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Lutein: Health Benefits, Side Effects, Uses, Dose & Precautions

Lutein

Other Name(s):

All-E-Lutein, All-E-Zeaxanthin, All-E-3'-dehydro-lutein, Beta,epsilon-carotene-3,3'-diol, Carotenoid, Caroténoïde, E-Lutein, Luteina, Lutéine, Lutéine Synthétique, Synthetic Lutein, Xanthophyll, Xanthophylle, Zeaxanthin, Zéaxanthine.

Overview

Lutein is a type of vitamin called a carotenoid. It is related to beta-carotene and vitamin A. Foods rich in lutein include broccoli, spinach, kale, corn, orange pepper, kiwi fruit, grapes, orange juice, zucchini, and squash. Lutein is absorbed best when it is taken with a high-fat meal.

Many people think of lutein as "the eye vitamin." They use it to prevent eye diseases including age-related macular degeneration (AMD), cataracts, eye strain, an inherited condition that causes vision loss (choroideremia), and a certain eye disease that affects the retina (retinitis pigmentosa).

Some people also use it for preventing numerous cancers, type 2 diabetes, amyotrophic lateral sclerosis (ALS), Parkinson's disease, cognitive function, high blood pressure during pregnancy (pre-eclampsia), and heart disease. Lutein has also been used to prevent complications in infants that are born too early and have low birth weight.

Many multivitamins contain lutein. They usually provide a relatively small amount of 0.25 mg per tablet.

How does work?

Lutein is one of two major carotenoids found as a color pigment in the human eye (macula and retina). It is thought to function as a light filter, protecting the eye tissues from sunlight damage.

Uses

Likely Effective for...

  • Lutein deficiency. Taking lutein by mouth prevents lutein deficiency.

Possibly Effective for...

  • An eye disease called age-related macular degeneration (AMD). People who eat higher amounts of lutein in their diet seem to have a lower risk of developing AMD. But people who already eat high amounts of lutein don't seem to benefit from increasing their intake even more. Taking lutein supplements for up to 36 months can improve some symptoms of AMD. But it does not seem to prevent AMD from becoming worse. Research on the use of supplements containing lutein and other ingredients shows conflicting results.
  • Cataracts. Eating higher amounts of lutein is linked with a lower risk of developing cataracts. Taking supplements containing lutein and zeaxanthin reduces the risk of developing cataracts that require surgical removal in people who eat low amounts of lutein and zeaxanthin as part of their diet. Also, taking lutein supplements seems to improve vision in older people who already have cataracts and do not already consume a lot of lutein and zeaxanthin.

Possibly Ineffective for...

  • A lung disease that affects newborns (bronchopulmonary dysplasia). . Research shows that giving preterm infants 0.5 mL of a product containing lutein and zeaxanthin (LUTEINofta, SOOFT Italia SpA) by mouth once daily does not reduce the chance of developing bronchopulmonary dysplasia.
  • Heart disease (cardiovascular disease). Research shows that taking lutein 10 mg with zeaxanthin 2 mg by mouth daily does not prevent death due to heart disease or heart-related adverse event such as stroke, heart attack, or chest pain in older people.
  • Clogged arteries (coronary heart disease). People who eat higher amounts of lutein do not have a lower the risk of developing clogged arteries compared to those who eat lower amounts.
  • Damage to tissue in the intestines of infants that causes the tissue to die (necrotizing enterocolitis; NEC). Research shows that giving preterm infants 0.5 mL of a product containing lutein and zeaxanthin (LUTEINofta, SOOFT Italia SpA) by mouth once daily does not prevent necrotizing enterocolitis.
  • An eye disorder in premature infants that can lead to blindness (retinopathy of prematurity). Research shows that giving preterm infants 0.5 mL or 1.8 mL/kg body weight of a product containing lutein and zeaxanthin (LUTEINofta, SOOFT Italia SpA) by mouth once daily does not prevent retinopathy of prematurity.
  • An eye disease that affects the retina (retinitis pigmentosa). Most research shows that taking lutein by mouth does not improve vision or other symptoms in people with retinitis pigmentosa.

Insufficient Evidence to Rate Effectiveness for...

  • Amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). Early research suggests that people who eat more lutein as part of their diet have a lower risk of developing ALS compared to people who eat lower amounts of lutein.
  • Eye strain (asthenopia). Early research shows that taking a combination supplement containing lutein reduces eye strain. The effect of lutein alone on eye strain is unclear.
  • Breast cancer. Research suggests that higher levels of lutein in the blood are linked with a reduced risk of developing breast cancer.
  • Cervical cancer. Early research suggests that lower intake of lutein as part of the diet is not linked with an increased risk of developing cervical cancer.
  • An inherited condition that causes vision loss (choroideremia). Early research suggests that taking 20 mg of lutein daily for 6 months does not improve vision in people with choroideremia.
  • Mental function. Some research shows that taking that taking 10 mg of lutein plus 2 mg of zeaxanthin does not improve speaking or memory in older people. However, other early research suggests that taking 12 mg of lutein with or without 800 mg of docosahexaenoic acid (DHA) for 4 months can improve speaking and memory in older women.
  • Colon and rectal cancer. There are conflicting results about whether diets containing higher amounts of lutein can reduce the risk of developing colon or rectal cancer.
  • Diabetes. Some research suggests that low blood levels of lutein or other carotenoids are linked with blood sugar problems. In theory, taking lutein might reduce the risk of developing diabetes. However, other research suggests that increasing lutein intake in the diet does not reduce the risk of developing diabetes.
  • Cancer of the esophagus. Early research suggests that high amounts of lutein in the diet are linked with a decreased risk of developing cancer of the esophagus.
  • Muscle soreness after exercise. Some research suggests that taking a combination product that contains lutein (BioAstin) daily for 3 weeks before exercise does not reduce muscle soreness after exercise.
  • Lung cancer. Some early evidence suggests that low blood levels of lutein are linked with an increased risk of developing lung cancer. However, other research shows that taking lutein does not affect the risk of developing or dying from lung cancer.
  • Parkinson's disease. Early research suggests that high amounts of lutein in the diet are not linked with a decreased risk of developing Parkinson's disease.
  • High blood pressure during pregnancy (pre-eclampsia). Some research suggests that high blood levels of lutein are linked with a lower risk of developing high blood pressure during pregnancy. It is not clear if taking lutein supplements lowers the risk of high blood pressure during pregnancy.
  • Prostate cancer. Early research shows that low blood levels of lutein are not linked with an increased risk of prostate cancer.
  • Respiratory infections. Early research shows that high blood levels of lutein are not linked with a decreased risk of respiratory infections.
  • Other conditions.
More evidence is needed to rate the effectiveness of lutein for these uses.

SLIDESHOW

Pink Eye (Conjunctivitis) Symptoms, Causes, Treatments See Slideshow

Side Effects

Lutein is LIKELY SAFE when taken by mouth appropriately. Consuming 6.9-11.7 mg/day of lutein as part of the diet appears to be safe. Lutein supplements have been used safely in studies in doses up to 15 mg daily for up to 2 years. Taking up to 20 mg of lutein both from the diet and supplements seems to be safe.

Children: Lutein is LIKELY SAFE when used appropriately. A specific product (LUTEINofta, SOOFT Italia SpA) containing lutein has been safely used in infants for 36 weeks.

Precautions

Pregnancy and breast-feeding: Lutein is LIKELY SAFE when used in the amounts found in food.

Cystic fibrosis: People with cystic fibrosis might not absorb some carotenoids from food very well, and often have low blood levels of lutein. How much the body absorbs from lutein supplementation might also be decreased in people with cystic fibrosis.

Skin cancer: There is some concern that higher blood levels of lutein are linked to slightly increased risk of skin cancer in people at high risk who also have a history of skin cancer.

Dosing

The following doses have been studied in scientific research:

BY MOUTH:

  • For an eye disease called age-related macular degeneration (AMD): For preventing AMD, about 6-12 mg of lutein daily, either through diet or supplementation has been used. For reducing symptoms of AMD, 10-20 mg daily has been used. For reducing symptoms, 10-12 mg of lutein daily has been used.
  • For cataracts: For preventing cataracts, about 6-12 mg of lutein daily, either through diet or supplementation has been used. For reducing symptoms, 15 mg of lutein three times weekly or 10 mg of lutein plus 2 mg of zeaxanthin daily has been used.
There is 44 mg of lutein per cup of cooked kale, 26 mg per cup of cooked spinach, and 3 mg per cup of broccoli.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

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References

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Iribarren, C., Folsom, A. R., Jacobs, D. R., Jr., Gross, M. D., Belcher, J. D., and Eckfeldt, J. H. Association of serum vitamin levels, LDL susceptibility to oxidation, and autoantibodies against MDA-LDL with carotid atherosclerosis. A case-control study. The ARIC Study Investigators. Atherosclerosis Risk in Communities. Arterioscler.Thromb.Vasc.Biol 1997;17(6):1171-1177. View abstract.

