Lutein reigns as key ingredient in ocular supplements

Balanced dietary supplement compounds fill in the gaps forged by disease and poor nutrition.

Issue: June 15, 2000

ByRochelle Nataloni

LA JOLLA, Calif. — Ophthalmologist and nutrition expert Steven G. Pratt, MD, emphasizes to his patients that if they want to experience the benefits afforded by increasing their consumption of lutein, zeaxanthin and other carotenoids, vitamins B, C and E, they should increase their intake of fruits, vegetables and whole grains. He considers nutritional supplements just that — supplements to a diet already rich in beneficial vitamins and minerals. But even he admits that as people get older, the variety and consumption of their food decreases, putting them at even greater nutritional risk than the average adult, and making them perfect candidates for ocular supplements. “They all need a general supplement, but if they want to take an ocular supplement in addition to that, that’s fine,” he said. “For instance, anyone who has macular problems needs even more lutein. Age-related macular degeneration is a horrible disease. I don’t know anyone who wants to get it. I try to give my patients a formula to ward it off or reduce it — a longevity and optimum health formula: supplements, sunglasses, etc. ‘Here’s what you have to do,’ I say, ‘and you will have less chance of having this problem than if you don’t.’ ”

Alcon Laboratories (Fort Worth, Texas) added lutein and zeaxanthin to its ICaps dietary supplement in response to that need, as well as others. In addition to lutein and zeaxanthin, ICaps contain zinc, in the form of zinc acetate, which is reportedly the easiest form of zinc for the body to absorb. ICaps also features time-release dosing, which may cut down on potential stomach upset, and Betalut, a beadlet that consists of all natural lutein, zeaxanthin and beta-carotene. According to Alcon, Betalut ensures the potency of these carotenoids.

These nutrients can be derived from food, but statistics paint a bleak picture with regard to trends in nutrition. According to Linda Nebeling, PhD, MPH, RD, of the National Institutes of Health/National Cancer Institute, most Americans do not consume enough lutein- and zeaxanthin-rich fruits and vegetables to get the protection they need. Between the years 1987 and 1992, lutein intake declined by 16% in women of all ages and in men and women between the ages of 40 and 69. “Women in the United States have decreased their consumption of vegetables like corn, green beans, broccoli, spinach, carrots and winter squash,” Dr. Nebeling said. “These vegetables are rich sources of carotenoids and other important nutrients. Consuming too little of these foods could lead to an increased risk of disease.”

Balance is the key

The Institute of Medicine of the National Academies recently reported that insufficient evidence exists to support claims that taking megadoses of dietary antioxidants can prevent chronic disease. “A direct connection between the intake of antioxidants and the prevention of chronic disease has yet to be adequately established,” said Norman I. Krinsky, PhD, chair of the study’s Panel on Dietary Antioxidants and Related Compounds, and a professor of biochemistry at Tufts University School of Medicine in Boston. “We do know, however, that dietary antioxidants can, in some cases, prevent or counteract cell damage that stems from exposure to oxidants.”

Dr. Pratt agrees that megadoses of even a good thing can be bad. “Megadoses of anything is not good,” he told Ocular Surgery News. “I am all for a balanced formula where you have all of these nutrients in the formula that really mimic food. Alcon has a product available overseas, Retoxil or ICaps-L, that is the closest thing I have seen to whole food because they have many of the nutrients that we know are in food in basically the same ratios that you find in spinach. The carotenoid ratio is the same as in spinach. All of the nutrients work synergistically together, and no one nutrient is a magic bullet,” Dr. Pratt said. “So if you are going to have a supplement that works, it’s going to have to mimic food and have more or less the same ratios that food has in it. Otherwise, it may not work and may even be harmful because you may drive down the absorption of one nutrient by too much of another.”

The important carotenoid

Robert Abel Jr., MD, ophthalmologist and author, said there are myriad opportunities when you open your eyes and look for new answers. “According to the World Health Organization, 80% of the world is still using a plant-based medical system. Our earliest pharmaceuticals came out of the rain forest and we’re still looking for them there. When you realize that genetics are not an absolute, that one out of five genes is a controller gene but four out of five can be induced, you understand that you can create your own chemical environment and [influence] how you may or may not develop a certain genetic predisposition.”

This, he said, is where lutein comes in. “Beta carotene used to get all of the attention, but lutein is a very important carotenoid. Lutein actually reflects blue light and ultraviolet light, and it is present in the macula along with zeaxanthin, but zeaxanthin can be made from lutein,” he said, “so it’s not vital.” Dr. Abel pointed out that studies have shown that when a patient is given 2.4 to 30 mg of lutein, an increase in macular pigment density may result. “As little as 2 mg of lutein has been shown to double the blood lutein level and affect the amount of pigment in the macula and improve vision. This is measured by flicker heterochromic photometry, and patients will tell you they have better contrast sensitivity. When you see people with macular degeneration gain a line or two, that’s hard to refute,” Dr. Abel said.

