If I’m taking AREDS 2 vitamins for Macular Degeneration should I take a multivitamin too?

High levels of antioxidants and zinc significantly reduce the risk of advanced age-related macular degeneration (AMD) and its associated vision loss. Researchers found that people at high risk of developing advanced stages of AMD, a leading cause of vision loss, lowered their risk up to 26% when taking vitamins which contained:

• 500 milligrams vitamin C
• 400 international units of vitamin E
• 10 milligrams lutein
• 2 milligrams zeaxanthin
• 80 milligrams zinc
• 2 mg copper

This dosage of vitamins and minerals is referred to as the AREDS 2 (Age Related Eye Disease Study 2) formula and most people at high risk for vision loss from macular degeneration should be on this formula.¹

There is some concern however with this formula if you add additional vitamins to it. Especially additional Vitamin E and Zinc

Effects of Vitamin E with Macular Degeneration

The level of vitamin E in the AREDS 2 formula is fairly high and although in the study it was shown to be a safe dosage, additional vitamin E over 400 units a day may lead to some unwanted side effects.

One analysis found an increased risk of death at doses over 400 IU/day. ²

Another study showed dosages over 400 IU/day may harm adult men in the general population by increasing their risk of prostate cancer.³

Vitamin E can can prevent or slow blood clotting, so taking large doses with anticoagulant or antiplatelet medications, such as warfarin (Coumadin®) can increase the risk of bleeding. The amounts of supplemental vitamin E needed to produce clinically significant effects are unknown but probably exceed 400 IU/day.

Effects of Zinc with Macular Degeneration

The AREDS study observed a zinc intake of 80 mg per day in the form of zinc oxide. This dosage has been associated with a significant increase in hospitalizations for genital and urinary conditions, raising the possibility that chronically high intakes of zinc adversely affect some aspects of urinary physiology.⁴

Therefore, total daily supplement of Zinc should probably not exceed the 80MG per day that is in the AREDS 2 formula.

Effects of Multivitamins with Macular Degeneration

Centrum Silver, one of leading multivitamin supplements, if taken along with the AREDS 2 formula vitamins would add another 50IU of vitamin E and an additional 11 mg of Zinc. Since the AREDS 2 formula already has close to what many consider the daily highest safe dosage of those two ingredients you need to be cautious about adding more to that.

The AREDS 2 formula alone does not provide many of the other vitamins that many people want such as Vitamin D and the B vitamins.  If you want to take those supplements also we recommend you take them individually to avoid excess vitamin E or Zinc. 

^{1) The Age-Related Eye Disease Study 2 (AREDS2) Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-15. [PubMed abstract]}

^{2) Miller ER 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005;142:37-46. [PubMed abstract]}

^{3) Klein EA, Thompson Jr. IM, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011;306:1549-1556. [PubMed abstract].}

^{4) Johnson AR, Munoz A, Gottlieb JL, Jarrard DF. High dose zinc increases hospital admissions due to genitourinary complications. J Urol 2007;177:639-43. [PubMed abstract]}