Zeaxanthin supplement benefit for vision, eyesight and ocular nutrition, dosage, benefit for cataract prevention - food sources, dosage and daily intake - Ray Sahelian, M.D.
October 15 2017

Zeaxanthin is a carotenoid found in many vegetables and fruits, particularly green leafy vegetables such as kale and spinach. Zeaxanthin and lutein are becoming more popular since we now know that they have an important role in eye health and eyesight. Supplementation can improve vision and that is why many people supplement with an eye formula daily for this visual enhancement benefit. The ideal daily intake of this nutrient in food is not known, nor do we know for certain whether taking this carotenoid as a supplement for many months or years is a healthy way to insure good vision. For the time being I advise that you take less rather than more and take breaks from use.

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Reports from users indicate enhanced clarity of vision, colors being brighter, better focus, and overall improvement in close and distance vision. We've had reports of some people noticing this effect within hours, while most people notice improved eyesight within several days or even a week or two later.

Ingredients in Eyesight Rx include:
Citrus bioflavonoids (hesperidin, flavonols, flavones, flavonoids, naringenin, and quercetin)
Mixed carotenoids (alpha carotene, astaxanthin, beta carotene, cryptoxanthin,
Lycopene, Zeaxanthin and Lutein )
Bilberry extract (Vaccinium myrtillus).
Jujube extract
Ginkgo biloba blood vessel circulation enhancer
Mucuna pruriens extract (Cowhage)
Cinnamon herb (Cinnamomum zeylanicum)
Lycium berry extract (Lycium Barbarum)
Sarsaparila (Sarsaparilla Smilax)

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Zeaxanthin side effects, safety, risk, danger
Not enough research has been done to determine if there are side effects or risk from excess ingestion. Perhaps there could be slight distortion in vision if too high amounts are consumed which may interfere with the proper balance in the retina of zeaxanthin, lutein, and other carotenoids and substances necessary for optimal vision health.

Food sources of zeaxanthin and lutein, role of diet
These carotenoid antioxidants are found in spinach, kale, eggs, turnip greens, collard greens, romaine lettuce, broccoli, zucchini, corn, garden peas and Brussels sprouts. Foods that contain particularly high amounts are kale and spinach. Zeaxanthin supplement is often made from marigold flowers. A typical Marigold flower carotenoid profile is 80 percent lutein and 5 percent zeaxanthin. Different marigold extracts have different concentrations.

Benefits of zeaxanthin supplement and from food sources

Cataract prevention
Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the Carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Women's Health Initiative.
Arch Ophthalmol. 2008. Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI USA.
Diets rich in lutein and zeaxanthin are moderately associated with decreased prevalence of nuclear cataract in older women. However, other protective aspects of such diets may in part explain these relationships.

Nutrients. Jan 22 2014. Association between Lutein and Zeaxanthin Status and the Risk of Cataract: A Meta-Analysis. The purpose of this meta-analysis was to evaluate the relationship between blood lutein and zeaxanthin concentration and the risk of age-related cataract (ARC). MEDLINE, EMBASE, ISI and Cochrane Library were searched to identify relevant studies up to April 2013. Meta-analysis was conducted to obtain pooled relative risks (RRs) for the highest-versus-lowest categories of blood lutein and zeaxanthin concentrations. One cohort study and seven cross-sectional studies were included in the meta-analysis. There were significant inverse associations between nuclear cataract and blood lutein and zeaxanthin concentrations, with the pooled RRs ranging from 0.63 for zeaxanthin to 0.73 for lutein. A stronger association between nuclear cataract and blood zeaxanthin might be noted for the studies conducted in the European Nations. Blood lutein and zeaxanthin were also noted to lead towards a decrease in the risk of cortical cataract and subcapsular cataract; however, these pooled RRs were not statistically significant, with the exception of a marginal association between lutein and subcapsular cataract. Our results suggest that high blood lutein and zeaxanthin are significantly associated with a decrease in the risk of nuclear cataract. However, no significant associations were found for ARC in other regions of the lens.

Macular 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 (RCTs) 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.

Orv Hetil. 2015. Non-pharmacologic therapy of age-related macular degeneration, based on the etiopathogenesis of the disease. Non-pharmacological interventions which may have beneficial effect in endothelial dysfunction include (1) smoking cessation; (2) reduction of increased body weight; (3) adequate physical activity; (4) appropriate diet (a) proper dose of flavonoids, polyphenols and kurcumin; (b) omega-3 long-chain polyunsaturated fatty acids: docosahexaenoic acid and eicosapentaenoic acid; (c) carotenoids, lutein and zeaxanthin), (d) management of dietary glycemic index, (e) caloric restriction, and (5) elimination of stressful lifestyle.

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.

The photoreceptor protector zeaxanthin induces cell death in neuroblastoma cells.
Anticancer Res. 2005. Department of Biomedical Sciences, University of Teramo. Teramo, Italy.
The dietary carotenoid zeaxanthin protects against age-related eye disease by preventing apoptosis in photoreceptor cells. This study examined its effect on neuroblastoma cells in which apoptosis can be induced with lipid peroxidation products. Since zeaxanthin can inhibit lipid peroxidation and beta-carotene inhibits lipoxygenase (LOX) activity, it was of concern that zeaxanthin might inhibit apoptosis in these cancer cells. Zeaxanthin is a remarkable dietary factor that is able to induce apoptosis in neuroblastoma cells while being able to prevent apoptosis in healthy cells.

