Lutein Benefit and side effects by RaySahelian, M.D.,

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Lutein benefit and side effect information
Lutein supplement information
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Lutein is a carotenoid which has become popular as a dietary supplement either by itself, or combined with zeaxanthin and other carotenoids, herbs, and vitamins for the prevention and improvement of visual disorders such as macular degeneration or to help support healthy eyesight. Humans consume 1 to 3 mg lutein per day and the lutein:zeaxanthin ratio in the diet is about 5:1.

Food sources of Lutein
Lutein is found in dark green leafy vegetables and egg yolks. Kale and spinach have high concentrations of lutein. Corn and collard greens also have lutein.

Lutein, 20 mg, 60 Capsules
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Lutein is a potent antioxidant carotenoid found in abundance in fruits and green leafy vegetables. Lutein is also one of the dominant pigments found in the macular region of the retina. In the macula, lutein is selectively accumulated from plasma and filters out visible blue light. Recent studies suggest this filtering process serves to protect the retina from damage caused by light or oxidation. This Lutein product is extracted from the marigold flower.

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Lutein Supplement Facts:
Lutein - 20 mg *

Suggested Use: One lutein capsule with breakfast one or two times a week, or as recommended by your health care professional.
* Lutein supplement daily value not established.

Eyesight Rx with Lutein and Zeaxanthin for better vision
Supports Healthy Vision
Developed by Ray Sahelian, M.D.

Supplement Facts:
Vitamin C (Ascorbic acid)
Citrus bioflavonoids (eriocitrin, hesperidin, flavonols, flavones,
flavonoids, naringenin, and quercetin)
Mixed carotenoids (astaxanthin, beta carotene, cryptoxanthin, lutein,
zeaxanthin, lycopene).
Bilberry extract  (Vaccinium myrtillus)
Eyebright extract (Euphrasia officianales)
Jujube extract (Zizyphus jujube)
Ginkgo biloba (Ginkgo biloba)
Suma extract (Pfaffia paniculata)
Mucuna-Pruriens extract (Cowhage)
Cinnamon (Cinnamomum zeylanicum)
Lycium berry extract (Lycium Barbarum)
Sarsaparila (Sarsaparilla Smilax)
Alpha Lipoic Acid

See
Eyesight-Rx for more information

The benefit of Lutein and Zeaxanthin in eyesight
Lutein is a pigment
found in the macula of the eye. The benefit of lutein and zeaxanthin is to absorb light in the blue-green region of the visible spectrum. In humans the roles of lutein and zeaxanthin are to improve visual function and to act as antioxidants in order to protect the macula from damage by oxidative stress. Of the many carotenoids circulating in human sera, only lutein and zeaxanthin are accumulated throughout the tissues of the eye. Within the eye, they reach their highest concentration in the central retina, where vision is at its sharpest.

Benefit of Lutein for Age Related Macular Degeneration
Age-related macular degeneration is the leading cause of vision loss in aging Western societies. The macula is a small area of the retina that has the sharpest vision. With age, the macula degenerates leading to poor eyesight.  Lutein supplementation appears to benefit. Lutein is also helpful in retinal degeneration.

Benefit of Lutein for Cataract
Visual function in patients with age-related cataracts who received lutein supplements improved, suggesting that a higher intake of lutein, through lutein -rich fruit and vegetables or supplements, may have beneficial effects on the visual performance of people with age-related cataracts.

Daily Requirement for Lutein
It has been estimated that Americans consume about 1 to 2 mg of lutein per day, although dietary guidelines of the US Dietary Association Food Guide Pyramid recommend closer to 3 mg a day.

Additional benefits of Lutein and Zeaxanthin
Lutein and zeaxanthin are xanthophyll carotenoids widely distributed in tissues and are the principal carotenoids in the eye lens and macular region of the retina. Epidemiologic studies indicating an inverse relationship between xanthophyll intake or status and both cataract and age-related macular degeneration suggest these compounds can play a protective role in the eye. Some studies have also shown these xanthophylls may help reduce the risk of certain types of cancer, particularly those of the breast and lung. Emerging studies suggest as well a potential contribution of lutein and zeaxanthin to the prevention of heart disease and stroke.

Lutein side effects
I can't find any research that points to any possible lutein side effects, however there could be some lutein side effects if too a high a dose is taken for too long. I am just guessing, but taking a very high amount of lutein supplement could disturb the balance of carotenoids in eye tissue or other organs and result in fuzzy vision until the lutein supplements are stopped and the balance restored over a few days. It is best to keep lutein dosage to less than 30 mg over a period of a week.

