Do you have insomnia? Perhaps you just have occasional difficulty getting to sleep or staying asleep. Either way, lack of sleep is a relatively common problem and is frequently treated with medications or alcohol. A consensus from population-based studies¹ and other research² indicate that approximately 30 percent of adult samples drawn from different countries report one or more of the symptoms of insomnia. A U.S. regional survey³ reported that about 20 percent or more of older American adults use some form of sleep aid, including prescription or over-the-counter drugs or alcohol.

MEDICATIONS AND ALCOHOL USE FOR SLEEP
The U.S. National Library of Medicine's PubMed Health⁴ website indicates that while over-the-counter sleep medicines to treat insomnia can sometimes be useful, there can be side effects such as daytime sleepiness, dry mouth, and blurred vision. These effects may be worse in the elderly. Furthermore, stopping these medications suddenly can cause rebound insomnia and withdrawal. Likewise, the Mayo Clinic⁵ indicates that taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem) may also help induce sleep. Side effects, which are often more pronounced in older people, may include excessive drowsiness, impaired thinking, night wandering, agitation, and balance problems. Prescription sleeping pills are generally not recommended for more than a few weeks, but several newer medications are approved for indefinite use. Nevertheless, some of these medications are habit-forming. Finally, alcohol is a sedative that may help induce sleep, but it also prevents deeper stages of sleep and often causes an awakening in the middle of the night.⁶

NATURAL ALTERNATIVES FOR SLEEP
So, what are the natural alternatives? Certainly, a variety of dietary supplements are commonly self-prescribed for treating sleep problems. Some of the most well known—of which include melatonin and valerian root—"old school" remedies which, nevertheless, do have adequate research to support their use for this purpose. However, it should be noted that melatonin and valerian are not always without side effects. Although generally well tolerated, the most common side effects of melatonin include daytime drowsiness, headache, and dizziness—although these don't seem to occur any more frequently than with placebo.⁷ Likewise, although generally well tolerated, valerian side effects reported in clinical studies include headaches, gastrointestinal upset, mental dullness, excitability, uneasiness, and cardiac disturbances.^8,9 Luckily, there are some other natural remedies, which have shown promising results for promoting healthy sleep, but without these side effects. These remedies include GABA, Apocynum venetum, ashwagandha, and lutein/zeaxanthin.

GABA AND Apocynum venetum
GABA (gamma amino butyric acid) is the primary neurotransmitter in the central nervous system for exerting sedative and anti-anxiety effects.¹⁰ Apocynum venetum is an herbal remedy with a long history of use in traditional Chinese medicine for soothing the nerves, insomnia, and for other purposes.¹¹ These two nutraceuticals have been used together and individually in human clinical research for their stress reducing, mood enhancing, and sleep-promoting effects. The stress-reducing effects are also important for sleep since stress can make it difficult to get to sleep and sustain sleep.

GABA AND Apocynum venetum STUDY 1
A double-blind, placebo-controlled crossover study¹² was conducted to examine the stress-reducing effect of ingesting 25 mg/day GABA, and 25 mg/day Apocynum venetum leaf extract (Venetron®), a combination of both, or a placebo. Following intake, subjects were exposed to a stress-inducing mental task and then tested for the stress marker known as salivary chromogranin A (CgA), and scored on a mental questionnaire. Results showed that the combination significantly reduced salivary CgA secretion compared to placebo. Individually, GABA and Apocynum venetum leaf extract also reduced CgA secretion, but they did not reach statistical significance over placebo. In conclusion, the combination of GABA and Apocynum venetum leaf extract was able to reduce markers of cognitive-induced mental stress.

GABA AND Apocynum venetum STUDY 2
In another study, the effects of 100 mg/day GABA and 25 mg/ day Apocynum venetum leaf extract (Venetron), were investigated on sleep improvement in a single-blind, placebo-controlled study.¹³ The electroencephalogram (EEG) test revealed that both nutraceuticals had beneficial effects on sleep. GABA shortened the time it took to fall asleep and increased non-rapid eye movement (REM) sleep time. Simultaneous intake of GABA and Apocynum venetum leaf extract shortened the time it took to fall asleep and increased non-REM sleep time. The result of questionnaires showed that GABA and Apocynum venetum leaf extract enabled subjects to realize the effects on sleep. These results mean that GABA can help people to fall asleep quickly, Apocynum venetum leaf extract induces deep sleep, and they function complementarily with a simultaneous intake. The researchers concluded that this combination can be regarded as safe and appropriate for daily intake in order to improve the quality of sleep.

