Lutein and Zeaxanthin for Protection
against Macular Degeneration
Age-related macular degeneration is the leading cause of legal blindness in older Americans.
Therefore, it’s important to decrease the risk as much as possible. The age-related eye disease studies (AREDS) showed that supplementation with certain micronutrients reduces the risk of progression from intermediate age-related macular degeneration to the advanced stage by 25 percent. Also, a diet rich in fruits and vegetables, as well as twice-weekly meals of fat-rich fish like salmon, sardines, tuna, or mackerel is associated with decreased risk.
There have been two AREDS studies. AREDS1 showed that 15 milligrams (mg) of beta carotene, 500 mg of vitamin C, 400 IU of vitamin E, 80 mg of zinc oxide, and 2 mg of cupric oxide reduced the risk of disease progression. AREDS2 tested the substitution of 10 mg of lutein and 2 mg of zeaxanthin for beta carotene. This substitution did not diminish the effectiveness of the formula, and was especially helpful for people who had low level consumption of lutein and zeaxanthin in their diet.
Beta carotene, lutein, and zeaxanthin are all specific types of phytochemicals (micronutrients from plants) called carotenoids, which are structurally related to vitamin A. Our bodies do not make these micronutrients; however, plants make them, in part, to serve as antioxidants* that protect them from potentially harmful sunlight. When we eat lutein and zeaxanthin, they are transported to the retina, where they are thought to protect against light-induced damage. There’s normally enough lutein and zeaxanthin in the macula, the central part of the retina, to turn this part yellow. In fact, the full name of the macula is macula lutea, means yellow spot. It has been shown that taking lutein and zeaxanthin supplements leads to increased levels of these antioxidants in the macula.
Foods such as egg yolk (go easy due to cholesterol), yellow corn, orange or yellow peppers, kale, broccoli, spinach, kiwi, grapes, zucchini, and squash have high levels of lutein and/or zeaxanthin.
For people without macular degeneration, the above foods are a good way to decrease the risk of AMD. For those with early macular degeneration,** the AREDS2 vitamins are recommended. AREDS1 formula vitamins are no longer recommended as the AREDS2 formula is at least as good, and the beta carotene in AREDS1 increases the risk of lung cancer in current smokers and perhaps also in past smokers.
Family members of people with macular degeneration often ask whether they should take AREDS2 vitamins or lutein/zeaxanthin. While these are safe to take during a period of at least five years (the duration of the AREDS2 study), it is not known whether it would be safe to take them for a number of decades. Therefore, it is recommended that family members eat foods containing high levels of lutein and zeaxanthin rather than take the supplements. These foods also contain hundreds of other phytochemicals that are likely to be helpful.
*Antioxidants are man-made or natural substances that may prevent or delay some types of cell damage. Antioxidants are found in many foods, including fruits and vegetables. They are also available as dietary supplements. (Source: Medline Plus)
**Early macular degeneration can be diagnosed by an ophthalmologist during a dilated eye exam showing a certain number of white spots in the retina called drusen.
Joshua L. Dunaief, MD, PhD Associate Professor of Ophthalmology Scheie Eye Institute University of Pennsylvania
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