Glow Skin by Advocare

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small study in healthy adults over 40 years of age with mild forgetfulness shows that taking a specific combination supplement (BGG Japan Co.) containing astaxanthin 9 mg and tocotrienols 50 mg daily for 12 weeks might improve composite and verbal memory when compared with placebo (105099). This study was funded by the supplement manufacturer.
• Age-related macular degeneration (AMD). Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with non-advanced AMD shows that a specific combination product (Azyr, Sifi S.p.A.) containing astaxanthin 4 mg, lutein, zeaxanthin, vitamin E, vitamin C, zinc, and copper, taken daily for 12 months, improves selective dysfunction in the central retina, but does not improve dysfunction in the peripheral retinal areas, when compared with baseline (19196). The validity of this finding is limited by the lack of a comparator group.
• Aging skin. Small studies suggest that oral and topical astaxanthin may be beneficial in aging skin; however, there is conflicting evidence regarding its effects on wrinkles. Details: Small studies in middle-aged adults show that taking astaxanthin (Astavita Astaxanthin, Astavita; AstaReal Oil 50F, Fuji Chemical Industry Co., Ltd.) 2-3 mg orally twice daily for 6-8 weeks improves elasticity, fine lines, wrinkles, and skin moisture when compared with placebo (19561,91734). However, a meta-analysis of small clinical studies in healthy adults shows that taking oral astaxanthin 2-12 mg daily for 4-16 weeks modestly improves moisture content and skin elasticity, but has no effect on wrinkle depth, when compared with placebo (107961). The validity of this meta-analysis is limited due to the population heterogeneity and variety of astaxanthin formulations utilized. In addition to oral astaxanthin, one study also used topical astaxanthin 0.094% (AstaTROL-Hp, Fuij Chemical Industry Co., Ltd.) 1 mL applied twice daily (91734). A systematic review of two very small, nonblinded studies in healthy adults suggests that topical application, either in combination with oral astaxanthin or alone, might have anti-aging skin effects when used for 2-3 weeks (107961).
• Alzheimer disease. Although there is interest in using oral astaxanthin for Alzheimer disease, there is insufficient reliable information about the clinical effects of astaxanthin for this condition.
• Athletic performance. Small studies suggest that oral astaxanthin may improve some aspects of athletic performance. Details: Two small studies in trained cyclists show that taking astaxanthin (Fuji Health Science, Inc. or AstaReal) 4-12 mg daily for 1 or 4 weeks decreases the time to complete a 20-40 km cycling trial by about 50-100 seconds when compared with placebo (91735,105096). However, a larger study in trained cyclists shows that taking astaxanthin (BioReal) 20 mg, vitamin C 300 mg, and vitamin E 50 mg daily for 4 weeks does not decrease time needed to complete a predetermined amount of cycling work (a timed trial) when compared with placebo (91738). Reasons for the discrepancies are not clear but may relate to the fitness level of the athletes in the studies or the differences in timed trial protocols used in the studies.
• Carpal tunnel syndrome. Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a combination of astaxanthin 4 mg, lutein, beta-carotene, and vitamin E (BioAstin, Cyanotech) orally 3 times daily for 8 weeks does not reduce the rate or duration of pain due to carpal tunnel syndrome when compared with placebo (19164).
• Diabetes. It is unclear if oral astaxanthin is beneficial for diabetes. Details: A small clinical trial in adults with diabetes shows that taking astaxanthin (Nature Vision) 8 mg daily for 8 weeks does not reduce levels of cholesterol or fasting blood glucose or reduce diastolic blood pressure when compared with placebo. However, there were some modest beneficial effects on visceral fat, triglyceride level, and systolic blood pressure (109778).
• Dry eye. It is unclear if oral astaxanthin is beneficial for dry eye syndrome. Details: A clinical study in adults and elderly patients with mild to moderate dry eye syndrome shows that taking oral astaxanthin 6 mg twice daily for 30 days improves symptom severity, tear break-up time, fluorescein break-up time, and meibomian gland dysfunction, but not visual acuity or intraocular pressure, when compared with baseline (107962). The validity of these findings is limited by the lack of a comparator group.
• Dyspepsia. It is unclear if oral astaxanthin improves symptoms of dyspepsia. Details: One clinical study in adults with functional dyspepsia with or without Helicobacter pylori infection shows that taking astaxanthin (AstaCarox, AstaReal AB) 16 mg or 40 mg daily for 4 weeks does not reduce indigestion, pain, or H. pylori counts when compared with placebo. However, astaxanthin 40 mg daily may reduce reflux in H. pylori-positive patients (19165).
