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Supplements

carotenoids

What Is It?
Health Benefits
Forms

Dosage Information

Guidelines for Use

General Interaction

Possible Side Effects

Cautions

References

Evidence Based Rating Scale

 

What Is It? 

Carotenoids are the pigments that color some fruits and vegetables red, orange and yellow. Research has shown that these natural plant compounds, acting as antioxidants, can boost the immune system and possibly lower the risk of heart disease, prevent the onset of some cancers, and protect against such age-related diseases as cataracts and macular degeneration. 

More than 600 carotenoids have been identified in foods. About 50 of them serve as vitamin A precursors: six are most common in human blood and known to be used in significant ways by the body: alpha-carotene, lycopene, lutein, zeaxanthin, cryptoxanthin, and, the best-known, beta-carotene. Alpha-carotene is plentiful in carrots and pumpkin. Lycopene is found in red fruits, such as watermelon, guava, red grapefruit, and is especially dominant in processed tomatoes. Lutein and zeaxanthin are present in red peppers, pumpkins and dark green vegetables (the yellow-orange pigments are masked by green chlorophyll). Cryptoxanthin is abundant in peaches, mangoes and oranges. And beta-carotene shows up in all these foods, as well as in sweet potatoes and cantaloupes.

For those who do not eat fruits and vegetables as a regular part of the diet, a mixed carotenoid supplement that contains a combination of the key carotenoids may be beneficial; however supplementation with beta-carotene alone has not been shown to be beneficial for most conditions and may, indeed, be risky. 

Health Benefits 

As antioxidants, carotenoids protect cells from damage by unstable oxygen molecules called Free Radicals. Though similar in structure, each carotenoid acts on a different type of body tissue. Certain carotenoids including beta-carotene, alpha-carotene and cryptoxanthin, are converted by the body into vitamin A, but only as the body requires it. 

Specifically, carotenoids may help to:

Lower the risk of certain types of cancer. Carotenoids may inhibit the growth of cancer cells. In the well-known Framingham Nurses study, where 83,000 women were followed for 14 years, researchers found that high supplemental intakes of lutein, zeaxanthin, beta-carotene and high food intakes of vitamin A (along with a diet generally high in fruits and vegetables) reduced the risk of premenopausal breast cancer. This was especially true in women more likely to develop this disease due to family history or alcohol consumption. (1) 

Other studies link high intakes of alpha-carotene, lutein, and zeaxanthin to a reduced risk for lung cancer. To provide anti-cancer actions, however, carotenoids must be taken as part of an antioxidant supplement formula featuring other carotenoids, vitamins C and E, and selenium. (2) In fact, large studies indicate that beta-carotene taken as a single supplement offers no cancer-protective actions at all, and may actually increase the risk of lung cancer in smokers. (3-7) One highly publicized study in Finland found that more cases of lung cancer developed in male smokers (including former smokers) who were taking high doses of the supplement. (8) 

Cryptoxanthin and alpha-carotene have been shown in small studies to decrease the chance of developing cervical cancer. (9-13) A 2005 review of 33 studies evaluated the level of evidence for the role of diet and nutrition in cervical dysplasia (pre-cancerous changes related to Human Papilloma Virus (HPV)). Fruits, vegetables, vitamins C and E, beta- and alpha-carotene, lycopene, lutein/zeaxanthin, cryptoxanthin, folate, retinol, and B12 were considered in the studies. The reviewers found a probable protective effect for these nutrients in the development of dysplasia and a possible protective effect for persistence of dysplasia, but concluded that the quantity of evidence was not yet convincing. (14) But in a study of 141 women with mild dysplasia, treatment with 30mg beta-carotene, 500mg vitamin C, or both over a two-year period provided no benefit. (46) Large studies are needed to further assess the role of diet, nutrition, and supplementation in prevention and treatment of cervical cancer. 

