According to the National Center For Health Statistics, about 10-30% of adults ages 70 and older have some form of vision impairment. This can take the form of macular degeneration, which is the leading cause of acquired blindness in adults, cataracts or glaucoma. Yet many cases of vision impairment can be prevented. Seniors are becoming more aware of the problem and with the baby boomer population slated to hit approximately 70 billion by the year 2030, the potential is huge.
Still, nutraceutical companies have their work cut out for them in terms of educating consumers about eye health and how dietary habits and supplementation can help. Lutein has been the hottest area recently due to American Home Products' Whitehall-Robins division adding lutein to its "Centrum" line. It is also the ingredient with the strongest clinical science at this point. Other ingredients are up and coming, however. Bilberry has a history of anecdotal evidence behind it and astaxanthin, while still in its infancy in terms of research, is definitely beginning to hit the radar screen.
Lutein (And Zeaxanthin): Leading The Field
Besides being carotenoids found in green leafy vegetables such as kale or spinach, lutein and zeaxanthin (usually found together) are also found in the macular region of the eye. Both carotenoids make up what is referred to as the macular pigment and according to experts, are the only two carotenoids present in a majority of the tissues in the eye.
According to Dr. Rodney Ausich, president, Kemin Foods, Des Moines, IA, "Our bodies do not synthesize lutein or zeaxanthin. The only source is from the diet. If we do not consume sufficient amounts from our diets or from supplements, then there will not be sufficient lutein or zeaxanthin found in the retina."
Dr. J. Paul Zimmer, scientific leader, human nutrition research, Roche Vitamins, Parsippany, NJ, added that the carotenoids protect the eye from oxidative damage and filter out damaging near-UV blue light.
Most of the studies on lutein and zeaxanthin revolve around the consumption of these two carotenoids in fruits and vegetables and the reduced incidence of eye-related illnesses. Studies have concluded that low consumption of these two carotenoids may increase the risk of developing eye-related illnesses.
Indications for lutein include age-related macular degeneration (AMD), cataracts and more recently, retinitis pigmentosa. Dr. Zakir Romazanov, executive vice president, Pharmline, Florida, NY, discussed the deficiency of lutein and the correlation of eye-related illnesses. "The deficiency of lutein is a major factor correlating to reducing risk for macular degeneration," he commented.
But What About Zeaxanthin?
If you take a look at the market for eye health in terms of the spectrum of carotenoids, lutein always takes center stage. But lutein does not work alone. According to experts, lutein has been the main focus because of two factors. According to the March 2000 issue of Optometry (Journal of the American Optometric Association), "Lutein can be metabolized into zeaxanthin and is therefore the more essential carotenoid." In addition, it has not been established how exactly zeaxanthin fits into the equation. In fact, it was only recently discovered that both lutein and zeaxanthin are the only two carotenoids present in the tissues of the eye and therefore are both important in maintaining eye health.
Roche's Dr. Zimmer said, "Because many studies reporting the benefits associated with lutein and zeaxanthin have not analyzed them separately, we don't really know which is the more efficacious component." What is known of zeaxanthin, according to Dr. Zimmer, is that some studies indicate that it may be a slightly better antioxidant than lutein.
Dr. Cindy Schweitzer, senior scientist, Cognis Health and Nutrition, LaGrange, IL, noted, "What we do know about zeaxanthin is that it is present in the center of the macula, and that as part of the macular pigment, it might help protect the eye against oxidative damage. To date there are no drugs on the market to prevent eye diseases, few to treat and certainly none to reverse eye disease. That's why indications from observational studies are promising."
Until recently zeaxanthin had not been available to the market in large quantities. Dr. Romazanov said Pharmline has developed and patented a technology to extract zeaxanthin in large quantities. Before this, he said, zeaxanthin was only available in trace amounts in supplements and primarily used as a marketing tool.
The Consumer Awareness Front
On the consumer awareness front, most industry sources agree that right now, awareness is relatively low but expected to explode. Barry Kaufman, product manager, BASF, Mount Olive, NJ, commented, "The awareness is extremely low but within six months to a year it will reach higher levels." He attributed lutein's projected growth to Whitehall Robins' Centrum product. "I think the growing popularity of lutein and its inclusion in Centrum multivitamins will cause a lot of multivitamins to re-formulate eventually," he said.
Kemin's Mr. Ausich offered, "We have performed consumer awareness studies on lutein and have found that about 25-30% of the population knows about lutein."
Cognis' Dr. Schweitzer also commented on low awareness levels, citing a lack of education. "Consumer education is still emerging and has a long way to go," she said.