Ito, Y., Wakai, K., Suzuki, K., Ozasa, K., Watanabe, Y., Seki, N., Ando, M., Nishino, Y., Kondo, T., Ohno, Y., and Tamakoshi, A. Lung cancer mortality and serum levels of carotenoids, retinol, tocopherols, and folic acid in men and women: a case-control study nested in the JACC Study. J Epidemiol. 2005;15 Suppl 2:S140-S149. View abstract.

Ito, Y., Wakai, K., Suzuki, K., Tamakoshi, A., Seki, N., Ando, M., Nishino, Y., Kondo, T., Watanabe, Y., Ozasa, K., and Ohno, Y. Serum carotenoids and mortality from lung cancer: a case-control study nested in the Japan Collaborative Cohort (JACC) study. Cancer Sci. 2003;94(1):57-63. View abstract.

Jacques, P. F., Chylack, L. T., Jr., Hankinson, S. E., Khu, P. M., Rogers, G., Friend, J., Tung, W., Wolfe, J. K., Padhye, N., Willett, W. C., and Taylor, A. Long-term nutrient intake and early age-related nuclear lens opacities. Arch.Ophthalmol. 2001;119(7):1009-1019. View abstract.

Johnson, E. J. A possible role for lutein and zeaxanthin in cognitive function in the elderly. Am.J.Clin.Nutr. 2012;96(5):1161S-1165S. View abstract.

Johnson, E. J., Chung, H. Y., Caldarella, S. M., and Snodderly, D. M. The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation. Am J Clin Nutr 2008;87(5):1521-1529. View abstract.

Johnson, E. J., McDonald, K., Caldarella, S. M., Chung, H. Y., Troen, A. M., and Snodderly, D. M. Cognitive findings of an exploratory trial of docosahexaenoic acid and lutein supplementation in older women. Nutr Neurosci 2008;11(2):75-83. View abstract.

Junghans, A., Sies, H., and Stahl, W. Macular pigments lutein and zeaxanthin as blue light filters studied in liposomes. Arch.Biochem.Biophys. 7-15-2001;391(2):160-164. View abstract.

Kaya, S., Weigert, G., Pemp, B., Sacu, S., Werkmeister, R. M., Dragostinoff, N., Garhofer, G., Schmidt-Erfurth, U., and Schmetterer, L. Comparison of macular pigment in patients with age-related macular degeneration and healthy control subjects - a study using spectral fundus reflectance. Acta Ophthalmol. 2012;90(5):e399-e403. View abstract.

Kiokias, S. and Gordon, M. H. Dietary supplementation with a natural carotenoid mixture decreases oxidative stress. Eur.J Clin.Nutr. 2003;57(9):1135-1140. View abstract.

LaRowe, T. L., Mares, J. A., Snodderly, D. M., Klein, M. L., Wooten, B. R., and Chappell, R. Macular pigment density and age-related maculopathy in the Carotenoids in Age-Related Eye Disease Study. An ancillary study of the women's health initiative. Ophthalmology 2008;115(5):876-883. View abstract.

Li, L., Chen, C. Y., Aldini, G., Johnson, E. J., Rasmussen, H., Yoshida, Y., Niki, E., Blumberg, J. B., Russell, R. M., and Yeum, K. J. Supplementation with lutein or lutein plus green tea extracts does not change oxidative stress in adequately nourished older adults. J Nutr.Biochem. 2010;21(6):544-549. View abstract.

Liew SH, Gilbert CE Spector TD Mellerio J Van Kuijk FJ Beatty S Fitzke F Marshall J Hammond CJ. Central retinal thickness is positively correlated with macular pigment optical density. Exp Eye Res. 2006;82(5):915-920.

Loughman, J., Nolan, J. M., Howard, A. N., Connolly, E., Meagher, K., and Beatty, S. The impact of macular pigment augmentation on visual performance using different carotenoid formulations. Invest Ophthalmol.Vis.Sci. 2012;53(12):7871-7880. View abstract.

Lyle, B. J., Mares-Perlman, J. A., Klein, B. E., Klein, R., Palta, M., Bowen, P. E., and Greger, J. L. Serum carotenoids and tocopherols and incidence of age-related nuclear cataract. Am J Clin Nutr 1999;69(2):272-277. View abstract.