Apocynum venetum LEAF EXTRACT STUDY 1
In a double-blind, randomized trial¹⁴, individuals with mild depression and symptoms of anxiety, were treated with 50 mg/ day Apocynum venetum leaf extract (Venetron) or placebo at different times over eight weeks. Global scores of depression and blood samples for serotonin levels were measured at baseline and after eight weeks. The changes were assessed using a 17-item Hamilton Depression (HAM-D) rating scale that evaluates depressed mood, vegetative and cognitive symptoms of depression, and anxiety symptoms. Global scores of depression and blood samples for serotonin levels were measured at baseline and after eight weeks. The results were that after eight weeks of treatment, 40 percent of the subjects in Apocynum venetum leaf extract group showed a greater-than-10-point decrease in HAM-D scores. Likewise, 50 percent had a decrease of 50 percent or greater in the symptoms of depression as compared with the placebo group. There were also significant improvements of decreased anxiety and reductions of insomnia in the middle of the night and later in the sleep cycle. In the Apocynum venetum leaf extract group, 50 percent of subjects had increased serotonin concentrations, demonstrating biochemical evidence of improvement (since maintaining healthy serotonin levels are necessary for healthy mood and sleep). HAM-D scores decreased by 50 percent or greater in the Apocynum venetum leaf extract group. Also, 60 percent of the Venetron group had a HAM-D score of eight or less by week eight. Other symptoms that showed significant improvements within the Apocynum venetum leaf extract group included middle- and late-night insomnia, work, activities, and anxiety. In conclusion Apocynum venetum leaf extract significantly improved anxiety and reduced insomnia in the middle of the night and later in the sleep cycle.

Apocynum venetum LEAF EXTRACT STUDY 2
In this human clinical intervention trial¹⁵, the symptoms of depression were assessed in subjects having widely varying severity using the Sheehan Disability Scale (SDS). This scale used to measure depression was developed to assess functional impairment using three interrelated areas: work/school, social, and family life. The patient is able to rate the extent that work/ school, social life, and home life or family responsibilities are impaired by symptoms of depression as a composite of three self-rated items designed to measure the extent to which these three major life sectors are impaired by panic, anxiety, phobic, or depressive symptoms. Patients took 50 mg/day Apocynum venetum leaf extract for 14 days. Results were that the SDS scores of subjects improved in symptoms of depression ranging from minimal to mild depression and moderate to severe depression. The mean measurement significantly declined to the normal range after 14 days of ingestion. In conclusion, Apocynum venetum leaf extract improved depression in patients with varying degrees of symptom severity.

VENETRON STUDY 3
A human clinical intervention trial¹⁶ consisting of case studies was conducted. Subjects included one 29-year-old woman with PMS, a 39-year-old woman with PMS, a 55-year-old woman, a man, 36 years old, and two older men, one 66 and the other 75 years of age. All subjects received 50 mg/day Apocynum venetum leaf extract. The results were as follows: In the 29-year-old woman with PMS, Apocynum venetum leaf extract for one month reduced melancholy and overeating. In the 39-year-old woman with PMS, Apocynum venetum leaf extract for two weeks before menses and over a 3-month period, improved emotional symptoms such as irritability and depression. In the 36-year-old man, Apocynum venetum leaf extract for six months resulted in improvements in concentration and his feeling more optimistic. The 55-year-old woman, using Apocynum venetum leaf extract decreased fatigue and grief. In the 66- and the 75-year-old men, Apocynum venetum leaf extract for two weeks resulted in decreases in the frequency of waking up throughout the night and promoted deeper sleep. In conclusion, case studies have shown very good results in patients with depressive PMS disorders, and in younger and older depressed patients. The types of symptoms that improved include melancholy, overeating, emotional symptoms such as irritability, difficulty in concentrating, optimistic outlook, fatigue, and grief, and improvements in sleep.

^{GABA STUDY 1}
Two studies¹⁷ investigated the effect of GABA on relaxation and stress in humans. The first study evaluated the effect of GABA intake on their brain waves. Electroencephalograms (EEG) were obtained after three tests on each volunteer as follows: intake only water, 100 mg GABA, or 200 mg L-theanine. After 60 minutes of administration, GABA significantly increases alpha waves (i.e. relaxing brain waves) and decreases beta waves compared to water or L-theanine. These findings denote that GABA not only induces relaxation but also reduces anxiety. The second study was conducted to see the role of relaxant and anxiolytic effects of 100 mg GABA intake on immunity in stressed volunteers. Eight acrophobic subjects were divided into two groups (placebo and GABA). All subjects were crossing a suspended bridge as a stressful stimulus. Immunoglobulin A (IgA) levels in their saliva were monitored during bridge crossing. The placebo group showed a marked decrease of their IgA levels, while GABA group showed significantly higher levels. In conclusion, GABA could work effectively as a natural relaxant and its effects could be seen within one hour of its administration to induce relaxation and diminish anxiety. Moreover, GABA administration could enhance immunity under stress conditions.

GABA STUDY 2
Researchers studied¹⁸ the psychological stress reducing effect of chocolate enriched with 28 mg/day GABA, on stress induced by an arithmetic task using changes of heart rate variability (HRV) and salivary chromogranin A (CgA). Fifteen minutes after eating GABA-enriched chocolate, subjects were assigned an arithmetic task for 15 minutes. After that, an electrocardiogram was recorded and saliva samples were collected. HRV was determined from the electrocardiogram, and the activity of the autonomic nervous system was estimated through HRV. The CgA concentration of all saliva samples, an index for acute psychological stress, was measured. From HRV, those taking GABA chocolate made a quick recovery to the normal state from the stressful state. The CgA value after the task in those taking GABA chocolate did not increase in comparison with that before ingestion. From these results, GABA chocolate was considered to have a psychological stress reducing effect.

