In our nutrition-based efforts to preserve our patients’ macular health and enhance visual performance, optometrists also may be supporting systemic wellness. The biological properties of xanthophylls lutein and zeaxanthin as well as emerging epidemiological evidence in relation to chronic and degenerative diseases have triggered interest in these carotenoids as potentially beneficial for general health.1,2

Like other carotenoids, they are not produced by the body and must be obtained through diet (see Foods High in Xanthophylls).1,3,4 While the highest concentrations of lutein and zeaxanthin are found in central neural regions, such as the retina (as macular pigment) and the brain’s frontal and occipital cortical regions, they are distributed throughout tissue in the entire body (see Xanthophylls in Human Tissue).1

Part 1 of this three-part series (“ Add Color to Your Diet,” May 2012) gave an overview of how xanthophylls protect the retina and enhance visual function. In this installment, we’ll take a look at xanthophylls beyond the eye, reviewing a number of studies that investigate their protective role in skin damage and various types of cancer.

Foods High in Xanthophylls
  • Collards, frozen, chopped, cooked, boiled, drained, without salt
  • Collards, cooked, boiled, drained, without salt
  • Kale, frozen, cooked, boiled, drained, without salt
  • Kale, cooked, boiled, drained, without salt
  • Spinach, canned, drained solids
  • Spinach, cooked, boiled, drained, without salt
  • Spinach frozen, chopped or leaf, cooked, boiled, drained, without salt
  • Turnip greens, frozen, cooked, boiled, drained, without salt
  • Turnip greens, cooked, boiled, drained, without salt

Source: Release 18 of the USDA National Nutrient Database for Standard Reference

Skin Damage
In the eye, lutein and zeaxanthin comprise macular pigment, which acts as a filter to absorb blue light. Macular pigment has been shown to act as a potent antioxidant, quenching free radicals associated with the pathogenesis of age-related macular degeneration.3,4 Recent research suggests that their roles are not exclusively protective to the eye, but to the skin as well.

As a consequence of dietary intake, lutein and zeaxanthin are found in the skin.5 Just as the lutein and zeaxanthin found in the macula protect the retina against exposure to damaging visible wavelengths of light, the lutein and zeaxanthin present in skin cells play a role in protecting the skin from environmental damage. Research suggests that the presence of lutein and zeaxanthin in the skin may be important in helping to maintain its health and proper function.

A 2007 double-blind, placebo-controlled study investigated oral, topical or combined (oral and topical) applications of lutein and zeaxanthin on the skin.6 Results indicated that separate topical or oral administration of lutein and zeaxanthin reduced lipid peroxidation and increased skin elasticity, superficial skin lipids and skin hydration.6 Applying the topical preparation while simultaneously taking the oral supplement increased the benefits obtained for each of the measured parameters.6

Cancer Risk
Some studies have suggested xanthophylls may play a potential protective role against carcinogenesis in many ways, including selective modulation of apoptosis, inhibition of angiogenesis, enhancement of gap junctional intercellular communication, induction of cell differentiation, prevention of oxidative damage and modulation of the immune system.7,8


The brain’s frontal cortex has high concentrations of xanthophylls.
A number of observational studies have found these xanthophylls may help reduce the risk of certain types of cancer, particularly those of the breast and lung.8

• Breast cancer. During the 14-year follow-up of the Nurses Health Study—a prospective study of more than 83,000 female nurses ages 34 to 59 at baseline—2,697 developed invasive breast cancer.9 Pre-diagnostic intake of lutein plus zeaxanthin was inversely associated with breast cancer risk in pre-menopausal women (784) but not in post-menopausal women (1,913).9

Researchers found a similar relationship when investigating pre-menopausal breast cancer risk and intake of nutrients in a case-control study of 297 cases and 311 control subjects.10 A reduction in pre-menopausal breast cancer risk was associated with a high intake of lutein plus zeaxanthin during the two years prior to dietary interview.10

In a study of 270 case-control pairs nested within a prospective cohort study with up to nine-year follow-up, breast cancer risk was doubled among subjects with pre-diagnostic serum lutein at the lowest quartile, compared to those at the highest quartile.11

Korean researchers reported the serum concentration of lutein plus zeaxanthin was inversely associated with breast cancer risk, while studies in human mammary cells and in animal models also support a protective role of xanthophylls.8,12

Xanthophylls in Human Tissue
  • Eye
    • Lens
    • Retina
  • Blood serum
  • Skin
    • Epidermis
    • Dermis
  • Cervix
  • Brain
    • Frontal cortex
    • Occipital cortex
  • Breast
Conversely, a large case-cohort analysis (1,452 cases, 5,239 controls) of women enrolled in the Canadian National Breast Screening Study who completed a self-administered dietary questionnaire exhibited different results. The research analysts found no association between dietary intakes of lutein plus zeaxanthin at baseline and breast cancer risk during the 11-year follow-up in the overall study population.13

• Lung cancer. A prospective study of male smokers in Finland in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study investigated the association of xanthophylls and lung cancer risk. Of 27,084 male smokers who completed a dietary questionnaire at baseline, 1,644 developed lung cancer during the 14-year follow-up.14 Men in the highest quintile of lutein plus zeaxanthin intake at baseline had a 17% lower risk of lung cancer compared to men in the lowest quintile.14

• Colon cancer. Other studies have found inverse associations of the xanthophylls with precancerous lesions in the colon and rectum. The concentration of serum zeaxanthin—but not of lutein or other carotenoids—was lower in 59 patients with adenomatous colorectal polyp than in a healthy control group.15

• Ovarian cancer. Dietary intake of lutein plus zeaxanthin has been inversely associated with ovarian cancer risk. A case-control study of 1,031 Italian patients with confirmed incident epithelial ovarian cancer and 2,411 patients admitted to area hospitals for acute, non-neoplastic diseases (controls) showed that those in the highest quintile of lutein plus zeaxanthin intake had a risk of developing ovarian cancer that was 40% lower than those in the lowest quintile of intake.16 

The literature discussed here is just a sampling of the growing body of data that suggests lutein and zeaxanthin may help prevent several systemic diseases and conditions. Randomized trials of diets high in carotenoid-rich vegetables and fruits are needed to confirm these results.

Keep an eye out for the final part of this series, which will appear in the September 2012 issue. There, we’ll discuss how xanthophylls factor into heart disease, stroke, diabetes, and brain and cognitive impairment.

Drs. Pelino and Pizzimenti have no proprietary interest in any instrument, food product, vitamin or supplement. Dr. Pizzimenti serves on the scientific advisory board for ZeaVision.

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