Lutein and DHA for optimal retinal health
It appears that lutein and DHA influence different areas of the retina and hence would be synergistic in their benefits.

The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation.
Am J Clin Nutr. 2008 May. Johnson EJ, Chung HY, Caldarella SM, Snodderly DM. Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 02111, USA.
Lutein and docosahexaenoic acid (DHA) may protect against age-related macular degeneration (AMD). Lutein is a component of macular pigment. DHA is in the retina. The objective of this 4-month study was to determine the effects of lutein (12 mg/d) and DHA (800 mg/d) on their serum concentrations and macular pigment optical density. Forty-nine women (60-80 years) were randomly assigned to placebo, DHA, lutein, or lutein + DHA supplement.  There was no interaction between lutein and DHA supplementations for serum lutein and macular pigment optical density. Lutein supplementation increased Macular pigment optical density eccentrically. DHA resulted in central increases. These results may be due to changes in lipoproteins. Lutein and DHA may aid in prevention of age-related macular degeneration.

Lutein Zeaxanthin safety
The xanthophylls lutein and zeaxanthin form the macular pigment with the highest density in the macula lutea.

Chronic Ingestion of (3R,3'R,6'R)- Lutein and (3R,3'R)- Zeaxanthin in the Female Rhesus Macaque.
Invest Ophthalmol Vis Sci. 2006 Dec;47(12):5476-86. Khachik F, London E, et al. Department of Chemistry and Biochemistry, Joint Institute for Food Safety and Applied Nutrition (JIFSAN), University of Maryland, College Park, Maryland;
To investigate how supplementation of the monkey's diet with high doses of lutein, zeaxanthin, or a combination of the two affects the plasma levels and ocular tissue deposition of these carotenoids and their metabolites over time and to determine whether these high doses can cause ocular toxicity. Eighteen female rhesus monkeys were divided into groups of control (n = 3 control), L-treated (n = 5, 9.34 mg lutein per kg and 0.66 mg zeaxanthin per kg), Zeaxanthin -treated (n = 5, 10 mg zeaxanthin /kg), and Lutein / Zeaxanthin -treated (n = 5, lutein and zeaxanthin, each 0.5 mg/kg). After 12 months of daily supplementation, one control animal, two Lutein -treated animals, two Zeaxanthin -treated animals, and all the Lutein / Zeaxanthin -treated animals were killed. The rest of the monkeys were killed after an additional six months without supplementation. Supplementation of monkeys with Lutein and/or Zeaxanthin  increased the mean plasma and ocular tissue concentrations of these carotenoids and their metabolites. The mean levels of Lutein and Zeaxanthin  in the retinas of the Lutein - and Zeaxanthin -treated animals after 1 year increased significantly over baseline. High dose supplementation of monkeys with Lutein or Z eaxanthin did not cause ocular toxicity and had no effect on biomarkers associated with kidney toxicity. CONCLUSIONS: The mean levels of Lutein and Zeaxanthin in plasma and ocular tissues of the rhesus monkeys increase with supplementation and in most cases correlate with the levels of their metabolites. Supplementation of monkeys with Lutein or Zeaxanthin at high doses, or their combination does not cause ocular toxicity.

Lutein Research Update
Plasma kinetics of lutein, zeaxanthin, and 3-dehydro-lutein after multiple oral doses of a lutein supplement.
American Journal of Clinical Nutrition, Vol. 82, No. 1, 88-97, July 2005
Adequate intake of lutein is thought to reduce the risk of age-related macular degeneration. The objective of this study was to determine lutein plasma kinetics in a multiple dosing design and to assess the effects of lutein intake on concentrations of other plasma carotenoids. After a run-in period of 7 d, 19 healthy volunteers were assigned to receive daily oral doses of 4.1 mg lutein (n = 8; group 1) or 20.5 mg lutein (n = 8; group 2) for 42 d or no lutein (n = 3; control group). The supplement contained 8.3% zeaxanthin relative to lutein (100%). Average plasma all-E- lutein concentrations increased from 0.14 to 0.52 and 1.45 µmol/L in groups 1 and 2, respectively. Dose-normalized lutein bioavailability in group 2 was {approx} 60% of that in group 1. On average, dosing for 18 d was required to reach a >90% fraction of the steady state concentration, which is consistent with an effective half-life for accumulation of {approx}5.6 d. Lutein was well tolerated and did not affect the concentrations of other carotenoids. Conclusion: Long-term supplementation with 4.1 and 20.5 mg lutein as beadlets increased plasma lutein concentrations {approx}3.5- and 10-fold, respectively.