ASHWAGANDHA STUDY
Withania somnifera, also known as ashwagandha, has historically been used in Asia for treating stress-related health conditions. In this study,¹⁹ researchers investigated the effects of standardized ashwagandha root and leaf extract (Sensoril®) in chronically stressed humans in a clinical trial. Participants were randomly assigned to receive different doses of ashwagandha root and leaf extract, or placebo. Stress levels were assessed at Days 0, 30, and 60 using a modified Hamilton anxiety (mHAM-A) scale. Between Days 0 and 60, those receiving 125 mg/day ashwagandha root and leaf extract experienced a significantly greater decrease than placebo for the average mHAM-A score, serum cortisol, serum C-reactive protein, pulse rate, and blood pressure. In addition, those receiving 125 mg/day ashwagandha root and leaf extract had an improvement in the sleeplessness score from 3.1 on day 0, to 1.9 on day 30, to 0.9 on day 60—a percentage change of about 71 percent. Therefore, this study provides evidence that the consumption of ashwagandha root and leaf extract significantly reduced experiential and biochemical indicators of stress without adverse effects.

LUTEIN/ZEAXANTHIN
To understand why lutein/zeaxanthin is beneficial for sleep, you must first understand a little bit about blue light, a powerful and potentially damaging component of visible light from the sun, digital devices (computers, tablets, smartphones, etc.) and artificial light.^{20,21,22,23,24,25} As it passes through the lens of the human eye, the visible wavelengths of light, including ultraviolet and blue light, focus upon the macular area of the retina. In particular, the blue wavelengths penetrate deeply into the eye, and have the greatest potential to damage retinal tissue by inducing free radicals, etc.^26,27,28,29 In fact, ongoing exposure to blue light (regardless of the source) is a major risk factor for various retinal damage.^30,31,32,33

SYMPTOMS OF CHRONIC BLUE LIGHT EXPOSURE
Research indicates that chronic exposure to blue light can cause a variety of symptoms. These include headaches, eye fatigue and other indications of eye strain are associated with the daily use of video display terminals on computers and other electronic devices and are common with three or more hours/day of exposure. In addition, blue light has been shown to delay or suppress the release of melatonin, your body's sleep hormone.^34,35,36 Unfortunately, 30 percent of adults spend more than half their waking hours (more than nine hours) using a digital device, 50 percent of Americans use digital devices more than five hours a day, and 70 percent use two or more digital devices at the same time.³⁷ Consequently, it's not surprising that so many people have problems with eye fatigue, eye strain and sleep.

PROTECTION WITH LUTEIN AND ZEAXANTHIN ISOMERS
The good news is that lutein and zeaxanthin isomers (rr- and rs-(meso)-zeaxanthin), macular carotenoids well known for the role they play in supporting eye health, can help mitigate the effects that blue light has on common retinal damage. The way it works is that lutein/zeaxanthin have a yellow coloration. Because yellow pigments absorb blue light, lutein effectively protects the retina from the region of the light spectrum that can cause tissue damage, and also limits the ability of light to generate free radicals. Basically, lutein/zeaxanthin act as a sort of internal pair of sunglasses, protecting the macular region of the retina from blue light damage. In addition, various studies have shown that supplementation with 10 mg/2 mg–20 mg/4 mg lutein/zeaxanthin (Lutemax®2020 Marigold flower extract) can help make users of computers and other digital devices more comfortable throughout the day, reducing eye strain and relieving tired eyes. Supplementation also protects eyes against harmful blue light and against oxidative stress and harmful free radicals.^38,39,40

LUTEIN AND ZEAXANTHIN ISOMERS, AND SLEEP
More specific to the subject of this article, there is a direct connection between blue light, lutein/zeaxanthin, and sleep. It has to do with melatonin, a hormone, secreted by the pineal gland,⁴¹ whose primary role is regulation of the body's circadian rhythm, and sleep patterns.^42,43 Specifically, light, including blue light, inhibits melatonin secretion and darkness stimulates secretion.^44,45 Consequently, too much light exposure, particularly at night, can inhibit melatonin secretion and interfere with sleep. Interestingly, research has shown that, at night, even blue light from smartphones can negatively impact sleep.⁴⁶ That's where blue-light filtering lutein and zeaxanthin isomers can help.

To determine if increasing macular levels of lutein/zeaxanthin, by supplementing lutein/zeaxanthin isomers, would affect sleep quality, a two-part study⁴⁷ was conducted. The first part was a 3-month, double-blind, placebo-controlled trial. Subjects in the active supplement group ingested lutein/zeaxanthin isomers daily (LutemaxR2020 Marigold flower extract). Sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Critical flicker fusion frequency1 (CFF) and contrast sensitivity (CS) were also measured. Outdoor and indoor exposure to light (UV) and electronic devices before and after supplementation were recorded. The results showed that the lutein/zeaxanthin group exhibited significant improvement in overall sleep quality and levels of macular pigments, as well as CS and CFF, at three months. There were no changes in the placebo group. This trial found that increasing macular pigments via lutein/zeaxanthin isomers supplementation, might serve to absorb more blue light from sources (such as computer screens, tablets, or smartphones) that can be used during nighttime hours, and would otherwise provide a circadian signal to stay awake.