John G. Meyer, Bausch & Lomb Pharmaceuticals (Tampa, Fla.) product manager, told Ocular Surgery News that until recently, pharmaceutical-grade sources of lutein were not commercially available, but now that lutein has been converted into a stable form, Ocuvite has included it in its newest formulation. The original Ocuvite formula is still available, but Bausch & Lomb has added Ocuvite Lutein capsules to its line of dietary supplements to address additional nutritional needs. Ocuvite Lutein capsules contain 6 mg of lutein per capsule; they also contain vitamins C and E, plus essential minerals zinc and copper. Ocuvite Lutein capsules have been formulated so patients can take multiple doses per day or take their existing multivitamin along with Ocuvite Lutein without worrying about excessive dosing of any one component. “Bausch & Lomb saw the need to diversify its dietary supplement line because they saw the need for different amounts of vitamins for different situations,” Dr. Abel said. They created Ocuvite Lutein capsules with 6 mg of lutein for those patients who were behind the eight-ball and had already developed macular problems.”

Synergistic blend

Spencer P. Thornton, MD, FACS, recommends ScienceBased Health’s (Corte Madera, Calif.) ocular nutritional supplements, he said, because they are a synergistic blend of antioxidants, multivitamins, essential trace minerals and phytochemicals that are focused on the nutrition of the retina and the entire eye. “The antioxidants that I recommend to my patients are natural products that are under high quality control. They are formulated by a group of PhDs and MDs who monitor the quality from the very sourcing of the material to the manufacturing of the material. The products don’t overdo any one thing.” He emphasized that, “It is a supplement, not a replacement.”

ScienceBased Health markets Ocular Essentials and OculaRx for general eye health, as well as HydroEye for dry eye, MaculaRx for patients who have presented symptoms of macula degeneration, as well as Optic Nerve Formula. The company recently began to market HydroEye in a kit along with OculaRx to laser in situ keratomileusis patients. Ocular Essentials costs less and is about one-half the potency of OculaRx, according to ScienceBased Health Director of Education Ellen Troyer, MT, MA. “Among other things, OculaRx includes 5 mg of lutein, which has been shown to reduce macular degeneration, as well as bilberry, which increases capillary blood flow and has been shown to improve night vision,” Ms. Troyer told Ocular Surgery News.

Dr. Thornton is enthusiastic about ScienceBased Health’s product line, but he said that beyond endorsing a product, he is endorsing the idea of nutrition in medicine and the idea of physicians getting involved so that the patients who come to them come to people who are knowledgeable rather than skeptical. “Ophthalmologists keep telling me they need to see documentation first, but it’s all there in the journals. They’re just not looking in the right ones.”

For Your Information:

Steven G. Pratt, MD, can be reached at 9850 Genessee Ave., Ste. 310, La Jolla, CA 92037; (858) 457-3010; fax: (858) 457-0028. Dr. Pratt has no direct financial interest in any of the products mentioned in this article. He is a paid consultant for Alcon.

Linda Nebeling, PhD, MPH, RD, can be reached at the National Institutes of Health/National Cancer Institute, EPN 4078, 6130 Executive Blvd., 7335 MSC, Bethesda, MD 20892; (301) 496-8520; fax: (301) 480-2087. Dr. Nebeling has no direct financial interest in any of the products mentioned in this article, nor is she a paid consultant for any companies mentioned.

Norman I. Krinsky, PhD, can be reached at Tufts University School of Medicine, Biochemistry Dept., Arnold Bldg., 136 Harrison Ave., Boston, MA 02111; (617) 636-6861; fax: (617) 636-2409. Dr. Krinsky has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Robert Abel Jr., MD, can be reached at Concord Plaza, Naamans Bldg., 3501 Silverside Rd., Wilmington, DE 19810; (302) 477-2600; fax: (302) 477-2650. Dr. Abel has no direct financial interest in any of the products mentioned in this article. He is a paid consultant for Bausch & Lomb.

John G. Meyer can be reached at Bausch & Lomb, 555 W. Arrow Highway, Claremont, CA 91711; (813) 975-7784; fax: (813) 975-7774. Mr. Meyer is a product manager for Bausch & Lomb.

Spencer P. Thornton, MD, FACS, can be reached at 5070 Villa Crest Dr., Nashville, TN 37220; (615) 373-1236; fax: (615) 373-0333. Ocular Surgery News could not confirm whether or not Dr. Thornton has a direct financial interest in any of the products mentioned in this article or if he is a paid consultant for any companies mentioned.

Ellen Troyer can be reached at ScienceBased Health, 300 Tamal Plaza, Ste. 220, Corte Madera, CA 94925; (888) 433-4726; fax: (415) 927-0990. Ms. Troyer is director of education for ScienceBased Health.

Alcon Laboratories can be reached at 6201 South Freeway, Fort Worth, TX 76134; (800) 862-5266; fax: (817) 241-0677.

Bausch & Lomb can be reached at 8500 Hidden River Parkway, Tampa, FL 33637; (800) 423-1871; fax: (909) 399-1525.

ScienceBased Health can be reached at 300 Tamal Plaza, Ste. 220, Corte Madera, CA 94925; (888) 433-4726; fax: (415) 927-0990; Web site: www.ScienceBasedHealth.com.