Lutein benefit and side effects, pills in 6 mg, 10 mg, 20 mg
Right dosage for long term use
Does this nutrient help improve vision and visual acuity?
July 2 2017 by Ray Sahelian, M.D.

Lutein is a carotenoid, not a vitamin, 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.
These xanthophylls form the macular pigment with the highest density in the macula lutea. In humans, as in plants, this xanthophyll 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.

Benefit for eyesight health, better vision
The benefit of these two carotenoids is to absorb light in the blue-green region of the visible spectrum. In humans their roles 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.

Physician Formulas, Lutein, 6 mg, 60 Capsules
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Lutein is a potent antioxidant carotenoid found in abundance in fruits and green leafy vegetables. It is also one of the dominant pigments found in the macular region of the retina. In the macula, it is selectively accumulated from plasma and filters out visible blue light. Studies suggest this filtering process serves to protect the retina from damage caused by light or oxidation. Oral supplementation with lutein and zeaxanthin increase the levels of macular pigments in the retina and plasma.
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Suggested Use, dosage, how much to take
One capsule with breakfast two or three times a week, or as recommended by your health care professional. There is a possibility that taking too high a dose could negatively alter the carotenoid balance in the retina and thus be counterproductive. That is why we suggest that most people will do fine with 6 mg using it a few times a week rather than daily. Some may benefit from 10 mg.

Supplement Facts
Serving Size: 1 Capsule
Serving Per Bottle: 60 Capsules
  Amount Per Capsule % DV
Lutein (Marigold petal extract) (with 240 mcg of Zeaxanthin)
6 mg
Daily Value or Recommended Daily Intake not established.

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.

Q. There are several products, which one is better: the Eyesight Rx or the 6 mg pill or 10 mg?
    A. Eyesight Rx contains more than a dozen nutrients for eye health, and most people notice visual benefits more from the formula than lutein alone.

Food sources, dietary intake
Lutein is found in dark green leafy vegetables and egg yolks. Kale and spinach have high concentrations. Corn and collard greens also have this substance.

Age related macular degeneration benefit and treatment
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 be of benefit and is also helpful in retinal degeneration.

Invest Ophthalmol Vis Sci. 2014. Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration. To evaluate the effects of lutein and zeaxanthin on visual function in randomized controlled trials of AMD patients. Lutein and zeaxanthin supplementation is a safe strategy for improving visual performance of AMD patients, which mainly showed in a dose-response relationship.

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).
Optometry. 2004.
The objective of the lutein antioxidant supplementation trial (LAST) is to determine whether nutritional supplementation with lutein or 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. 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; and in Group 3, a placebo over 12 months. In this study, visual function is improved with lutein supplement alone or together with other nutrients.

Molecules. 2017. The Pharmacological Effects of Lutein and Zeaxanthin on Visual Disorders and Cognition Diseases. Lutein and zeaxanthin are dietary carotenoids derived from dark green leafy vegetables, orange and yellow fruits that form the macular pigment of the human eyes. It is hypothesized that they protect against visual disorders and cognition diseases, such as age-related macular degeneration (AMD), age-related cataract (ARC), cognition diseases, ischemic/hypoxia induced retinopathy, light damage of the retina, retinitis pigmentosa, retinal detachment, uveitis and diabetic retinopathy. The mechanism by which they are involved in the prevention of eye diseases may be due their physical blue light filtration properties and local antioxidant activity. In addition to their protective roles against light-induced oxidative damage, there are increasing evidences that they may also improve normal ocular function by enhancing contrast sensitivity and by reducing glare disability. Surveys about lutein and zeaxanthin supplementation have indicated that moderate intakes are associated with decreased AMD risk and less visual impairment.

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

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.
Seventeen patients clinically diagnosed with age-related cataracts were randomized in a double-blind study involving dietary supplementation with lutein 15 mg, alpha-tocopherol 100 mg, or placebo, three times a week for up to 2 years. 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.