(1. CFF is a diagnostic tool used for several purposes, including the degree of light or dark adaptation, i.e., the duration and intensity of previous exposure to background light, which affects both the intensity sensitivity and the time resolution of vision.)

The second part was also a 6-month, double-blind, placebo-controlled trial in which 34 healthy individuals participated. The same supplementation regimen and assessment methods were used as with the 3-month study. Results were that at six months macular pigments, CFF, CS, sleep quality improved with lutein/ zeaxanthin supplementation, with no changes in the placebo group.

Endnotes

1. Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22(Suppl 2):S347.53.
2. Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7(2):123.30.
3. Johnson EO, Roehrs T, Roth T, Breslau N. Epidemiology of alcohol and medication as aids to sleep in early adulthood. Sleep. 1998 Mar 15;21(2):178.86.
4. PubMed Health: Insomina. National Center for Biotechnology Information, U.S. National Library of Medicine Bethesda MD. Review Date: 8/16/2011. Retrieved December 2, 2011 from Insomnia/.
5. Insomnia: Treatment & Drugs. Mayo Foundation for Medical Education and Research. Jan. 7, 2011. Retrieved December 2, 2011 from Insomnia.
6. Insomnia: Ibid.
7. Buscemi N, Vandermeer B, Pandya R, et al. Melatonin for treatment of sleep disorders. Summary, Evidence Report/Technology Assessment #108. (Prepared by the Univ of Alberta Evidence-based Practice Center, under Contract#290-02-0023.) AHRQ Publ #05-E002-2. Rockville, MD: Agency for Healthcare Research & Quality. November 2004.
8. Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999;56:125.38.
9. National Toxicology Program, US Department of Health and Human Services. Chemical Information Review Document for Valerian (Valeriana officinalis L.) [CAS No. 8057-49-6] and Oils [CAS No. 8008-88-6]. Supporting Nomination for Toxicological Evaluation by the National Toxicology Program. November 2009.
10. Kalant H, Roschlau WHE, Eds. Principles of Med. Pharmacology. New York, NY: Oxford Univ Press, 1998.
11. Xie W, Zhang X, Wang T, Hu J. Botany, traditional uses, phytochemistry and pharmacology of Apocynum venetum L. (Luobuma): A review. J Ethnopharmacol. 2012 May 7;141(1):1.8.
12. Yoto A, Ishihara S, Li-Yang J, Butterweck V, Yokogoshi H. The Stress Reducing Effect of γ-Aminobutyric Acid and Apocynum venetum Leaf Extract on Changes in Concentration of Salivary Chromogranin A. Japanese Journal of Physiological Anthropology. 2009 14(3): 55.59.
13. Yamatsu A, Yamashita Y, Maru I, Yang J, Tatsuzaki J, Kim M. The Improvement of Sleep by Oral Intake of GABA and Apocynum venetum Leaf Extract. J Nutr Sci Vitaminol(Tokyo). 2015;61(2):182.7.
14. Venetron® brochure, Tokiwa. Summarized in Maypro document "Venetron Clinical Evidence." Topic: What was the effect of a daily dose of 50 mg of Venetron® in individuals with mild depression over 8 weeks?
15. Venetron® brochure, Tokiwa. Summarized in Maypro document "Venetron Clinical Evidence." Topic: What effect does Venetron® have on patients with various degrees of depression?
16. Venetron® brochure, Tokiwa. Summarized in Maypro document "Venetron Clinical Evidence." Topic: What have been the results of Venetron® in case studies of patients having depression, PMS, anxiety, and/or insomnia?
17. Abdou AM, Higashiguchi S, Horie K, Kim M, Hatta H, Yokogoshi H. Relaxation and immunity enhancement effects of gammaaminobutyric acid (GABA) administration in humans. Biofactors. 2006;26(3):201-8.
18. Nakamura H, Takishima T, Kometani T, Yokogoshi H. Psychological stress-reducing effect of chocolate enriched with gamma-aminobutyric acid (GABA) in humans: assessment of stress using heart rate variability and salivary chromogranin A. Int J Food Sci Nutr. 2009;60 Suppl 5:106.13.
19. Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A Standardized Withania Somnifera Extract Significantly Reduces Stress-Related Parameters in Chronically Stressed Humans: A Double-Blind, Randomized, Placebo-Controlled Study. JANA. 2008;11(1):2008:50.56.
20. Nakashima Y, Ohta S1, Wolf AM2. Blue light-induced oxidative stress in live skin. Free Radic Biol Med. 2017 Mar 15. pii: S0891. 5849(17)30134-X.
21. Tosini G, Ferguson I, Tsubota K. Effects of blue light on the circadian system and eye physiology. Mol Vis. 2016 Jan 24;22:61.72.
22. The Vision Council. Eyes Overexposed: The Digital Device Dilemma. 2016 Digital Eye Strain Report. Thevisioncouncil.org.
23. The Vision Council. Hindsight is 20/20/20: Protect your eyes from digital devices. 2015 Digital Eye Strain Report. Thevisioncouncil.org.
24. Smick K, et al. Blue Light Hazard: New Knowledge, New Approaches to Maintaining Ocular Health. Report of a Roundtable: March 16, 2013, New York City, NY, USA. Essilor of America.
25. Kuse Y, Ogawa K, Tsruma K, Shimazawa M, Hara H. Damage of photoreceptor-derived cells in culture induced by light emitting diode-derived blue light. Sci Rep. 2014 Jun 9;4:5223.
26. Tosini, Ibid.
27. Wu J, Seregard S, Algvere PV. Photochemical damage of the retina. Surv Ophthalmol. 2006 Sep-Oct;51(5):461–81.
28. Algvere PV, Marshall J, Seregard S. Age-related maculopathy and the impact of blue light hazard. Acta Ophthalmol Scand. 2006 Feb;84(1):4–15.
29. Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). 2012. Health Effects of Artificial Light. Accessed from http://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_035.pdf.
30. Cruickshanks KJ, Klein R, Klein BEK. Sunlight and age-related macular degeneration—the Beaver Dam Eye Study. Arch Ophthalmol. 1993;111:514–8.
31. Klein R, Klein BEK, Jensen SC, Cruickshanks KJ. The relationship of ocular factors to the incidence and progression of agerelated maculopathy. Arch Ophthalmol. 1998;116:506–13.
32. Algvere, Ibid.
33. Taylor HR, Muñoz B, West S, Bressler NM, Bressler SB, Rosenthal FS. Visible light and risk of age-related macular degeneration. Trans Am Ophthalmol Soc. 1990;88:163–73.
34. Figueiro MG. Individually tailored light intervention through closed eyelids to promote circadian alignment and sleep health. Sleep Health. 2015 Mar 1;1(1):75–82.
35. Daneault V, Dumont M, Massé É, Vandewalle G, Carrier J. Light-sensitive brain pathways and aging. J Physiol Anthropol. 2016; Mar 15;35:9.
36. Lockley SW, Evans EE, Scheer FA, Brainard GC, Czeisler CA, Aeschbach D. Short-wavelength sensitivity for the direct effects of light on alertness, vigilance, and the waking electroencephalogram in humans. Sleep. 2006 Feb;29(2):161–8.
37. Richer S. Lutein and zeaxanthin protect against "bad blue" light. Eye Health Insider. December 2016: 4.
38. Stringham J. Effects of three levels of lutein supplementation on macular pigment optical density, psychological stress levels, and overall health. Nutritional Neuroscience Laboratory, University of Georgia. Unpublished. 2016:17 pgs.
39. Lutein/Zeaxanthin Isomers Supplementation Impact on Vision Health. Unpublished. 2016:8 pgs.
40. Blue Light Study Eye Stress. Unpublished. 2016: 2 pgs.
41. Nurnberger JI Jr, Adkins S, Lahiri DK, et al. Melatonin suppression by light in euthymic bipolar and unipolar patients. Arch Gen Psychiatr 2000;57:572-9.
42. Brzezinski A. Melatonin in humans. N Engl J Med 1997;336:186-95.
43. Lissoni P, Barni S, Meregalli S, et al. Modulation of cancer endocrine therapy by melatonin: a phase II study of tamoxifen plus melatonin in metastatic breast cancer patients progressing under tamoxifen alone. Br J Cancer 1995;71:854-6.
44. Brzezinski, Ibid.
45. Daneault, Ibid.
46. Yoshimura M, Kitazawa M, Maeda Y, Mimura M, Tsubota K, Kishimoto T. Smartphone viewing distance and sleep: an experimental study utilizing motion capture technology. Nat Sci Sleep. 2017 Mar 8;9:59-65.
47. Stringham JM et al. Short-term macular carotenois supplementation improves overall sleep quality. ARVO 2016 Annual Meeting Abstracts