• Exercise-induced muscle damage. Small clinical studies in trained athletes suggest that oral astaxanthin may not improve markers of muscle damage from exercise. Details: A small study in professional male soccer players shows that taking astaxanthin 4 mg daily for 90 days does not seem to reduce exercised-induced biomarkers of muscle damage, such as creatinine kinase, when compared with placebo (91739). Taking a combination of astaxanthin 4 mg and lutein 480 mg (BioAstin, Cyanotech) daily for 3 weeks also did not reduce creatinine kinase levels after exercise in trained athletes when compared with placebo (safflower oil) (19199).
• Exercise-induced muscle soreness. Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small study in resistance trained athletes shows that taking a combination of astaxanthin 4 mg and lutein 480 mg (BioAstin, Cyanotech) daily for 3 weeks does not reduce muscle soreness or improve muscle performance 96 hours after exercise when compared with placebo (safflower oil) (19199).
• Fatigue. Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy patients shows that taking a specific combination product (ASTOTS, Fujifilm Co.) containing astaxanthin 6 mg and sesamin 10 mg after breakfast daily for 4 weeks does not improve overall fatigue after completion of mental and physical tasks when compared with placebo (98769).
• Heart failure. Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with heart failure with reduced left ventricular ejection fraction (LVEF) shows that taking a specific supplement containing astaxanthin 12 mg, tocotrienol 40 mg, and L-ascorbic acid 2-glucoside 30 mg (AstaReal ACT, AstaReal Co., Ltd.) daily for 3 months may increase LVEF from 34% to 38% and modestly increase exercise tolerance as measured by the six-minute walk test when compared with baseline (105097). The validity of these findings is limited by the lack of a comparator group. Furthermore, this study was funded by the supplement manufacturer.
• Hyperlipidemia. Small clinical studies suggest that oral astaxanthin is not beneficial for reducing cholesterol levels. Details: One small clinical study in adults with mild hyperlipidemia shows that taking astaxanthin (AstaReal Astaxanthin, Fuji Chemical Industry) 12 mg or 18 mg daily for 12 weeks reduces triglyceride levels, while taking 6 mg or 12 mg daily increases high-density lipoprotein (HDL) cholesterol levels, when compared with placebo. However, total cholesterol and low-density lipoprotein (LDL) cholesterol levels were not affected (19167). Meta-analyses of small clinical studies mostly in adults without hyperlipidemia have also been conducted. One shows that taking astaxanthin 4-18 mg daily for up to 12 weeks does not reduce total or LDL cholesterol levels, but may increase HDL cholesterol levels, when compared with control (105100). A more recent analysis shows that taking astaxanthin 4-20 mg daily for up to 6 months has no beneficial effects on blood lipid levels and might actually increase levels of LDL cholesterol (109776).
• Hypertension. It is unclear if oral astaxanthin reduces blood pressure. Details:A meta-analysis of four small clinical trials shows that taking astaxanthin does not have a clinically beneficial effect on systolic or diastolic blood pressure (109776). However, none of the trials were conducted in patients with hypertension.
• Impaired glucose tolerance (prediabetes). It is unclear if oral astaxanthin is beneficial in patients with prediabetes. Details: A small clinical study in healthy adults and adults with prediabetes shows that taking oral astaxanthin 12 mg daily for 12 weeks improves glycated hemoglobin (HbA1c) when compared with baseline, but not when compared with placebo. Insulin sensitivity and postprandial glucose levels were also improved when compared with baseline, but no statistical comparison to the placebo group was conducted (107965). The validity of this study is limited due to unclear reporting.
• Infertility. It is unclear if oral astaxanthin improves reproductive outcomes in patients with infertility due to endometriosis or polycystic ovary syndrome (PCOS). Details: A small clinical study in adults with infertility secondary to moderate or severe endometriosis undergoing assisted reproductive therapy in Iran shows that taking astaxanthin (AstaReal, AstaReal Co.) 6 mg daily for 12 weeks improves the numbers of oocytes retrieved, mature oocytes, and high-quality embryos but not the quantity of immature oocytes, fertilization rate, number of transferred embryos, or clinical pregnancy rate when compared with placebo (112434). Similarly, a small clinical study also conducted in Iran in patients with infertility due to PCOS undergoing assisted reproductive therapy shows that taking astaxanthin (Algalife Pure astaxanthin) 8 mg daily for 40 days prior to egg retrieval modestly improves the high-quality embryo rate, but not the total number of embryos or the clinical pregnancy rate, when compared with placebo (109775).
• Male infertility. It is unclear if oral astaxanthin improves male infertility. Details: A small low-quality clinical study in males with infertility who are participating in intra-uterine insemination shows that taking astaxanthin (AstaCarox, AstaReal AB) 16 mg daily for 3 months does not seem to increase sperm count and quality, but might result in a higher total pregnancy rate of 23% compared with a 3.6% rate in the placebo group (19197). The validity of this finding is limited by poor study methodology and differences between treatment groups. Another small clinical study in males with infertility and oligospermia shows that taking astaxanthin (Astasan, Sensilab) 16 mg daily does not increase sperm concentration or sperm motility when compared with placebo (105098).