Conversely, Dr. Robert Abel, clinical professor of ophthalmology, Thomas Jefferson University, Philadelphia, PA, and author of The Eye Care Revolution, suggested, "Consumer awareness is growing all over the place; however, they need to know more of the interesting developments." Part of the problem, he said, is physicians' lack of knowledge of nutraceuticals. "Physicians are not in tune with the nutraceuticals industry and patients must turn elsewhere for their information. Physicians should be encouraged to read journals and attend conferences to expand their knowledge of the nutraceuticals industry to better serve their patients," he explained. The effort to involve physicians is happening slowly. According to Dr. Abel, "Bausch & Lomb has been talking to doctors and encouraging them to learn about the science behind lutein."
The Supplement Story
Since the body cannot make its own lutein-and since the public does not eat enough green leafy vegetables-supplements are imperative. Also, according to Roche's Dr. Zimmer, "In one study lutein in supplement form was compared to spinach and the study concluded that the supplement form had two times the bioavailability."
Dr. Schweitzer said similarly, "Nutrients from supplements are more bioavailable than nutrients from foods. That is a key point. Supplementation from natural mixed carotenoids provides a natural bridge for those of us who do not consume enough fruits and vegetables."
In terms of supplements, combinations may be the way to go. BASF's Mr. Kaufman suggested, "In terms of consumer usage, beta-carotene is way above lutein but what I think will evolve over the next few years will be a package with major mixed carotenoids like lutein, beta-carotene, lycopene, zeaxanthin and maybe a couple of others." He continued, "That is a story the consumer understands-give them a supplement that mirrors the essential carotenoids in fruits and vegetables."
Depending on how many nutrients you want to fit into a supplement, combinations can be good and bad. Dr. Ausich explained, "Because of limitations on the size of the capsule or tablet, formulators may not be able to add the desired amount of a specific vitamin or nutrient in the multivitamin formulation."
Dr. Abel agreed, "Adding lutein to a multivitamin depends on cost and how many ingredients are already in the supplement."
The problem in the supplement market right now, according to Dr. Romazanov, is that lutein as a single ingredient cannot do more than a combination of ingredients. "The benefits of mixed carotenoids have been known for hundreds of years," he said, "It's rather nice to have a mix of carotenoids like lutein, zeaxanthin and beta-carotene-that is an ideal supplement."
Bilberry: From Pilots To The Public
The old story behind bilberry, according to Don Stanek, director of sales, Linnea, Locarno, Switzerland, goes back to World War II. "The British Royal Air Force pilots used to eat bilberries and it was believed that these men had better night vision as a result," he said. The story was later confirmed by follow up studies that bilberry could improve visual acuity as well (The Lawrence Review of Natural Products, Facts and Comparisons, St. Louis, MO, 1996). According to Herbal Medicinals, A Clinicians Guide, bilberries are black, coarsely wrinkled berries with many small, shiny brownish-red seeds that have a sweetly caustic taste. A bilberry consists of about 10% tannins, but most of the medicinally beneficial pharmacology come from the 25% anthocyanosides. The bilberry is the European blueberry.
Bilberry has been noted for relieving gastrointestinal upset, improving various eye problems such as eye ulcers, diabetic retinopathy, myopia, cataracts and retinol disturbances, but mostly it has come to prominence for improving night vision.
The good part about bilberry, said Rodger Rohde, Jr., president, Triarco Industries, Wayne, NJ, is that it has a long history of use. "In Europe it has been used for a thousand years," he said, "I don't think lutein has the same history behind it."
Matt Humphrey, marketing director, Draco Natural Products, San Jose, CA, agreed. In addition, he said, "The mechanisms of action, the anthocyanosides, specifically target the eye's vascular system, which requires more blood circulation than any other part of the body because the vascular network in the eye is very complex and fine."
Consumer awareness of bilberry and eye health is still relatively low, however, according to David Wilson, president, A.M. Todd Botanicals, Montgomeryville, PA. "We are only just beginning to see an increase in people looking at bilberry for increasing night vision. There is a very specialized group asking for it right now, but it is starting to get out there."
Triarco's Mr. Rohde agreed. "Consumer awareness for bilberry is only high among users of natural products," he explained. "It has not yet transcended the herbal market to become its own category like garlic. Over time it will come into its own but there is a longer curve of acceptance for it."
According to Katie Ferren, marketing director, Soft Gel Technologies/OptiPure, Los Angeles, CA, "People who are aware of bilberry associate it with eye health more than anything else. It is an eye health product first and an antioxidant second. It also has a stronger association with eye health than lutein or astaxanthin."
To Combine Or Not To Combine
Combining bilberry with other beneficial ingredients for eye health seems like a good idea in theory, but Mr. Wilson noted, "I see the possibility of combinations and I think it is a good idea. But you can't just throw a bunch of herbs or nutrients together without doing your homework."