Ma, L., Dou, H. L., Huang, Y. M., Lu, X. R., Xu, X. R., Qian, F., Zou, Z. Y., Pang, H. L., Dong, P. C., Xiao, X., Wang, X., Sun, T. T., and Lin, X. M. Improvement of retinal function in early age-related macular degeneration after lutein and zeaxanthin supplementation: a randomized, double-masked, placebo-controlled trial. Am.J.Ophthalmol. 2012;154(4):625-634. View abstract.

Ma, L., Dou, H. L., Wu, Y. Q., Huang, Y. M., Huang, Y. B., Xu, X. R., Zou, Z. Y., and Lin, X. M. Lutein and zeaxanthin intake and the risk of age-related macular degeneration: a systematic review and meta-analysis. Br.J.Nutr. 2012;107(3):350-359. View abstract.

Ma, L., Lin, X. M., Zou, Z. Y., Xu, X. R., Li, Y., and Xu, R. A 12-week lutein supplementation improves visual function in Chinese people with long-term computer display light exposure. Br.J.Nutr. 2009;102(2):186-190. View abstract.

Ma, L., Yan, S. F., Huang, Y. M., Lu, X. R., Qian, F., Pang, H. L., Xu, X. R., Zou, Z. Y., Dong, P. C., Xiao, X., Wang, X., Sun, T. T., Dou, H. L., and Lin, X. M. Effect of lutein and zeaxanthin on macular pigment and visual function in patients with early age-related macular degeneration. Ophthalmology 2012;119(11):2290-2297. View abstract.

Malila, N., Virtamo, J., Virtanen, M., Pietinen, P., Albanes, D., and Teppo, L. Dietary and serum alpha-tocopherol, beta-carotene and retinol, and risk for colorectal cancer in male smokers. Eur.J.Clin.Nutr. 2002;56(7):615-621. View abstract.

Mares-Perlman, J. A., Fisher, A. I., Klein, R., Palta, M., Block, G., Millen, A. E., and Wright, J. D. Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the third national health and nutrition examination survey. Am.J.Epidemiol. 3-1-2001;153(5):424-432. View abstract.

Martin, K. R., Failla, M. L., and Smith, J. C., Jr. Beta-carotene and lutein protect HepG2 human liver cells against oxidant-induced damage. J.Nutr. 1996;126(9):2098-2106. View abstract.

Moeller, S. M., Parekh, N., Tinker, L., Ritenbaugh, C., Blodi, B., Wallace, R. B., and Mares, J. A. Associations between intermediate age-related macular degeneration and lutein and zeaxanthin in the Carotenoids in Age-related Eye Disease Study (CAREDS): ancillary study of the Women's Health Initiative. Arch.Ophthalmol. 2006;124(8):1151-1162. View abstract.

Moeller, S. M., Voland, R., Tinker, L., Blodi, B. A., Klein, M. L., Gehrs, K. M., Johnson, E. J., Snodderly, D. M., Wallace, R. B., Chappell, R. J., Parekh, N., Ritenbaugh, C., and Mares, J. A. 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;126(3):354-364. View abstract.

Morganti, P., Fabrizi, G., and Bruno, C. Protective effects of oral antioxidants on skin and eye function. Skinmed. 2004;3(6):310-316. View abstract.

Murray, I. J., Makridaki, M., van der Veen, R. L., Carden, D., Parry, N. R., and Berendschot, T. T. Lutein supplementation over a one-year period in early AMD might have a mild beneficial effect on visual acuity: the CLEAR study. Invest Ophthalmol.Vis.Sci. 2013;54(3):1781-1788. View abstract.

Natarajan, L., Rock, C. L., Major, J. M., Thomson, C. A., Caan, B. J., Flatt, S. W., Chilton, J. A., Hollenbach, K. A., Newman, V. A., Faerber, S., Ritenbaugh, C. K., Gold, E., Stefanick, M. L., Jones, L. A., Marshall, J. R., and Pierce, J. P. On the importance of using multiple methods of dietary assessment. Epidemiology 2004;15(6):738-745. View abstract.

Nussbaum, J. J., Pruett, R. C., and Delori, F. C. Historic perspectives. Macular yellow pigment. The first 200 years. Retina 1981;1(4):296-310. View abstract.