Zeaxanthin and vision, visual acuity
When people are polled about their health concerns, loss of vision is one of the top conditions listed. While some nutrients that support eye health are well-known and growing in popularity, recent attention is focusing on natural zeaxanthin as an important addition to eye health supplementation. Zeaxanthin (pronounced zee-uh-zaní-thin) is a dietary carotenoid found mostly in the macula, the central part of the retina in the eye that is responsible for most fine vision. Zeaxanthin, like its better-known cousin lutein, is thought to be a critical nutrient for eye health and can help guard against age-related vision loss. People who are at risk include those over 50 years old, people who smoke, those with hypertension and those with a family history of AMD. It affects the central vision, making it difficult to impossible to read, drive, and recognize faces. While not physically painful, AMD is debilitating. Lutein has become increasingly popular, and is now included in many multivitamins. Zeaxanthin, however, is only beginning to be recognized as an important supplement by the general population.

Zeaxanthin research studies
Enhanced bioavailability of zeaxanthin in a milk-based formulation of wolfberry
Br J Nutr. 2006.
The carotenoid zeaxanthin is concentrated within the macula. Increased macular zeaxanthin is suggested to lower the risk of age-related macular degeneration. The small red berry, wolfberry (Fructus barbarum; Gou Qi Zi and Kei Tze), is one of the richest natural sources of zeaxanthin. However, carotenoid bioavailability is low, and food-based products with enhanced bioavailability are of interest. The present study investigated its bioavailability from three wolfberry formulations. Results showed clearly that homogenisation of wolfberry in hot skimmed milk results in a formulation that has a 3-fold enhanced bioavailability of zeaxanthin compared with both the 'classical' hot water and warm skimmed milk treatment of the berries.

Human eye cells treated with lutein and zeaxanthin showed less damage after being exposed to ultraviolet rays, the sunlight rays 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 both 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. It's always better to eat antioxidant-rich foods than supplements, in order to get the benefits of other healthy substances present in foods. Journal of Nutrition, 2004.

Macular carotenoids: zeaxanthin and lutein.
Dev Ophthalmol. 2005.
The yellow color of the macula lutea is due to the presence of the carotenoid pigments zeaxanthin and lutein. 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.

Fasting plasma zeaxanthin response to Fructus barbarum (Kei Tze) in a food-based human supplementation trial.
Br J Nutr. 2005.
Age-related macular degeneration (AMD) is a common disorder that causes irreversible loss of central vision. Increased intake of foods containing zeaxanthin may be effective in preventing AMD because the macula accumulates zeaxanthin and lutein, oxygenated carotenoids with antioxidant and blue light-absorbing properties. Lycium barbarum L. is a small red berry known as Fructus lycii and wolfberry in the West, and Kei Tze and Gou Qi Zi in Asia. Wolfberry is rich in zeaxanthin dipalmitate, and is valued in Chinese culture for being good for vision. The aim of this study, which was a single-blinded, placebo-controlled, human intervention trial of parallel design, was to provide data on how fasting plasma zeaxanthin concentration changes as a result of dietary supplementation with whole wolfberries. Fasting blood was collected from healthy, consenting subjects; fourteen subjects took 15 g/d wolfberry (estimated to contain almost 3 mg zeaxanthin) for 28 d. Repeat fasting blood was collected on day 29. Age- and sex-matched controls (n 13) took no wolfberry. Responses in the two groups were compared using the Mann-Whitney test. After supplementation, plasma zeaxanthin increased 2.5 fold. This human supplementation trial shows that zeaxanthin in whole wolfberries is bioavailable and that intake of a modest daily amount markedly increases fasting plasma zeaxanthin levels. These new data will support further study of dietary strategies to maintain macular pigment density.

Plasma kinetics of zeaxanthin and 3'-dehydro-lutein after multiple oral doses of synthetic zeaxanthin.
Am J Clin Nutr. 2004.
The objective was to investigate the plasma kinetics of synthetic zeaxanthin after repeated oral doses and to assess the possible influence of other carotenoids on plasma concentrations. Long-term oral intake of 1 and 10 mg zeaxanthin as beadlets increases plasma zeaxanthin concentrations approximately 4- and 20-fold, respectively. Evidence that all-E-3-dehydro-lutein is formed from zeaxanthin was strong.

Q. Can a zeaxanthin supplement be taken the same day as serrapeptase enzyme or curcumin?
   A. I am not sure about serrapeptase, but I don't see a problem taking this nutrient with curcumin.

Q. I respect your opinion and wanted to know if you could comment on this abstract I came across:
Lutein and zeaxanthin intakes and risk of age-related macular degeneration and cataracts: an evaluation using the Food and Drug Administration's evidence-based review system for health claims.
American Journal of Clinical Nutrition, 2006. From the Division of Nutrition Programs and Labeling, Food and Drug Administration, College Park, MD
The labeling of health claims that meet the significant scientific agreement standard and of qualified health claims on conventional foods and dietary supplements requires premarket approval by the Food and Drug Administration. The FDA conducts an evidence-based review to ascertain whether sufficient evidence exists to support a significant scientific agreement standard or a qualified health claim. The FDA recently reviewed intervention and observational studies that evaluated the role of lutein and zeaxanthin in reducing the risk of age-related macular degeneration and cataracts. On the basis of this evidence-based review, the FDA concluded that no credible evidence exists for a health claim about the intake of zeaxanthin or lutein (or both) and the risk of age-related macular degeneration or cataracts.
   A. I think there is some evidence that zeaxanthin and lutein can help with vision and perhaps help reduce eye disease in old age, however there is no absolute proof yet and the dosages of these nutrients for optimal vision enhancement is not known. I disagree with their opinion that there is "no credible evidence." Actually, all one has to do is to take a lutein or zeaxanthin supplement, and notice that color perception is improved after a few days. Although there is no absolute proof, I lean on the side of taking small amounts of these supplements, particularly by those who have a diet that lacks adequate intake of fruits and vegetables.