Lycopene appears to be somewhat effective at inhibiting prostate cancer. Research conducted at Harvard University found that men who ate 10 or more servings of tomato-based foods a week lowered their risk of prostate cancer by almost 45%. (15) But a 2004 meta-analysis of 11 studies found that while tomato products play a role in preventing prostate cancer, their role is modest and requires high amounts of tomato intake. (16) Additionally, a large-scale epidemiological study in 2006 showed no association between dietary lycopene intake and prostate cancer risk except in a subgroup of men with a family history of prostate cancer where lycopene intake was associated with a lower risk. (17) More research is needed to assess efficacy. Lycopene may also protect against cancers of the digestive tract, stomach, and lungs. (18-19) 

Boost the immune system in those undergoing cancer therapies. Lycopene and beta-carotene, taken along with vitamins C and E, may help protect the body against the side-effects of chemotherapy or radiation, both of which can damage healthy cells as well as cancer cells. Evidence indicates the antioxidant effects of beta-carotene and lycopene aid in protecting cells from free radical damage. (20, 21) A 2007 review of 280 laboratory and animal studies, as well as 50 human clinical trials involving more than 8,000 patients (5,000 of whom also received nutrients such as beta-carotene, vitamins A, C and E, selenium, B vitamins, vitamin D3, vitamin K3 and glutathione individually or in combination) found the nutrients enhance the effect of conventional therapies against cancer, decrease side effects of conventional treatment, and help to protect healthy cells. In 15 of the human studies, more than 3,000 patients who took the nutrients actually had increased survival. (21) 

Protect against heart disease. Experts believe that all dietary carotenoids—especially alpha-carotene, lycopene, and beta-carotene—help to prevent heart disease and heart attack by inhibiting the formation of harmful LDL cholesterol. In a major European study, men who ate large amounts of lycopene-rich foods were 50% less likely to have a heart attack than men who consumed little lycopene. Nonsmokers experienced the most benefit. (22) A study of 1,300 older people found that those who ate the most foods rich in carotenoids were half as likely to develop heart disease, and 75% as likely to have a heart attack, as those who ate the least amount of carotenoids; these results included people who smoked and had high cholesterol levels. (23)  But results of later studies were conflicting. In male and female patients with no history of cardiovascular disease, beta-carotene from food or supplements had no effect on death rates from cardiovascular causes. (24-28) Further studies found that smokers who take 20 to 30 mg of beta-carotene daily increase their risk of cardiovascular mortality by 12% to 26%. (3, 8) And a 1997 study published in Lancet found that the risk of fatal coronary heart disease increases by as much as 43% in male smokers who had prior heart attacks and took 20 mg of beta-carotene daily. (29) A Science Advisory from the American Heart Association states that the evidence does not justify use of antioxidants such as beta-carotene for reducing the risk of cardiovascular disease. (30) 

Prevent cataracts and macular degeneration. By filtering out the sun's harmful ultraviolet (UV) rays and by keeping free radicals from damaging the retina—the light-sensitive part of the eye— lutein and zeaxanthin may help to protect against macular degeneration, the progressive loss of vision that is the leading cause of blindness in older adults. Other carotenoids may help preserve lens of the eye, decreasing the risk of cataracts. Studies have shown that taking 15 mg of beta-carotene daily, combined with vitamins C and E and zinc, reduces the risk of visual acuity loss by 27% and reduces the risk of progression of age-related macular degeneration (AMD) by 25%. (31, 32) However, conflicting evidence exists regarding the prevention of AMD, and benefit for cataracts has not been demonstrated. (33, 34) 

Combat chronic fatigue syndrome. Because of their anti-oxidant properties, carotenoids can enhance immunity: taking a mixed carotenoid supplement along with vitamin C and echinacea theoretically may help the body fight the persistent tiredness and flu-like symptoms associated with this ailment; however carotenoids have not been specifically studied for this indication. (35, 36) 

Reduce the risk of developing diabetes. In a 1999 study conducted by the Centers for Disease Control, researchers found that those with high levels of beta-carotene, lycopene, and cryptoxanthin had normal glucose tolerance, while those with the lowest levels of these compounds were more likely to be among those newly diagnosed with type 2 diabetes. (37)  And a 2004 cohort study of 2,285 men and 2,019 women over age 40 found that intake of carotenoids was associated with a reduced risk of developing type 2 diabetes. (38) However, in the Physician’s Health Study, supplementation with beta-carotene for an average of twelve years had no effect on the risk for type 2 diabetes. (47) 