Olmedilla, B., Granado, F., Blanco, I., and Vaquero, M. 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;19(1):21-24. View abstract.

Olmedilla, B., Granado, F., Southon, S., Wright, A. J., Blanco, I., Gil-Martinez, E., Berg, H., Corridan, B., Roussel, A. M., Chopra, M., and Thurnham, D. I. Serum concentrations of carotenoids and vitamins A, E, and C in control subjects from five European countries. Br J Nutr 2001;85(2):227-238. View abstract.

Paetau, I., Rao, D., Wiley, E. R., Brown, E. D., and Clevidence, B. A. Carotenoids in human buccal mucosa cells after 4 wk of supplementation with tomato juice or lycopene supplements. Am J Clin Nutr 1999;70(4):490-494. View abstract.

Palombo, P., Fabrizi, G., Ruocco, V., Ruocco, E., Fluhr, J., Roberts, R., and Morganti, P. Beneficial long-term effects of combined oral/topical antioxidant treatment with the carotenoids lutein and zeaxanthin on human skin: a double-blind, placebo-controlled study. Skin Pharmacol.Physiol 2007;20(4):199-210. View abstract.

Perrone, S., Longini, M., Marzocchi, B., Picardi, A., Bellieni, C. V., Proietti, F., Rodriguez, A., Turrisi, G., and Buonocore, G. Effects of lutein on oxidative stress in the term newborn: a pilot study. Neonatology. 2010;97(1):36-40. View abstract.

Piermarocchi, S., Saviano, S., Parisi, V., Tedeschi, M., Panozzo, G., Scarpa, G., Boschi, G., and Lo, Giudice G. Carotenoids in Age-related Maculopathy Italian Study (CARMIS): two-year results of a randomized study. Eur.J.Ophthalmol. 2012;22(2):216-225. View abstract.

Rapp, L. M., Maple, S. S., and Choi, J. H. Lutein and zeaxanthin concentrations in rod outer segment membranes from perifoveal and peripheral human retina. Invest Ophthalmol.Vis.Sci. 2000;41(5):1200-1209. View abstract.

Ravindran, R. D., Vashist, P., Gupta, S. K., Young, I. S., Maraini, G., Camparini, M., Jayanthi, R., John, N., Fitzpatrick, K. E., Chakravarthy, U., Ravilla, T. D., and Fletcher, A. E. Inverse association of vitamin C with cataract in older people in India. Ophthalmology 2011;118(10):1958-1965. View abstract.

Riccioni, G., Speranza, L., Pesce, M., Cusenza, S., D'Orazio, N., and Glade, M. J. Novel phytonutrient contributors to antioxidant protection against cardiovascular disease. Nutrition 2012;28(6):605-610. View abstract.

Richer, S. ARMD--pilot (case series) environmental intervention data. J Am Optom.Assoc 1999;70(1):24-36. View abstract.

Richer, S. P., Stiles, W., Graham-Hoffman, K., Levin, M., Ruskin, D., Wrobel, J., Park, D. W., and Thomas, C. Randomized, double-blind, placebo-controlled study of zeaxanthin and visual function in patients with atrophic age-related macular degeneration: the Zeaxanthin and Visual Function Study (ZVF) FDA IND #78, 973. Optometry. 2011;82(11):667-680. View abstract.

Richer, S., Devenport, J., and Lang, J. C. LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic age-related macular degeneration to dietary supplementation with xanthophylls. Optometry. 2007;78(5):213-219. View abstract.

Robman, L., Vu, H., Hodge, A., Tikellis, G., Dimitrov, P., McCarty, C., and Guymer, R. Dietary lutein, zeaxanthin, and fats and the progression of age-related macular degeneration. Can.J.Ophthalmol. 2007;42(5):720-726. View abstract.

Rock, C. L., Flatt, S. W., Wright, F. A., Faerber, S., Newman, V., Kealey, S., and Pierce, J. P. Responsiveness of carotenoids to a high vegetable diet intervention designed to prevent breast cancer recurrence. Cancer Epidemiol.Biomarkers Prev. 1997;6(8):617-623. View abstract.

Rock, C. L., Thornquist, M. D., Neuhouser, M. L., Kristal, A. R., Neumark-Sztainer, D., Cooper, D. A., Patterson, R. E., and Cheskin, L. J. Diet and lifestyle correlates of lutein in the blood and diet. J.Nutr. 2002;132(3):525S-530S. View abstract.

