Role in macular health and AMD
Zeaxanthin and lutein are the only carotenoids that accumulate in the human macula. Observational studies have found that people with higher dietary intake or higher blood levels of both pigments tend to have a lower risk of age-related macular degeneration (AMD). A large randomised trial (AREDS2, 4,203 participants) found that supplementing with lutein and zeaxanthin did not significantly reduce AMD progression in the trial population as a whole, but participants who had the lowest dietary intake of these carotenoids before the study showed about a 25% reduced risk of progression when supplemented. A 10-year follow-on study continued to show benefit of lutein and zeaxanthin over beta-carotene in the AREDS formulation, particularly for current and former smokers.
The AREDS2 randomised trial found lutein and zeaxanthin supplementation (10mg and 2mg per day) did not significantly reduce AMD progression overall, but participants with the lowest baseline dietary intake showed approximately 25% lower risk of progression to advanced AMD.
2013RCTAREDS2 Research Group, JAMA, 2013 (AREDS2 Report No. 1 and secondary analyses in JAMA Ophthalmology 2013)
Supplementation with lutein and zeaxanthin increases macular pigment optical density (MPOD) in RCTs. Six of seven included trials in one review found measurable MPOD increases with sufficient dosing.
2024Meta-analysisAdvances in Nutrition, systematic review and network meta-analysis, 2024
Observational studies consistently report that higher dietary lutein and zeaxanthin intake is associated with lower odds of AMD, particularly late AMD.
2016ObservationalMacular Pigment in Retinal Health and Disease, PMC, 2016
Toxicology and acceptable intake
Multiple toxicology studies have examined zeaxanthin at high doses in animals and humans. A two-generation rat reproduction study established a no observed adverse effect level. Genotoxicity tests were all negative. Human intervention studies at doses up to 20mg per day for six months reported no adverse effects. JECFA (the joint WHO/FAO expert committee) initially set a group ADI for lutein and zeaxanthin in 2006, then raised it to 'not specified' in 2018, reflecting the low hazard profile. EFSA evaluated synthetic zeaxanthin for food supplement use in 2012 and found that up to 2mg per day raised no grounds to restrict it.
JECFA raised the group ADI for lutein and zeaxanthin to 'not specified' in 2018, following reassessment of the two-generation rat study NOAEL at 500mg/kg body weight per day.
2018Regulatory reviewJECFA (Joint FAO/WHO Expert Committee on Food Additives), 2018 reassessment
EFSA's NDA Panel concluded in 2012 that synthetic zeaxanthin at up to 2mg per day in food supplements did not raise safety concerns, applying an uncertainty factor of 200 to the NOAEL of 150mg/kg body weight per day from the two-generation rat study.
2012RegulatoryEFSA NDA Panel, EFSA Journal 2012;10(10):2891
All in vitro and in vivo genotoxicity assays for synthetic zeaxanthin were negative. Subchronic studies in rats and mice showed no adverse effects at 1000mg/kg per day. A 52-week primate study showed no adverse ocular changes.
2016Lab + animalEdwards JA, Zeaxanthin: Review of Toxicological Data and Acceptable Daily Intake, Journal of Ophthalmology, 2016
Human trials at 20mg per day for up to 6 months reported no clinically significant adverse effects. The most commonly noted effect at sustained high intake across multiple carotenoids is carotenodermia, a reversible yellow-orange skin tinge.
2016RCTEdwards JA, Journal of Ophthalmology, 2016; clinical trial literature reviewed therein
EU and UK regulatory classification
Zeaxanthin holds an E number (E161h) and an INS number (161h) under the international Codex Alimentarius framework, but it is not currently listed in EU Regulation 1333/2008 Annex II as a permitted food colour additive. This means it cannot legally be used as a food colourant in the UK or EU. It has separate authorisation as a novel food ingredient, restricted to food supplements at a maximum of 2mg per person per day. Any use of zeaxanthin as a food colour would require a distinct authorisation that has not been granted.
E161h (zeaxanthin) does not appear in Annex II of the consolidated EU Regulation 1333/2008 (the Union list of permitted food additives). E161b (lutein) and E161g (canthaxanthin) are listed; E161h is not.
2024RegulatoryConsolidated EU Regulation 1333/2008, EUR-Lex (version updated 2 June 2024)
Synthetic zeaxanthin was authorised as a novel food ingredient in the EU (Commission Implementing Decision 2013/49/EU) and is retained in UK law (FSA Novel-151), permitting use only in food supplements at a maximum of 2mg per person per day.
2013RegulatoryCommission Implementing Decision 2013/49/EU; UK FSA Regulated Products database, Novel-151
The UK FSA approved-additives list does not include E161h. The FSA confirmed that any use of zeaxanthin as a food colour additive falls within the scope of Regulation 1333/2008 and requires separate authorisation.
RegulatoryUK Food Standards Agency, Approved Additives and E Numbers guidance