Dietary lutein and zeaxanthin: possible effects on visual function.
Nutr Rev. 2005 Feb;63(2):59-64.
Of the many carotenoids circulating in human sera, only lutein and zeaxanthin are accumulated throughout the tissues of the eye. Within the eye, they reach their highest concentration in the central retina, where they are clinically referred to as the macula lutea. Lutein and zeaxanthin, more commonly referred to as macular pigments, may serve a variety of roles in the specialized vision of higher primates. This paper reviews recent studies investigating the influence of macular pigments on human visual performance. Such studies have offered insight into why lutein and zeaxanthin are uniquely concentrated in ocular tissues.

Macular carotenoids: lutein and zeaxanthin.
Dev Ophthalmol. 2005;38:70-88.
The yellow color of the macula lutea is due to the presence of the carotenoid pigments lutein and zeaxanthin. In contrast to human blood and tissues, no other major carotenoids including Beta-carotene or lycopene are found in this tissue. The macular carotenoids are suggested to play a role in the protection of the retina against light-induced damage. Epidemiological studies provide some evidence that an increased consumption of lutein and zeaxanthin with the diet is associated with a lowered risk for age-related macular degeneration, a disease with increasing incidence in the elderly. Protecting ocular tissue against photooxidative damage carotenoids may act in two ways: first as filters for damaging blue light, and second as antioxidants quenching excited triplet state molecules or singlet molecular oxygen and scavenge further reactive oxygen species like lipid peroxides or the superoxide radical anion.

Human eye cells treated with lutein and zeaxanthin showed less damage after being exposed to ultraviolet rays, the sunlight ingredient considered a major contributor to cataracts. Cataracts occur when proteins in the eye's lens begin to clump together, forming a milky cloud that obscures vision. It is thought that the more sunlight a person is exposed to in life, the greater the risk for cataracts. Foods that contain particularly high doses of lutein and zeaxanthin include kale and spinach. Researchers at Ohio State University in Columbus grew human lens cells in a laboratory, then added lutein, zeaxanthin, vitamin E, or left the cells alone. The researchers then exposed the eye cells to ultraviolet (UV) radiation, in order to mimic the effect of sunlight. Lens cells mixed with lutein and zeaxanthin showed significantly less damage following UV-exposure than cells that had no shielding from antioxidants. Although vitamin E appeared to offer some protection from UV rays, it was surpassed by both lutein and zeaxanthin. SOURCE: Journal of Nutrition, December 2004.

An ideal ocular nutritional supplement?
Ophthalmic Physiol Opt. 2004 Jul;24(4):339-49.
The aim of this review is to identify those antioxidants most appropriate for inclusion in an ideal ocular nutritional supplement, suitable for those with a family history of glaucoma, cataract, or age-related macular disease, or lifestyle factors predisposing onset of these conditions, such as smoking, poor nutritional status, or high levels of sunlight exposure. It would also be suitable for those with early stages of age-related ocular disease. Literature searches were carried out on Web of Science and PubMed for articles relating to the use of nutrients in ocular disease. Those highlighted for possible inclusion were vitamins A, B, C and E, carotenoids beta-carotene, lutein, and zeaxanthin, minerals selenium and zinc, and the herb, Ginkgo biloba. Conflicting evidence is presented for vitamins A and E in prevention of ocular disease; these vitamins have roles in the production of rhodopsin and prevention of lipid peroxidation respectively. B vitamins have been linked with a reduced risk of cataract and studies have provided evidence supporting a protective role of vitamin C in cataract prevention. Beta-carotene is active in the prevention of free radical formation, but has been linked with an increased risk of lung cancer in smokers. Improvements in visual function in patients with age-related macular disease have been noted with lutein and zeaxanthin supplementation. Selenium has been linked with a reduced risk of cataract and activates the antioxidant enzyme glutathione peroxidase, protecting cell membranes from oxidative damage. As well as reducing platelet aggregation and increasing vasodilation, Gingko biloba has been linked with improvements in pre-existing field damage in some patients with normal tension glaucoma. We advocate that vitamins C and E, and lutein / zeaxanthin should be included in our theoretically ideal ocular nutritional supplement.