Blue light-which comes from sunlight, digital devices (computers, tablets, smartphones, etc.) and artificial light,^1,2,3,4,5,6 penetrates deeply into the human eye and has great potential to damage retinal tissue.^7,8,9,10 This ongoing exposure to blue light (regardless of the source) is a major risk factor for various retinal pathologies.^11,12,13,14 In fact, research¹⁵ has demonstrated that headaches, eye fatigue, disturbed visual acuity, mucosal dryness, and eye burning and other indications of eye strain are associated with the daily use of video display terminals on computers and other electronic devices, and are common with three or more hours/day of exposure. Furthermore, some research indicates blue light exposure from sunlight is a risk factor for the development of age-related macular degeneration.^16,17 Such visual health-related symptoms in adults and children resulting from blue light digital exposure is now referred to as Computer Vision Syndrome (CVS).¹⁸ Perhaps most alarming, children may be at higher risk for blue light retinal damage than adults, since their eyes absorb more blue light than adults from digital device screens.^19,20

Children's exposure to blue light
More than 70 percent of American adults report their children receive more than two hours of screen time per day-and among the most popular activities children engage in are playing on a digital device (23.1 percent) and watching TV (20.1 percent). Not surprisingly, American adults report their children experience the following after being exposed to two or more hours of screen time:²¹