Fight the onset of Alzheimer's disease and provide anti-aging actions. The antioxidant properties of carotenoids, in combination with vitamins C and E, may help keep nerve cells in the brain from deteriorating. This may help guard against the effects of aging in general as well as the more specific memory loss and disorientation associated with Alzheimer's disease. Low levels of these nutrients have been found in Alzheimer's patients. (39-41) While a 2002 review of studies found insufficient evidence to recommend supplementation to prevent or treat Alzheimer's disease, further studies have been promising. (42) In the Rotterdam Study, a population-based, prospective cohort study of more than 5,000 participants in the Netherlands in 2002, increased intake of beta-carotene was associated with a decreased risk of developing Alzheimer's disease. (43)  

Treat male infertility. Mixed carotenoids, taken with vitamins C and E, may help protect sperm from damage by free radicals. However, research is limited. In a preliminary study in 2002, 66% of men who took 2,000 mcg of lycopene twice a day for three months had improved sperm concentration, 53% had improved motility, and 46% showed improved sperm morphology (shape and size). Those with higher sperm concentrations showed significant improvement in fertility, resulting in six pregnancies in 26 patients (23%). (44) In a 2005 study of 97 healthy, non-smoking men, a higher intake of the combination of vitamins C and E and beta-carotene was associated with improved sperm count and motility. (45)  

Photosensitivity. Carotenoids have been used to treat congenital photosensitivity diseases, and 25mg missed carotenoids daily for three months reduced sunburn in sun-sensitive people. (48)  

Forms

  • Food

  • Capsules

  • Tablet 

Dosage Information 

Special tips: 

  • The majority of benefits from carotenoids appear to come from food rather than supplements. Eat at least five servings of colorful fruits and/or vegetables daily. Additional supplementation for the general public has not been recommended. If additional supplementation is needed, take a mixed carotenoid supplement containing 15-30mg of beta carotene as well as other carotenoids.  Higher doses may be needed to protect against specific ailments. 

  • Women taking oral contraceptives or who use estrogen-based hormone replacement therapy—both of which reduce blood levels of carotenoids—may consider taking a mixed carotenoid supplement daily.  

Be sure to check out our Dosage Recommendations Chart for Carotenoids, which lists therapeutic dosages for specific ailments at a glance. 

Guidelines for Use

Taking carotenoid supplements with foods that contain some fat helps the body absorb these compounds more readily. 

General Interactions 

  • Avoid taking carotenoid supplements in combination with conventional statin medications and with vitamin B3 (niacin) used to treat high cholesterol and to prevent heart disease. When taken together, the carotenoids can lower high-density lipoprotein (good cholesterol) levels and reduce the benefits of the conventional medications or antioxidant in people with heart disease.

  • Avoid drinking high amounts of alcohol when taking carotenoid supplements, as it can decrease serum concentrations of beta-carotene and other carotenoids, lead to hepatotoxicity (liver inflammation), and increase serum concentrations of retinol – high levels of which may lead to the formation of cancer cells.

  • A number of medications may reduce beta-carotene absorption from food. None have been demonstrated to be clinically significant when taken for short periods of time, Supplementation might be considered with long-term use of cholestyramine (Questran) and colestipol (Colestid), mineral oil, Neomycin,orlistat (Xenical, Alli), and proton pump inhibitors such as Lansoprazole (Prevacid), Omeprazole (Prilosec, Losec), Rabeprazole (Aciphex), and Pantoprazole (Protonix, Pantoloc). 

 

Possible Side Effects

Ingesting high levels of carotenoids from either foods or supplements may cause the palms of the hands and soles of the feet to turn orange. Stop taking extra carotenoids if this occurs, and consult a doctor. 

Cautions

Avoid taking large amounts of any one carotenoid as a supplement; doing so may decrease the usefulness of other carotenoids to the body and appears to increase a variety of risks. 