Double-masked, placebo-controlled, randomized trial of antioxidant and  lutein supplement in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).
Richer S, Stiles W, Statkute L et al. Optometry. 2004;75:216-30.
Age-related macular degeneration (ARMD) is the leading cause of vision loss in aging Westem societies. The objective of the lutein antioxidant supplementation trial (LAST) is to determine whether nutritional supplementation with lutein or lutein together with antioxidants, vitamins, and minerals, improves visual function and symptoms in atrophic ARMD. The study was a prospective, 12-month, randomized, double-masked, placebo-controlled trial conducted at an urban midwestern Veterans Administration Hospital from August 1999 to May 2001. Ninety patients with atrophic ARMD were referred by ophthalmologists at two Chicago-area veterans medical facilities. Patients in Group 1 received lutein 10 mg (L); in Group 2, a lutein 10 mg/antioxidants/vitamins and minerals broad spectrum supplementation formula (L/A); and in Group 3, a maltodextrin placebo (P) over 12 months. In Groups 1 L and 2 L/A, mean eye macular pigment optical density increased approximately 0.09 log units from baseline, Snellen equivalent visual acuity improved 5.4 letters for Group 1 L and 3.5 letters for Group 2 L/A, and contrast sensitivity improved. In this study, visual function is improved with lutein supplement alone or lutein together with other nutrients. Further studies are needed with more patients, of both genders, and for longer periods of time to assess long-term effects of lutein or lutein together with a broad spectrum of antioxidants, vitamins, and minerals in the treatment of atrophic age-related macular degeneration.


Antioxidants, Lutein and Eyesight -- The January, 2003 issue of the medical journal
The macula is a small area of the retina that has the sharpest vision. With age, the macula degenerates leading to poor eyesight. Thirty patients with early macular degeneration were divided into two groups, antioxidant group (A) and no treatment group (NT). Patients in the A group were given lutein, 15 mg; vitamin E, 20 mg; and nicotinamide, 18 mg, daily for 180 days, whereas NT patients had no dietary supplementation during the same period. In all patients and normal subjects, retinal assessment was performed at the start of the study and after 180 days. When evaluated at 180 days, the macula had improved in those taking the antioxidants while the NT group did not have any changes. The results suggest that increasing the level of retinal antioxidants influences macular function early in the disease process, as well as in normal aging. Dr. Sahelian says: There are so many antioxidants to choose from for enhanced eyesight that it is difficult to recommend a specific combination that would apply to everyone. Supplements of lutein, vitamins C and E, and lipoic acid should be on the top of the list for eyesight improvement, along with, of course, plenty of organic fruits and vegetables.

Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-y double-blind, placebo-controlled pilot study.

Nutrition. 2003 Jan;19(1):21-4.
We investigated the effect of long-term antioxidant supplementation (lutein and alpha-tocopherol) on serum levels and visual performance in patients with cataracts. METHODS: Seventeen patients clinically diagnosed with age-related cataracts were randomized in a double-blind study involving dietary supplementation with lutein (15 mg; n = 5), alpha-tocopherol (100 mg; n = 6), or placebo (n = 6), three times a week for up to 2 y. Serum carotenoid and tocopherol concentrations were determined with quality-controlled high-performance liquid chromatography, and visual performance (visual acuity and glare sensitivity) and biochemical and hematologic indexes were monitored every 3 mo throughout the study. Changes in these parameters were assessed by General Linear Model (GLM) repeated measures analysis. RESULTS: Serum concentrations of lutein and alpha-tocopherol increased with supplementation, although statistical significance was reached only in the lutein group. Visual performance (visual acuity and glare sensitivity) improved in the lutein group, whereas there was a trend toward the maintenance of and decrease in visual acuity with alpha-tocopherol and placebo supplementation, respectively. No significant side effects or changes in biochemical or hematologic profiles were observed in any of the subjects during the study. CONCLUSIONS: Visual function in patients with age-related cataracts who received the lutein supplements improved, suggesting that a higher intake of lutein, through lutein-rich fruit and vegetables or supplements, may have beneficial effects on the visual performance of people with age-related cataracts.

