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Carotenoids

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Carotenoids

Carotenoids are red, orange, and yellow pigments found in fruits and vegetables. About 600 carotenoids have been identified. All of them have antioxidant properties; some of them can be converted in the body to vitamin A , and these are called “provitamin A” carotenoids.
Some of the most well-known carotenoids are beta-carotene , lutein , lycopene , astaxanthin and zeaxanthin. The results of some but not all observational studies suggest that a diet high in these carotenoids can reduce the risk of developing various illnesses, including cardiovascular disease, age-related vision loss, and various types of cancer. 1-3 These findings led to large-scale studies of synthetic beta-carotene for preventing cancer (especially lung cancer), heart disease , cataracts , strokes , and macular degeneration . To everyone’s surprise, the results showed at best no benefit, and, at worst, a possible increase in risk. 4-13
Many proponents of alternative medicine considered this outcome paradoxical, and attempted to explain it away in various ways:
  • Beta-carotene alone may not be as useful as mixed carotenoids (and other healthful substances) found in fruits and vegetables.
  • Synthetic beta-carotene may be less effective than natural beta-carotene.
  • The participants in these studies were the wrong group of people (generally, smokers).
However, while any of these explanations may be correct, it is also quite possible that carotenoids simply do not provide any of the healthful effects attributed to them. Observational studies are notoriously unreliable for proving a treatment effective. Such studies only find associations between events, rather than cause and effect. It is quite possible, for example, that people who tend to eat more fruits and vegetables may be healthier in various other ways than those who do not, and that these other factors account for the apparent improvements. Consider the history of medical beliefs about hormone replacement therapy (HRT) for menopausal women. Observational studies had found evidence that women who used hormone replacement therapy had less heart disease, and on this basis millions of women were prescribed HRT. However, when proper double-blind studies were done, the results indicated that HRT actually caused heart disease. (For information on why double-blind studies are the best type of study, see Why Does This Database Rely on Double-blind Studies? )
Similarly, nothing more reliable than observational studies underlies the widespread belief that lycopene can prevent prostate cancer and lutein can do the same for cataracts . One double-blind study does hint that mixed carotenoids is beneficial for people with HIV , but the results were statistically weak. 14 Thus, while it seems to be a good idea to eat fruits and vegetables, it is not at all clear that taking concentrated extracts of various substances found in fruits and vegetables provides any benefits.
For more information, see the individual articles on beta carotene , lutein , and lycopene .

References

1 Cooper DA, Eldridge AL, Peters JC. Dietary carotenoids and certain cancers, heart disease, and age-related macular degeneration: a review of recent research. Nutr Rev . 1999;57:201–14.

2 Epstein KR. The role of carotenoids on the risk of lung cancer. Semin Oncol . 2003;30:86–93.

3 Hak AE, Stampfer MJ, Campos H, et al. Plasma carotenoids and tocopherols and risk of myocardial infarction in a low-risk population of US male physicians. Circulation . 2003;108:802–7. Epub 2003 Aug 04.

4 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;330:1029–1035. 47.

5 Albanes D, Heinonen OP, Huttunen JK, et al. Effects of alpha-tocopherol and beta-carotene supplements on cancer incidence in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study. Am J Clin Nutr . 1995;62(6 suppl):1427S–1430S.

6 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;334:1150–1155.

7 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;334:1145–1149.

8 Frieling UM, Schaumberg DA, Kupper TS, et al. A randomized, 12-year primary-prevention trial of beta carotene supplementation for nonmelanoma skin cancer in the Physicians' Health Study. Arch Dermatol . 2000;136:179–184.

9 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;91:2102–2106.

10 The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. N Engl J Med . 1994;330:1029–1035.

11 Rapola JM, Virtamo J, Ripatti S, et al. Randomized trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet . 1997;349:1715–1720.

12 Rapola JM, Virtamo J, Haukka JK, et al. Effect of vitamin E and beta carotene on the incidence of angina pectoris. A randomized, double-blind, controlled trial. JAMA . 1996;275:693–698.

13 Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol . 2001;119:1439–1452.

14 Austin J, Singhal N, Voigt R et al. A community randomized controlled clinical trial of mixed carotenoids and micronutrient supplementation of patients with acquired immunodeficiency syndrome. Eur J Clin Nutr. 2006 May 24 [Epub ahead of print].

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