• Headaches (8.8%)
• Neck/shoulder pain (5%)
• Eye strain, dry or irritated eyes (9.1%)
• Reduced attention span (15.2%)
• Poor behavior (13.3%)
• Irritability (13.5%)

Now consider that personal electronic devices are able to stimulate blue-light-sensitive ganglion cell photoreceptors that regulate circadian rhythms.²² As a result, cellular telephone, tablet and personal computer use before bedtime can delay sleep onset, degrade sleep quality and impair alertness the following day.²³ Extended use of these devices has also been shown to cause symptoms of dry eyes, blurred vision and headaches.²⁴ Limitation of personal electronic device use before bedtime is recommended to be the most effective method for reducing light-induced sleep disruption in children.

The importance of lutein and zeaxanthin isomers
So besides restricting digital device us, what can concerned parents do to help protect their children's eyes from damaging blue light? Enter lutein and zeaxanthin isomers (rr- and rs-(meso)-zeaxanthin). These carotenoids (related to beta-carotene and lycopene) are found in high concentrations in the part of the retina where they play a critical role in protecting against blue light.²⁵ Furthermore, supplementation with lutein and zeaxanthin isomers can provide substantial protection against blue light damage.

Of all the carotenoids, only lutein and zeaxanthin isomers are located in the eye, and make up the macular pigment. As a result of these carotenoids being yellow, they selectively absorb blue light, which protects the retina from associated damage. In short, they act as primary filters of blue light.

However, the average daily intake of lutein and zeaxanthin in the U.S. is less than 2 mg and less than 0.5 mg, respectively-which is far below the 10-20 mg of lutein and 2-4 mg of zeaxanthin shown in research to be beneficial. That's why supplementation with these carotenoids is so important.

Eye strain, eye fatigue, headache and visual performance

A study conducted at the University of Georgia showed a relationship between exposure to blue light from digital devices and visual performance. They found that supplementing with lutein and zeaxanthin isomers (as Lutemax® 2020 from OmniActive Health Technologies) reduced headaches, eye fatigue, and eye strain. Another double-blind, placebo-controlled, 12-month trial^26,27,28 examined the effects of lutein and zeaxanthin isomers (as Lutemax® 2020) versus placebo. Two levels of daily lutein supplementation were used: 10 mg (2 mg Z), and 20 mg (4 mg Z). The results were that both doses significantly improved contrast sensitivity (CS), glare performance, and photo stress recovery (i.e. a clinical procedure measuring the amount of time required for the macula to return to its normal level of function after being exposed to a bright light source). In addition, lutein/zeaxanthin improved levels of BDNF, a neurotrophin that is particularly active in hippocampus, cortex, and basal forebrain-areas that are involved in learning, memory, and higher cognitive processes.²⁹

Stress and health
Another 12-week, double-blind, placebo-controlled trial30 was conducted at the University of Georgia in 28 healthy subjects using three different daily dosage levels of lutein and zeaxanthin isomers (as Lutemax® 2020) versus placebo. The three doses of lutein were 6 mg (1.5 mg Z), 10 mg (2 mg Z), and 20 mg (4 mg Z), versus placebo. The results were that supplementation with lutein/zeaxanthin isomers increased the amount of optical pigment density (greater increase with higher doses), which helped subjects maintain a lower psychological stress profile (p = 0.0087). After 12 weeks of lutein supplementation, psychological stress levels were found to be reduced significantly. The placebo group did not change in this regard. Furthermore, those with higher optical pigment density tended to have fewer health-related problems, such as being sick less often and suffering less from allergies (p = 0.002). After 12 weeks of lutein supplementation, each group exhibited a significant reduction in health-related problems (6 mg: p = 0.041; 10 mg: p = 0.029; 20 mg: p = 0.047).

Quality of sleep
The primary function of melatonin, a hormone, secreted by the pineal gland,³¹ is regulation of the body's circadian rhythm, and sleep patterns.^32,33 However, too much light exposure, particularly at night, can inhibit melatonin secretion and interfere with sleep.^34,35 Even blue light from smart phones can negatively impact sleep with nighttime exposure.³⁶ But lutein and zeaxanthin isomers can help. A 3-month, double-blind, placebo-controlled trial with 45 healthy individuals (the first of a two-part study³⁷) found that 20 mg lutein and 4 mg zeaxanthin isomers daily (as Lutemax® 2020) significantly improved overall sleep quality (p = 0.0063), with no changes in the placebo group. The second 6-month, double-blind, placebo-controlled trial in 34 healthy individuals found similar results.

Delivery forms
Generally, lutein/zeaxanthin isomers are readily available as capsule or tablet supplements for adults. Children, however, cannot easily swallow capsules or tablets. Consequently, chewable tablets or gummies are preferable lutein/zeaxanthin isomer delivery forms for children. Gummies, in particular, are likely the best choice as children tend to see gummies as a treat, rather than treatment-so to speak.