Lutein improves visual function in some patients with retinal degeneration: a pilot study via the Internet.
Optometry. 2000 Mar;71(3):147-64.
The purpose of this article is to examine the effects of lutein supplementation on visual acuity, central visual-field area, and subjective visual disturbances in retinitis pigmentosa (RP) and related retinal degenerations, in an international study population recruited via an Internet mailing list. Sixteen participants (13 with RP, three with other retinal degenerations) completed a 26-week program of lutein supplementation (40 mg/day for 9 weeks, 20 mg/day thereafter); 10 participants also took 500-mg docosahexaenoic acid (DHA)/day, vitamin B complex, and digestive enzymes. Ten participants previously taking vitamin A and/or beta-carotene continued those supplements throughout the study. Participants self-tested their visual acuity on their computer screen and their central visual-field extent on a wall chart, weekly for 14 weeks, bi-weekly thereafter. Mean visual acuity improved by 0.7 dB and mean visual-field area by 0.35 dB. Improvements started 2 to 4 weeks after supplementation began, and plateaued at 6 to 14 weeks. Visual acuity gains were strongly correlated with eye color: 1.2 dB in seven blue-eyed participants, but 0.3 dB in seven dark-eyed participants. Participants who received previous supplements showed greater benefits in central visual-field area (0.55 dB) than those not receiving previous supplements (no change). No significant effects of age, sex, disease stage, or study supplement were found. Short-term vision improvements after lutein supplementation--previously reported in age-related macular degeneration--also occur in RP, especially in blue-eyed individuals; vitamin A may increase visual field benefits.

The macular pigments are predominantly composed of three carotenoids: lutein, zeaxanthin, and meso-zeaxanthin. These pigments have two major roles: as filters and antioxidants. Evidence suggests that increased levels of macular pigment are correlated with a decreased risk of age-related macular degeneration. Studies reveal that oral supplementation with lutein and zeaxanthin can increase the levels of macular pigments in the retina and plasma.

The science behind lutein.
Toxicol Lett. 2004 Apr 15;150(1):57-83.
In humans, as in plants, the xanthophyll lutein is believed to function in two important ways: first as a filter of high energy blue light, and second as an antioxidant that quenches and scavenges photo induced reactive oxygen species (ROS). Evidence suggests that lutein consumption is inversely related to eye diseases such as age-related macular degeneration (AMD) and cataracts. This is supported by the finding that lutein (and a stereo isomer, zeaxanthin) are deposited in the lens and the macula lutea, an area of the retina responsible for central and high acuity vision. Human intervention studies show that lutein supplementation results in increased macular pigment and improved vision in patients with AMD and other ocular diseases. Lutein may also serve to protect skin from UV-induced damage and may help reduce the risk of cardiovascular disease. Crystalline lutein is readily absorbed from foods and from dietary supplements whereas, to enter the bloodstream, lutein esters require prior de-esterification by intestinal enzymes. Unlike the hydrocarbon carotenoids which are mainly found in the LDL fraction, xanthophylls like lutein and zeaxanthin are incorporated into both HDL and LDL. Today, lutein can be obtained from the diet in several different ways, including via supplements, and most recently in functional foods. Animal toxicology studies have been performed to established lutein's safety as a nutrient. These studies have contributed to the classification of purified crystalline lutein as generally recognized as safe (GRAS). The achievement of GRAS status for purified crystalline lutein allows for the addition of this form into several food and beverage applications. This achievement speaks directly to the quality and safety of purified lutein.

Lutein is not a vitamin. Lutein and zeaxanthin are often found together in supplements for eye health.

Lutein Manufacturers
Hi-Fil Lutein products, manufactured by Industrial Organica and distributed exclusively by Pharmline Inc., has self-affirmed GRAS (Generally Recognized As Safe) status, through an independent evaluation by an expert panel of scientists. This designation permits the incorporation of Hi-Fil in a variety of foods and beverages. Industrial Organica (IOSA), a leading manufacturer of a patented line of lutein and zeaxanthin products marketed under the Hi-Fil label, has been producing carotenoids in their cGMP facility since 1966. Sensing a market demand, IOSA conducted a review by an independent panel of scientific experts to determine the feasibility of Hi-Fil Lutein in food and beverage products applications. After comprehensive review, the panel unanimously agreed to award GRAS status, affirming the safety of the ingredient as an additive.

Lutein benefit and lutein side effect questions
Q. Are there any side effects to lutein supplement use? Is lutein for eyes, only?
   A. I would guess that high doses of lutein supplement could cause side effects but research has not indicated what these side effects would be. It is best to take a break from using a lutein supplement at least 2 days a week. Lutein is mainly for eyes, but since it is an antioxidant, it could potentially be helpful in other conditions, but research is quite limited. I would suggest not taking more than 20 mg 2 or 3 times a week.

Q. How much lutein is in Ocuvite?
   A. I have not used this product, so I don't know how much lutein is in Ocuvite.

Q. How much lutein is there in bilberry? I want to take lutein for eyes, I have macular degeneration.
   A. I don't know how much lutein is in bilberry.