References 

1. Zhang S, Hunter DJ, Forman MR, et al. Dietary carotenoids and vitamins A, C, and E and risk of breast cancer. J Natl Cancer Inst. 1999;91:547-56.
2. Hercberg S, Galan P, Preziosi P, et al. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004;164:2335-42.
3. Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta-carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150-5.
4. Albanes D, Heinonen OP, Taylor PR, et al. Alpha-tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of baseline characteristics and study compliance. J Natl Cancer Inst. 1996;88:1560-70.
5. Omenn GS. Chemoprevention of lung cancer: the rise and demise of beta-carotene. Annu Rev Public Health. 1998;19:73-99.
6. Cooper DA, Eldridge AL, Peters JC. Dietary carotenoids and lung cancer: a review of recent research. Nutr Rev. 1999;57:133-45.
7. Virtamo J, Pietinen P, Huttunen JK, et al. Incidence of cancer and mortality following alpha-tocopherol and beta-carotene supplementation: a postintervention follow-up. JAMA. 2003;290:476-85.
8. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994;330:1029-35.
9. Peng YM, Peng YS, Childers JM, et al. Concentrations of carotenoids, tocopherols, and retinol in paired plasma and cervical tissue of patients with cervical cancer, precancer, and noncancerous diseases. Cancer Epidemiol Biomarkers Prev. 1998 Apr;7(4):347-50.
10. Gamboa-Pinto AJ, Rock CL, Ferruzzi MG, et al. Cervical tissue and plasma concentrations of alpha-carotene and beta-carotene in women are correlated. J Nutr. 1998 Nov;128(11):1933-6.
11. Nagata C, Shimizu H, Yoshikawa H, et al. Serum carotenoids and vitamins and risk of cervical dysplasia from a case-control study in Japan. Br J Cancer. 1999 Dec;81(7):1234-7.
12. Schiff MA, Patterson RE, Baumgartner RN, et al. Serum carotenoids and risk of cervical intraepithelial neoplasia in Southwestern American Indian women. Cancer Epidemiol Biomarkers Prev. 2001 Nov;10(11):1219-22.
13. Ghosh C, Baker JA, Moysich KB, et al. Dietary intakes of selected nutrients and food groups and risk of cervical cancer. Nutr Cancer. 2008;60(3):331-41.
14. Garcîa-Closas R, Castellsagué X, Bosch X, González CA. The role of diet and nutrition in cervical carcinogenesis: a review of recent evidence. Int J Cancer. 2005 Nov 20;117(4):629-37.
15. Giovannucci E, Ascherio A, Rimm EB, et al. Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst. 1995;87:1767-76.
16. Etminan M, Takkouche B, Caamaño-Isorna F. The role of tomato products and lycopene in the prevention of prostate cancer: a meta-analysis of observational studies. Cancer Epidemiol Biomarkers Prev. 2004 Mar;13(3):340-5.
17. Kirsh VA, Mayne ST, Peters U, et al. A prospective study of lycopene and tomato product intake and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev. 2006;15:92-8.
18. Michaud DS, Feskanich D, Rimm EB, et al. Intake of specific carotenoids and risk of lung cancer in 2 prospective US cohorts. Am J Clin Nutr. 2000;72:990-7.
19. Nkondjock A, Ghadirian P, Johnson KC, Krewski D. Dietary intake of lycopene is associated with reduced pancreatic cancer risk. Canadian Cancer Registries Epidemiology Research Group. J Nutr. 2005;135:592-7.
20. Drisko JA, Chapman J, Hunter VJ. The use of antioxidant therapies during chemotherapy. Gynecol Oncol. 2003 Mar;88(3):434-9.
21. Simone CB 2nd, Simone NL, Simone V, Simone CB. Antioxidants and other nutrients do not interfere with chemotherapy or radiation therapy and can increase kill and increase survival, Part 2. Altern Ther Health Med. 2007 Mar-Apr;13(2):40-7.
22. Kardinaal AF, Aro A, Kark JD, et al. Association between beta-carotene and acute myocardial infarction depends on polyunsaturated fatty acid status. The EURAMIC Study. European Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast. Arterioscler Thromb Vasc Biol. 1995 Jun;15(6):726-32.