Romagnoli, C., Giannantonio, C., Cota, F., Papacci, P., Vento, G., Valente, E., Purcaro, V., and Costa, S. A prospective, randomized, double blind study comparing lutein to placebo for reducing occurrence and severity of retinopathy of prematurity. J.Matern.Fetal Neonatal Med. 2011;24 Suppl 1:147-150. View abstract.

Ros, M. M., Bueno-de-Mesquita, H. B., Kampman, E., Aben, K. K., Buchner, F. L., Jansen, E. H., van Gils, C. H., Egevad, L., Overvad, K., Tjonneland, A., Roswall, N., Boutron-Ruault, M. C., Kvaskoff, M., Perquier, F., Kaaks, R., Chang-Claude, J., Weikert, S., Boeing, H., Trichopoulou, A., Lagiou, P., Dilis, V., Palli, D., Pala, V., Sacerdote, C., Tumino, R., Panico, S., Peeters, P. H., Gram, I. T., Skeie, G., Huerta, J. M., Barricarte, A., Quiros, J. R., Sanchez, M. J., Buckland, G., Larranaga, N., Ehrnstrom, R., Wallstrom, P., Ljungberg, B., Hallmans, G., Key, T. J., Allen, N. E., Khaw, K. T., Wareham, N., Brennan, P., Riboli, E., and Kiemeney, L. A. Plasma carotenoids and vitamin C concentrations and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2012;96(4):902-910. View abstract.

Rosenthal, J. M., Kim, J., de, Monasterio F., Thompson, D. J., Bone, R. A., Landrum, J. T., de Moura, F. F., Khachik, F., Chen, H., Schleicher, R. L., Ferris, F. L., III, and Chew, E. Y. Dose-ranging study of lutein supplementation in persons aged 60 years or older. Invest Ophthalmol.Vis.Sci. 2006;47(12):5227-5233. View abstract.

Rubin, L. P., Chan, G. M., Barrett-Reis, B. M., Fulton, A. B., Hansen, R. M., Ashmeade, T. L., Oliver, J. S., Mackey, A. D., Dimmit, R. A., Hartmann, E. E., and Adamkin, D. H. Effect of carotenoid supplementation on plasma carotenoids, inflammation and visual development in preterm infants. J Perinatol. 2012;32(6):418-424. View abstract.

Sabour-Pickett, S., Nolan, J. M., Loughman, J., and Beatty, S. A review of the evidence germane to the putative protective role of the macular carotenoids for age-related macular degeneration. Mol.Nutr.Food Res. 2012;56(2):270-286. View abstract.

San Giovanni, J. P., Chew, E. Y., Clemons, T. E., Ferris, F. L., III, Gensler, G., Lindblad, A. S., Milton, R. C., Seddon, J. M., and Sperduto, R. D. The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22. Arch.Ophthalmol. 2007;125(9):1225-1232. View abstract.

SanGiovanni, J. P. and Neuringer, M. The putative role of lutein and zeaxanthin as protective agents against age-related macular degeneration: promise of molecular genetics for guiding mechanistic and translational research in the field. Am.J.Clin.Nutr. 2012;96(5):1223S-1233S. View abstract.

Sasamoto, Y., Gomi, F., Sawa, M., Tsujikawa, M., and Nishida, K. Effect of 1-year lutein supplementation on macular pigment optical density and visual function. Graefes Arch.Clin.Exp.Ophthalmol. 2011;249(12):1847-1854. View abstract.

Saxena, S., Srivastava, P., and Khanna, V. K. Antioxidant supplementation improves platelet membrane fluidity in idiopathic retinal periphlebitis (Eales' disease). J.Ocul.Pharmacol.Ther. 2010;26(6):623-626. View abstract.

Schalch, W., Cohn, W., Barker, F. M., Kopcke, W., Mellerio, J., Bird, A. C., Robson, A. G., Fitzke, F. F., and van Kuijk, F. J. Xanthophyll accumulation in the human retina during supplementation with lutein or zeaxanthin - the LUXEA (LUtein Xanthophyll Eye Accumulation) study. Arch.Biochem.Biophys. 2-15-2007;458(2):128-135. View abstract.

Shao, A. and Hathcock, J. N. Risk assessment for the carotenoids lutein and lycopene. Regul.Toxicol Pharmacol 2006;45(3):289-298. View abstract.