Conclusion
Blue light, especially from digital devices, has the potential to damage retinal tissue and cause a variety of eye-related problems, including eye strain, eye fatigue, headache, visual impairment, psychological stress, and poor sleep quality. This is particularly true in children since their eyes absorb more blue light than adults. The good news is that daily supplementation with lutein (10-20 mg) and zeaxanthin isomers (2-4 mg)-most likely in a gummy supplement-can help reduce these risks and support eye health.

References

1. Nakashima Y, Ohta S1, Wolf AM2. Blue light-induced oxidative stress in live skin. Free Radic Biol Med. 2017 Mar 15. pii: S0891-5849(17)30134-X.
2. Tosini G, Ferguson I, Tsubota K. Effects of blue light on the circadian system and eye physiology. Mol Vis. 2016 Jan 24;22:61-72.
3. The Vision Council. Eyes Overexposed: The Digital Device Dilemma. 2016 Digital Eye Strain Report. Thevisioncouncil.org.
4. The Vision Council. Hindsight is 20/20/20: Protect your eyes from digital devices. 2015 Digital Eye Strain Report. Thevisioncouncil.org.
5. Smick K, et al. Blue Light Hazard: New Knowledge, New Approaches to Maintaining Ocular Health. Report of a Roundtable: March 16, 2013, New York City, NY, USA. Essilor of America.
6. Kuse Y, Ogawa K, Tsruma K, Shimazawa M, Hara H. Damage of photoreceptor-derived cells in culture induced by light emitting diode-derived blue light. Sci Rep. 2014 Jun 9;4:5223.
7. Tosini G, Ferguson I, Tsubota K. Effects of blue light on the circadian system and eye physiology. Mol Vis. 2016 Jan 24;22:61-72.
8. Wu J, Seregard S, Algvere PV. Photochemical damage of the retina. Surv Ophthalmol. 2006 Sep-Oct;51(5):461-81.
9. Algvere PV, Marshall J, Seregard S. Age-related maculopathy and the impact of blue light hazard. Acta Ophthalmol Scand. 2006 Feb;84(1):4-15.
10. Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). 2012. Health Effects of Artificial Light. Accessed from http://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_035.pdf.
11. Cruickshanks KJ, Klein R, Klein BEK. Sunlight and age-related macular degeneration-the Beaver Dam Eye Study. Arch Ophthalmol. 1993;111:514-8.
12. Klein R, Klein BEK, Jensen SC, Cruickshanks KJ. The relationship of ocular factors to the incidence and progression of age-related maculopathy. Arch Ophthalmol.1998;116:506-13.
13. Algvere PV, Marshall J, Seregard S. Age-related maculopathy and the impact of blue light hazard. Acta Ophthalmol Scand. 2006;84:4-15.
14. Taylor HR, Muñoz B, West S, Bressler NM, Bressler SB, Rosenthal FS. Visible light and risk of age-related macular degeneration. Trans Am Ophthalmol Soc. 1990;88:163-73.
15. Kowalska M, Zejda JE, Bugajska J, Braczkowska B, Brozek G, Mali?ska M. [Eye symptoms in office employees working at computer stations]. [Article in Polish] Med Pr. 2011;62(1):1-8.
16. Tomany SC, Cruickshanks KJ, Klein R, Klein BE, Knudtson MD. Sunlight and the 10-year incidence of age-related maculopathy: the Beaver Dam Eye Study. Arch Ophthalmol. 2004;122:750-7.
17. Cruickshanks KJ, Klein R, Klein BE, Nondahl DM. Sunlight and the 5-year incidence of early age-related maculopathy: the beaver dam eye study. Arch Ophthalmol. 2001;119:246-50.
18. Akinbinu TR, Mashalla YJ. Impact of computer technology on health: Computer Vision Syndrome (CVS). Medical Practice and Review. 2014;5(3):20-30.
19. Boettner EA, Wolter JR. Transmission of the Ocular Media. Investigative Ophthalmology 1962;1:776-83.
20. Behar-Cohen F, Martinsons C, Viénot F, Zissis G, Barlier-Salsi A, Cesarini JP, Enouf O, Garcia M, Picaud S, Attia D. Light-emitting diodes (LED) for domestic lighting: any risks for the eye? Prog Retin Eye Res. 2011 Jul;30(4):239-57.
21. Digital Eye Strain. The Vision Council. Retrieved February 19, 2019 from https://www.thevisioncouncil.org/content/digital-eye-strain.
22. Berson DM, Dunn FA, Takao M. Phototransduction by retinal ganglion cells that set the circadian clock. Science 2002;295:1070-3.
23. Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A 2015;112:1232-7.
24. Klamm J, Tarnow KG. Computer Vision Syndrome: A Review of Literature. Medsurg Nurs 2015;24:89-93.
25. Bone RA. Landrum JT. Distribution of macular pigment components, zeaxanthin and lutein, in human retina. Methods Enzymol 1992:213:360-6.
26. Stringham JM, O'Brien KJ, Stringham NT. Macular carotenoid supplementation improves disability glare performance and dynamics of photo stress recovery. Eye Vis (Lond). 2016 Nov 11;3:30.
27. Stringham NT, Holmes PV, Stringham JM. Supplementation with macular carotenoids reduces psychological stress, serum cortisol, and sub-optimal symptoms of physical and emotional health in young adults. Nutr Neurosci. 2017 Feb 15:1-11.
28. Contrast sensitivity - Accepted (IOVS) in press.
29. Stringham NT et al. Macular Carotenoid Supplementation Increases Serum BDNF in Healthy Young Adults. EB Abstract 2016.
30. Stringham J. Effects of three levels of lutein supplementation on macular pigment optical density, psychological stress levels, and overall health. Nutritional Neuroscience Laboratory, University of Georgia. Unpublished. 2016:17 pgs.
31. Nurnberger JI Jr, Adkins S, Lahiri DK, et al. Melatonin suppression by light in euthymic bipolar and unipolar patients. Arch Gen Psychiatr 2000;57:572-9.
32. Brzezinski A. Melatonin in humans. N Engl J Med 1997;336:186-95.
33. Lissoni P, Barni S, Meregalli S, et al. Modulation of cancer endocrine therapy by melatonin: a phase II study of tamoxifen plus melatonin in metastatic breast cancer patients progressing under tamoxifen alone. Br J Cancer 1995;71:854-6.
34. Brzezinski A. Melatonin in humans. N Engl J Med 1997;336:186-95.
35. Daneault V, Dumont M, Massé É, Vandewalle G, Carrier J. Light-sensitive brain pathways and aging. J Physiol Anthropol. 2016 Mar 15;35:9.
36. Yoshimura M, Kitazawa M, Maeda Y, Mimura M, Tsubota K, Kishimoto T. Smartphone viewing distance and sleep: an experimental study utilizing motion capture technology. Nat Sci Sleep. 2017 Mar 8;9:59-65.
37. Stringham JM et al. Short-term macular carotenois supplementation improves overall sleep quality. ARVO 2016 Annual Meeting Abstracts.