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. 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. Journal of Nutrition, 2004.

Retinitis pigmentosa help
Supplementation appears to be of benefit in those who have retinitis pigmentosa.

Lutein improves visual function in some patients with retinal degeneration: a pilot study via the Internet.
Optometry. 2000.
Sixteen participants (13 with retinitis pigmentosa, 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. Mean visual acuity improved starting 2 to 4 weeks after supplementation, and plateaued at 6 to 14 weeks.

Additional benefits
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 to the prevention of heart disease and stroke.

Heart disease, blood vessel health
Atherosclerosis. 2013. Lutein supplementation reduces plasma lipid peroxidation and C-reactive protein in healthy nonsmokers.

Am J Clin Nutr. 2016. The effects of lutein on cardiometabolic health across the life course: a systematic review and meta-analysis. Our findings suggest that higher dietary intake and higher blood concentrations of lutein are generally associated with better heart health. However, evidence mainly comes from observational studies in adults, whereas large-scale intervention studies and studies of lutein during pregnancy and childhood are scarce.

Daily requirement
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.

Lutein side effects, safety, concern, risk
I can't find any human 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 for long periods may disturb the balance of carotenoids in eye tissue or other organs and result in fuzzy vision until the supplements are stopped and the balance restored over a few days. It is best to keep dosage to a total of less than 30 mg over a period of a week.

Chronic Ingestion of Lutein and Zeaxanthin in the Female Rhesus Macaque.
Invest Ophthalmol Vis Sci. 2006.
Eighteen female rhesus monkeys were divided into groups of control, L-treated 9.3 mg lutein per kg and 0.6 mg zeaxanthin per kg, Zeaxanthin -treated 10 mg/kg), and Lutein / Zeaxanthin -treated each 0.5 mg/kg. Supplementation increased the mean plasma and ocular tissue concentrations of these carotenoids and their metabolites. The mean levels in the retinas of the treated animals after 1 year increased significantly over baseline. High dose supplementation of monkeys with these two carotenoids did not cause ocular toxicity and had no effect on biomarkers associated with kidney toxicity.

With 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. Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA.
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 the combination. Lutein supplementation increased macular pigment optical density eccentrically. DHA resulted in central increases. These results may be due to changes in lipoproteins. Both may aid in prevention of age-related macular degeneration.

Research studies
Plasma kinetics of lutein, zeaxanthin, and 3-dehydro-lutein after multiple oral doses of a lutein supplement.
American Journal of Clinical Nutrition 2005
After a run-in period of 7 d, 19 healthy volunteers were assigned to receive daily oral doses of 4 mg lutein or 20 mg for 42 days or placebo. Lutein was well tolerated and did not affect the concentrations of other carotenoids. Long-term supplementation with 4 and 20 mg increased plasma lutein concentrations approximately 3.5- and 10-fold, respectively.

Macular carotenoids
Dev Ophthalmol. 2005.
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. 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.

How much lutein is there in bilberry?
   I don't know how much is found in bilberry but I suspect it is very small.

Other products to purchase online
Now Foods, Lutein, 10 mg, 120 Softgels
Now Foods lutein product is extracted from the marigold flower.

Supplement Facts
Serving Size: 1 Softgel
  Amount Per Serving % Daily Value
Lutein (Free Lutein) (from 18.5 mg Lutein Esters) (Xangold) (derived from Marigold Flowers) 10 mg *
* Daily Value not established.

Supplement Facts: Lutein 10 mg each pill
Buy Lutein or Eyesight Rx vision formula that work in a day or two

Doctor's Best, Lutein with OptiLut, 20 mg, 120 Veggie Caps
Jarrow Formulas Lutein, Supports Visual Function and Macular Health, 20mg, 30 Softgels - If you pruchase 20 mg pills use them only at most three times a week.

How much lutein is in Ocuvite?
   I have not used this product, but a search reveals there is 6 mg in Ocuvite.