Siems, W. G., Sommerburg, O., and van Kuijk, F. J. Lycopene and beta-carotene decompose more rapidly than lutein and zeaxanthin upon exposure to various pro-oxidants in vitro. Biofactors 1999;10(2-3):105-113. View abstract.

Sin, H. P., Liu, D. T., and Lam, D. S. Lifestyle modification, nutritional and vitamins supplements for age-related macular degeneration. Acta Ophthalmol. 2013;91(1):6-11. View abstract.

Snellen, E. L., Verbeek, A. L., Van Den Hoogen, G. W., Cruysberg, J. R., and Hoyng, C. B. Neovascular age-related macular degeneration and its relationship to antioxidant intake. Acta Ophthalmol.Scand. 2002;80(4):368-371. View abstract.

Sommerburg, O. G., Siems, W. G., Hurst, J. S., Lewis, J. W., Kliger, D. S., and van Kuijk, F. J. Lutein and zeaxanthin are associated with photoreceptors in the human retina. Curr.Eye Res. 1999;19(6):491-495. View abstract.

Sumantran, V. N., Zhang, R., Lee, D. S., and Wicha, M. S. Differential regulation of apoptosis in normal versus transformed mammary epithelium by lutein and retinoic acid. Cancer Epidemiol.Biomarkers Prev. 2000;9(3):257-263. View abstract.

Takeda, S., Masuda, Y., Usuda, M., Marushima, R., Ueji, T., Hasegawa, M., and Maruyama, C. Effects of mayonnaise on postprandial serum lutein/zeaxanthin and beta-carotene concentrations in humans. J.Nutr.Sci.Vitaminol.(Tokyo) 2009;55(6):479-485. View abstract.

Tan, J. S., Wang, J. J., Flood, V., Rochtchina, E., Smith, W., and Mitchell, P. Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study. Ophthalmology 2008;115(2):334-341. View abstract.

Tanaka, T., Shnimizu, M., and Moriwaki, H. Cancer chemoprevention by carotenoids. Molecules. 2012;17(3):3202-3242. View abstract.

Taylor, A., Jacques, P. F., Chylack, L. T., Jr., Hankinson, S. E., Khu, P. M., Rogers, G., Friend, J., Tung, W., Wolfe, J. K., Padhye, N., and Willett, W. C. Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities. Am.J.Clin.Nutr. 2002;75(3):540-549. View abstract.

Teixeira, V. H., Valente, H. F., Casal, S. I., Marques, A. F., and Moreira, P. A. Antioxidants do not prevent postexercise peroxidation and may delay muscle recovery. Med.Sci.Sports Exerc. 2009;41(9):1752-1760. View abstract.

Thomson, C. A., Stendell-Hollis, N. R., Rock, C. L., Cussler, E. C., Flatt, S. W., and Pierce, J. P. Plasma and dietary carotenoids are associated with reduced oxidative stress in women previously treated for breast cancer. Cancer Epidemiol.Biomarkers Prev. 2007;16(10):2008-2015. View abstract.

Thyagarajan, B., Meyer, A., Smith, L. J., Beckett, W. S., Williams, O. D., Gross, M. D., and Jacobs, D. R., Jr. Serum carotenoid concentrations predict lung function evolution in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am.J.Clin.Nutr. 2011;94(5):1211-1218. View abstract.

Trumbo, P. R. and Ellwood, K. C. 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. Am.J.Clin.Nutr. 2006;84(5):971-974. View abstract.

Upritchard, J. E., Schuurman, C. R., Wiersma, A., Tijburg, L. B., Coolen, S. A., Rijken, P. J., and Wiseman, S. A. Spread supplemented with moderate doses of vitamin E and carotenoids reduces lipid peroxidation in healthy, nonsmoking adults. Am J Clin Nutr 2003;78(5):985-992. View abstract.

Valero, M. P., Fletcher, A. E., De Stavola, B. L., Vioque, J., and Alepuz, V. C. Vitamin C is associated with reduced risk of cataract in a Mediterranean population. J.Nutr. 2002;132(6):1299-1306. View abstract.

Vallverdu-Queralt, A., Martinez-Huelamo, M., Arranz-Martinez, S., Miralles, E., and Lamuela-Raventos, R. M. Differences in the carotenoid content of ketchups and gazpachos through HPLC/ESI(Li(+) )-MS/MS correlated with their antioxidant capacity. J Sci Food Agric. 8-15-2012;92(10):2043-2049. View abstract.

van der Horst-Graat JM, Kok, F. J., and Schouten, E. G. Plasma carotenoid concentrations in relation to acute respiratory infections in elderly people. Br J Nutr 2004;92(1):113-118. View abstract.