Dear Readers,

Welcome to the March 2019 issue of TotalHealth Magazine.

Charles K. Bens, PhD, in “The Biochemistry Of Smoking: Helping the Brain To Live Without Nicotine” gives us an explanation on the effects of nicotine on the brain, showing why it is so difficult to quit smoking. Bens goes on with his experience with several individuals who were able to change their lifestyle through diet and exercise, and lead healthy lives. This is not to say one shouldn’t quit smoking but changing one’s lifestyle is a big influence on one’s health.

In “Lutein & Zeaxanthin: Protectors for Your Children,” Gene Bruno, MS, MHS, RH(AHG), enlightens readers on blue light, especially from digital devices. It has the potential to damage retinal tissue and cause a variety of eye-related problems, including eye strain, eye fatigue, headache, visual impairment, psychological stress and poor sleep quality. This is particularly true in children since their eyes absorb more blue light than adults.

“How Smart Fats Reset Your Hunger Hormones,” Ann Louise Gittleman, PhD, CNS, focus is on Adiponectin; a real hormone game changer that you may not be very familiar with. It is a big player in firing up belly fat burn and is known as the body’s “fat burning torch.” This special super hormone that flips your body’s fat burning switch is already circulating in your bloodstream because it is made in your fat cells. Adiponectin is balanced by monounsaturated omega-rich foods and oils as: olives and olive oil, avocados and avocado oil, and macadamias and macadamia nut oil.

Jacob E. Teitelbaum, MD, offers “X-Rays Meaningless for Arthritis and Back Pain?” We’ve known for decades that spinal X-Rays, MRIs and CT scans add very little information about back pain. They most often DON’T tell doctors whether the pain is coming from the spine or from disc, arthritic or bone disease. (Though they MAY reveal if the problem can be fixed with a chiropractic adjustment.)

Gloria Gilbère, CDP, DAHom, PhD, contributes “One Dish Baked Caprese Chicken.” Another of Gilbère’s fabulous recipes from her test kitchen in Ecuador. In addition to this recipe Gilbère offers two recipes to use for leftovers. Included is background on the health benefits of organic chicken.

Shawn Messonnier’s, DVM, topic this month is “Pinellia Combination in Pets.” Pinellia combination is a Chinese herbal mix. This formula contains ginseng, ginger, jujube, Coptis and Scute, along with pinellia, and is for vomiting in pets. Because of the Chinese diagnosis and classification of diseases, the ingredients in each formula may vary. Individual Chinese pharmacists include herbs in their tented formulas based upon their experience. However, they can compound formulas to the needs of an individual pet.

Best in health,

TWIP—The Wellness Imperative People

Click here to read the full March 2019 issue.

• The Biochemistry Of Smoking: Helping the Brain To Live Without Nicotine
  Charles Bens, PhD
• Lutein & Zeaxanthin: Protectors For Your Children
  Gene Bruno, MS, MHS
• How Smart Fats Reset Your Hunger Hormones
  Anne Louise Gittleman, PhD, CNS
• X-Rays Meaningless For Arthritis And Back Pain?
  Jacob Teitelbaum, MD
• One Dish Baked Caprese Chicken
  Gloria Gilbère, CDP, DAHom, PhD
• Pinellia Combination in Pets
  Shawn Messonnier, DVM