Mr. Stanek discussed combinations further. "I think combinations are very beneficial. We put out a product that contains bilberry, lutein, vinpocetine and ginkgo and the combination of lutein and bilberry seems to be a great one."
Ms. Ferren added, "Right now bilberry is the leader as a single entity product but there is a trend toward cocktail products. I think the cocktail products are a good idea because by combining essential nutrients you increase your chances of fighting disease."
Mr. Rohde concurred. "Bilberry has been used mostly as a single herb but used in combination especially with other bioflavanoids it would be very beneficial," he said, adding, "It would be good for the whole industry to make combinations because then we aren't so crop dependent-bilberry is not as bountiful as we would like it to be."
In an interesting aside to bilberry's market, the herb reportedly has applications among diabetics. According to Mr. Stanek, "Bilberry has been indicated for diabetic retinopathy. People who have diabetes have increased blood sugar levels, which over a long period of time can impede vision and eventually lead to permanent blindness."
Astaxanthin: The New Ingredient On The Block
It is hard to be the new nutraceutical on the block and those who produce astaxanthin should know, as growth in the mainstream continues slowly. While it has been typically used in animal feed, it has come to the nutraceuticals market very recently as an ingredient for eye health. Astaxanthin is a carotenoid found in many types of seafood, including lobster, shrimp, prawns, crab, salmon and trout and it is what gives these sea creatures their pinkish color. But the main source for "rich" astaxanthin, according to the companies who are currently producing it for human consumption, is microalgae, specifically Haematococcus pluvialis.
Companies that currently deal with astaxanthin for human consumption include LaHaye Laboratories, Redmond, WA, which is currently marketing and manufacturing its "astaZANTHIN" brand astaxanthin, Cyanotech, Kailua-Kona, HI, which is a supplier of astaxanthin through its "BioAstin" product and Aquasearch, Kailua-Kona, HI, which last month launched "The AstaFactor." The Astafactor is an astaxanthin-rich dietary supplement that has been shown in studies to be 100-550 times more powerful than Vitamin E and consists of Hawaii-grown haematococcus microalgae blended with natural rice bran oil.
According to the Michael Maloney, president and CEO of LaHaye Laboratories, the late president of the company Peter LaHaye began to investigate the nutritional link between the early onset of eye diseases and the lack of antioxidants in the mid 1980's. As a result the company developed "Icaps" dietary supplements, a blend of vitamins and minerals designed to protect the eyes, which was sold to Nestlé in 1998.
Commenting on its current capabilities, Mr. Maloney said, "AstaZanthin is a patented antioxidant, which traps more free radicals than any other antioxidant." In addition, he noted astaxanthin's ability to cross the blood brain barrier. "There are few antioxidants that have the ability to do this and the brain happens to be the area most susceptible to oxidative stress," he explained.
Dr. Todd Lorenz, scientific director, Cyanotech, Kailua-Kona, HI, concurred, "Astaxanthin can cross the blood brain barrier and can protect the eyes and the rest of the central nervous system from scavenging free radicals and singlet oxygen," he said.
Up to this point there are no human clinical studies on astaxanthin; however, according to Mr. Maloney, "There are some comprehensive animal models investigating macular degeneration and astaxanthin intake."
Dr. Samuel Lockwood, director of medical affairs at Aquasearch, commented on future studies. "In terms of it being tested for eye health, human clinical trials have been planned. We want to market a product with sponsored clinical research behind it."
Astaxanthin Vs. Other Eye Health Nutraceuticals
Is astaxanthin a superior carotenoid? "We know that lutein is very important to eye health because it is found in the eye along with zeaxanthin. But what is questionable is whether one needs to supplement with these because they are so abundant in the diet," Mr. Maloney commented. In terms of astaxanthin he said, "Unless you are an Eskimo and eat extremely large quantities of seafood, you are not getting any astaxanthin in your diet. It is also important to eat a diet of mixed carotenoids but if you have the choice to supplement you are better off with astaxanthin."
Cyanotech's Dr. Lorenz said of carotenoid combinations, "I think that more studies need to be done but I think that astaxanthin is a very good complement to lutein and zeaxanthin."
Commenting on the issue of awareness, Mr. Maloney said the research community and the consumer have become very familiar with only a small portion of the carotenoid family through beta-carotene. In terms of acquainting the consumer with astaxanthin, he said, "It doesn't take much for people to understand when you tell them astaxanthin is what gives salmon and flamingos their pink color-then they get it." According to Dr. Lorenz, astaxanthin is still quite unknown, although he has noticed a significant increase within the past four months.
Dr. Lockwood predicted, "I think we are at a threshold level right now. The main thing we can do is provide objective information to the consumers," he said, "There is going to be a buzz around here in three months similar to what happened with St. John's Wort-we are right at the beginning of the learning curve for astaxanthin."