Vojnikovic, B., Kovacevic, D., Njiric, S., and Coklo, M. Long term results of age-related macular degeneration therapy with prednisolone acetate--special refer to peripheral visual field changes. Coll.Antropol. 2008;32(2):351-353. View abstract.

Weigert, G., Kaya, S., Pemp, B., Sacu, S., Lasta, M., Werkmeister, R. M., Dragostinoff, N., Simader, C., Garhofer, G., Schmidt-Erfurth, U., and Schmetterer, L. Effects of lutein supplementation on macular pigment optical density and visual acuity in patients with age-related macular degeneration. Invest Ophthalmol.Vis.Sci. 2011;52(11):8174-8178. View abstract.

Williams, M. A., Woelk, G. B., King, I. B., Jenkins, L., and Mahomed, K. Plasma carotenoids, retinol, tocopherols, and lipoproteins in preeclamptic and normotensive pregnant Zimbabwean women. Am J Hypertens. 2003;16(8):665-672. View abstract.

Wright, A. J., Hughes, D. A., Bailey, A. L., and Southon, S. Beta-carotene and lycopene, but not lutein, supplementation changes the plasma fatty acid profile of healthy male non-smokers. J Lab Clin Med 1999;134(6):592-598. View abstract.

Yagi, A., Fujimoto, K., Michihiro, K., Goh, B., Tsi, D., and Nagai, H. The effect of lutein supplementation on visual fatigue: a psychophysiological analysis. Appl.Ergon. 2009;40(6):1047-1054. View abstract.

Yamini, S., West, K. P., Jr., Wu, L., Dreyfuss, M. L., Yang, D. X., and Khatry, S. K. Circulating levels of retinol, tocopherol and carotenoid in Nepali pregnant and postpartum women following long-term beta-carotene and vitamin A supplementation. Eur.J.Clin.Nutr. 2001;55(4):252-259. View abstract.

Yeum, K. J., Booth, S. L., Sadowski, J. A., Liu, C., Tang, G., Krinsky, N. I., and Russell, R. M. Human plasma carotenoid response to the ingestion of controlled diets high in fruits and vegetables. Am.J Clin.Nutr 1996;64(4):594-602. View abstract.

Zeimer, M. B., Kromer, I., Spital, G., Lommatzsch, A., and Pauleikhoff, D. Macular telangiectasia: patterns of distribution of macular pigment and response to supplementation. Retina 2010;30(8):1282-1293. View abstract.

Zhao, X., Aldini, G., Johnson, E. J., Rasmussen, H., Kraemer, K., Woolf, H., Musaeus, N., Krinsky, N. I., Russell, R. M., and Yeum, K. J. Modification of lymphocyte DNA damage by carotenoid supplementation in postmenopausal women. Am J Clin Nutr 2006;83(1):163-169. View abstract.

Albanes D, Virtamo J, Taylor PR, et al. Effects of supplemental beta-carotene , cigarette smoking, and alcohol consumption on serum carotenoids in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Clin Nutr 1997;66:366-72. View abstract.

Berson EL, Rosner B, Sandberg MA, et al. A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa. Arch Ophthalmol 1993;111:761-72. View abstract.

Bloomer RJ, Fry A, Schilling B, Chiu L, et al. Astaxanthin supplementation does not attenuate muscle injury following eccentric exercise in resistance-trained men. Int J Sport Nutr Exerc Metab 2005;15:401-12. View abstract.

Bonds DE, Harrington M, Worrall BB, et al. Effect of long-chain ?-3 fatty acids and lutein + zeaxanthin supplements on cardiovascular outcomes: results of the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA Intern Med. 2014 May;174(5):763-71. View abstract.

Bowen PE, Herbst-Espinosa SM, Hussain EA, Stacewicz-Sapuntzakis M. Esterification does not impair lutein bioavailability in humans. J Nutr 2002;132:3668-73. View abstract.

Brown L, Rimm EB, Seddon JM, et al. A prospective study of carotenoid intake and risk of cataract extraction in US men. Am J Clin Nutr 1999;70:517-24. View abstract.

Cangemi, F. E. TOZAL Study: an open case control study of an oral antioxidant and omega-3 supplement for dry AMD. BMC Ophthalmol 2007;7:3. View abstract.

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