23. Greenberg ER, Baron JA, Karagas MR, et al. Mortality associated with low plasma concentration of beta carotene and the effect of oral supplementation. JAMA. 1996 Mar 6;275(9):699-703.
24. Hennekens CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta-carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med. 1996;334:1145-9.
25. Virtamo J, Rapola JM, Ripatti S, et al. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Arch Intern Med. 1998;158:668-75.
26. Lee IM, Cook NR, Manson JE, et al. Beta-carotene supplementation and incidence of cancer and cardiovascular disease: the Women's Health Study. J Natl Cancer Inst. 1999;91:2102-6.
27. Klipstein-Grobusch K, den Breeijen JH, Grobbee DE, et al. Dietary antioxidants and peripheral arterial disease: the Rotterdam study. Am J Epidemiol. 2001;154:145-9.
28. Knekt P, Ritz J, Pereira MA, et al. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80:1508-20.
29. Rapola JM, Virtamo J, Ripatti S, et al. Randomised trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet. 1997;349:1715-20.
30. Kris-Etherton PM, Lichtenstein AH, Howard BV, et al. AHA Science Advisory: Antioxidant vitamin supplements and cardiovascular disease. Circulation. 2004;110:637-41.
31. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. AREDS report no. 8. Arch Ophthalmol. 2001;119:1417-36.
32. Age-Related Eye Disease Study Research Group. Potential public health impact of age-related eye disease study results: AREDS report no 11. Arch Ophthalmol. 2003;121:1621-4.
33. Seddon JM, Ajani UA, Sperduto R, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. JAMA. 1994;272:1413-20.
34. Cho E, Seddon JM, Rosner B, et al. Prospective study of intake of fruits, vegetables, vitamins, and carotenoids and risk of age-related maculopathy. Arch Ophthalmol. 2004;122:883-92.
35. Verillo EF, Gellman LM. Fatigue Syndrome: A Treatment Guide. New York; Macmillan: 1998.
36. Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Altern Med Rev. 2001 Oct;6(5):450-9.
37. Ford ES, Will JC, Bowman BA, Narayan KM. Diabetes mellitus and serum carotenoids: findings from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 1999 Jan 15;149(2):168-76.
38. Montonen J, Knekt P, Jarvinen R, Reunanen A. Dietary antioxidant intake and risk of type 2 diabetes. Diabetes Care. 2004 Feb;27(2):362-6.
39. Zaman Z, Roche S, Fielden P, et al. Plasma concentrations of vitamins A and E and carotenoids in Alzheimer's disease. Age Ageing. 1992 Mar;21(2):91-4.
40. Jiménez-Jiménez FJ, Molina JA, de Bustos F, et al. Serum levels of beta-carotene, alpha-carotene and vitamin A in patients with Alzheimer's disease. Eur J Neurol. 1999 Jul;6(4):495-7.
41. González-Gross M, Marcos A, Pietrzik K. Nutrition and cognitive impairment in the elderly. Br J Nutr. 2001 Sep;86(3):313-21.
42. Grundman M, Grundman M, Delaney P. Antioxidant strategies for Alzheimer's disease. Proc Nutr Soc. 2002 May;61(2):191-202.
43. Engelhart MJ, Geerlings MI, Ruitenberg A, et al. Dietary intake of antioxidants and risk of Alzheimer disease. JAMA. 2002 Jun 26;287(24):3223-9.
44. Gupta NP, Kumar R. Lycopene therapy in idiopathic male infertility – a preliminary report. Int Urol Nephrol. 2002;34(3):369-72.
45. Eskenazi B, Kidd SA, Marks AR, et al. Antioxidant intake is associated with semen quality in healthy men. Hum Reprod. 2005 Apr;20(4):1006-12.
46. Mackerras D, Irwig L, Simpson JM et al. Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. Br J Cancer,1999;79:1448-1453.
47. Liu S, Ajani U, Chae C et al. Long-term β-carotene supplementation and risk of type 2 diabetes mellitus. JAMA 1999;282:1073-1075.
48. Stahl W, Heinrich U, Jungmann H, et al. Carotenoids and carotenois plus vitamin E protect against ultraviolet light-induced erythema in humans. Am J Clin Nutr, 2000;71:795-8.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

 

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Date Published: 04/18/2005
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