the treatment group received 2.5 mg of folic acid, 50 mg of pyridoxine hydrochloride (B-6), and 1 mg of cyanocobalamin (B-12) per day.
Any questions? Has anyone been affected by macular degeneration?
By James Hubbard, MD, MPH
My Family Doctor Blog
[Originally posted March 2, 2009, James Hubbard’s My Family Doctor Web site.]
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