3/20/2014 Macular Society | Nutrition | Lutein and zeaxanthin

http://www.macularsociety.org/about-macular-conditions/Nutrition/Xanthophylls-Lutein-Zeaxanthin-Meso-zeaxanthin 1/3
Lutein and zeaxanthin
Since the first Age-Related Eye Disease Study (AREDS 1) in 1992, research has
suggested that the dietary xanthophyll-s lutein and zeaxanthin may be effective
in reducing the risk of getting age-related macular degeneration (AMD) or its
progression. This is due to their high concentrations in the macula, where they
are known as the macular pigment. The AREDS 2 trial investigated this link
further.
Introduction
The macular pigment has protective qualities which may be related to AMD. Xanthophylls
are only obtained from the diet; therefore a persons macular pigment levels may be
dependent on dietary habits.
A large amount of research suggests that lutein and zeaxanthin may be more effective
than other nutrients in reducing the risk of getting AMD or it progressing. This is due to
their antioxidant and protective properties.
A high concentration of lutein, zeaxanthin, and a related compound meso-zeaxanthin, are
found in the macula, where they are known as the macular pigment.
The macular pigment protects the macula in several ways, it has the ability to interact with
free radicals and filter out damaging blue light. By acting as a blue light filter the macular
pigment can protect the cells responsible for vision from light damage. Lutein in particular
has been shown to have the highest blue light filtering properties.
Free radicals are produced in the body when oxygen reacts with certain molecules. They
are known to damage or destroy cells, altering their function and preventing them from
regenerating. They may be formed in the retina (light sensitive area at the back of the eye
which contains the macula) due to its high demand for oxygen. Long term exposure may
cause damage of the light sensing cells responsible for vision.
Dietary sources of lutein and zeaxanthin
Lutein and zeaxanthin can only be obtained by the human body from the diet, and meso-
zeaxanthin is converted from lutein in the macula. An individuals macular pigment levels
can therefore vary depending on their diet.
Around 78% of lutein and zeaxanthin is gained from eating vegetables particularly dark
green leafy vegetables, such as kale and spinach. Corn and corn products are also a major
source of zeaxanthin.
Eggs also contain high levels of both lutein and zeaxanthin, which is more easily absorbed
by the body than from vegetables because of the fats they contain.
3/20/2014 Macular Society | Nutrition | Lutein and zeaxanthin
http://www.macularsociety.org/about-macular-conditions/Nutrition/Xanthophylls-Lutein-Zeaxanthin-Meso-zeaxanthin 2/3
Similarly, cooking, or eating these foods with fats or oil, or choosing a supplement that
contains lutein and zeaxanthin bound in oil, can also help the body absorb them more
effectively.
The list below shows which vegetables have the highest amount of lutein.
Lutein mg/100mg
Kale 21.9
Spinach 12.6
Celery 3.6
Broccoli 1.8
Peas 1.7
Sprouts 1.3
Macular pigment and lutein, zeaxanthin & meso-zeaxanthin
The level of macular pigment can be increased with dietary change, either by taking
supplements containing lutein and zeaxanthin or by eating foods rich in these nutrients.
Doses of 10mg or higher per day of lutein have been found to have the most positive
effects on macular pigment levels.
Other factors which may influence the levels of macular pigment in a person include
smoking habits (lower levels in smokers), genetics such as iris colour (lower levels with
lighter iris colour), and gender (higher levels reported in men in some studies). Some
studies have also reported that an increased body fat is associated with decreased levels
of macular pigment.
One research group has looked at the relationship between supplements containing meso-
zeaxanthin and macular pigment levels. They have found that supplements containing
lutein, zeaxanthin and meso-zeaxanthin potentially offer advantages over supplements
that do not contain meso-zeaxanthin. Further large scale trials may be needed to confirm
these findings.
What does this mean?
Research supports the theory that high macular pigment levels may reduce your risk of
AMD or its progression. Macular pigment can be increased by taking supplements with
lutein or zeaxanthin or by changing your diet to include more of them.
Effects on visual performance
A number of small trials have shown AMD patients who use supplements containing lutein
have improved visual performance including their visual acuity, contrast sensitivity, glare
recovery and visual distortion.
The majority of these studies have found an improvement in the visual performance of
patients given 10 mg or higher per day with lutein alone or combined with zeaxanthin and
other antioxidants.
The large scale AREDS 2 trial found no effect of lutein 10mg and zeaxanthin 2mg together
3/20/2014 Macular Society | Nutrition | Lutein and zeaxanthin
http://www.macularsociety.org/about-macular-conditions/Nutrition/Xanthophylls-Lutein-Zeaxanthin-Meso-zeaxanthin 3/3
on visual acuity. The trial analysed the progression to moderate or worse vision loss,
defined as a reduction of 15 or more letters.
The AREDS 2 results mean that findings from smaller trials which suggest improvements
on visual performance should be treated with caution - more large scale studies are
needed.
AMD prevention or delay with lutein and zeaxanthin
Higher macular pigment levels due to taking supplements with lutein and zeaxanthin has
been shown to delay or prevent AMD in some studies, but research is still on-going in this
area.
There are a number of trials which have investigated the protective role of lutein and
zeaxanthin supplements in individuals with AMD, such as AREDS 2.
The AREDS 2 trial investigated the effect of lutein, zeaxanthin and omega-3 to delay the
progression of advanced AMD. It found that overall there was no additional benefit of
adding lutein and zeaxanthin to the original AREDS formula of antioxidants, however,
participants who took the AREDS formulation with no beta-carotene but with lutein and
zeaxanthin, had their risk of progressing to advanced AMD reduced by 18%. Participants
who had a low dietary intake of lutein and zeaxanthin at the start of the study who took a
version of the AREDS formula with lutein and zeaxanthin instead of beta-carotene were
also 25% less likely to develop advanced AMD.
Investigators have suggested that beta-carotene may have masked the effects of lutein
and zeaxanthin in the overall analysis because it competes with lutein for absorption in the
body. It also is linked to an increased risk of lung cancer in smokers and former smokers.
The AREDS 2 investigators now suggest that 10mg of lutein and 2mg of zeaxanthin should
replace beta-carotene in the original AREDS formula. This is a safe and effective tool for
the treatment of AMD.
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