• Menopausal symptoms. Although there is interest in using oral astaxanthin for menopausal symptoms, there is insufficient reliable information about the clinical effects of astaxanthin for this purpose.
• Metabolic syndrome. Although there is interest in using oral astaxanthin for metabolic syndrome, there is insufficient reliable information about the clinical effects of astaxanthin for this condition.
• Nonalcoholic fatty liver disease (NAFLD). Although there is interest in using oral astaxanthin for NAFLD, there is insufficient reliable information about the clinical effects of astaxanthin for this condition.
• Osteoarthritis. Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with mild knee or hip osteoarthritis shows that taking a combination product containing astaxanthin 2 mg, krill oil, and hyaluronic acid daily for 12 weeks (FlexPro MD, Valensa) reduces joint pain and stiffness and improves objective and subjective measures of joint function but does not improve overall physical function when compared with placebo (112432). It is unclear if these effects are due to astaxanthin, other ingredients, or the combination.
• Obesity. Although there is interest in using oral astaxanthin for weight loss, there is insufficient reliable information about the clinical effects of astaxanthin for this purpose.
• Parkinson disease. Although there is interest in using oral astaxanthin for Parkinson disease, there is insufficient reliable information about the clinical effects of astaxanthin for this condition.
• Physical performance. It is unclear if oral astaxanthin improves physical performance in older adults. Details: A small clinical trial in healthy nursing home residents shows that taking astaxanthin (AstaReal) 12 mg twice daily for 16 weeks, in combination with vitamin E 40 mg and vitamin C 30 mg daily, increases the 6-minute walking distance by about 38 meters, a significant increase when compared with placebo containing vitamin E and vitamin C. However, there was no effect on muscle strength (109777). Another small clinical trial in healthy, older adults (aged 65-85 years) undergoing exercise endurance testing shows that a specific combination product (AstaReal; Fuji Health Science, Inc) containing astaxanthin 12 mg, tocotrienol 10 mg, and zinc 6 mg, taken as 2 capsules daily for 12 weeks, reduces the respiratory exchange ratio, but does not improve leg muscle endurance or perceived exertion, when compared with placebo. In a subgroup analysis of males, but not females, those taking astaxanthin had a greater total exercise efficiency when compared with placebo (107963).
• Rheumatoid arthritis (RA). Oral astaxanthin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with RA shows that taking a supplement containing astaxanthin 4 mg, lutein 40 mcg, vitamin A 65 IU, vitamin E 50 IU, and safflower oil 460 mg (BioAstin, Cyanotech) three times daily for 8 weeks reduces pain and improves satisfaction by approximately 40% when compared with placebo (94125).
• Stroke. Although there is interest in using oral astaxanthin for recovery from stroke, there is insufficient reliable information about the clinical effects of astaxanthin for this purpose.
• Sunburn. It is unclear if oral astaxanthin might help to prevent sunburn. Details: A very small clinical study in Japanese adults shows that taking astaxanthin (Astots, Fujifilm Corporation) 4 mg daily for 9 weeks might increase skin tolerance to ultraviolet (UV) light when compared with placebo (96884). It is unclear if this translates to a lower risk of sunburn. More evidence is needed to rate astaxanthin for these uses.

(Read more about ASTAXANTHIN)

POSSIBLY EFFECTIVE

• Diabetes. Oral tocotrienols may improve glycemic control in adults with type 2 diabetes. Details: A meta-analysis of 8 clinical trials of adults with type 2 diabetes shows that taking a tocotrienol-rich fraction, primarily derived from palm fruit, 250-400 mg daily for 2-18 months leads to slight improvements in glycated hemoglobin (HbA1c) when compared with placebo (112286). The benefit was primarily among those with a higher baseline HbA1c, a duration of diabetes less than 10 years, and in studies with a duration of less than 6 months. Most studies were rated high quality with a low risk of bias, but most were also small with moderate heterogeneity. Most of the studies were conducted in Malaysia, where tocotrienol-rich palm oil was already regularly consumed as part of the diet, potentially limiting the generalizability of the findings to other populations with different baseline tocotrienol intakes.

POSSIBLY INEFFECTIVE

• Hypercholesterolemia. Oral tocotrienols are not likely to induce clinically meaningful improvements in cholesterol levels. Details: A meta-analysis of 19 small clinical trials shows that taking tocotrienols 50-600 mg daily for 1-6 months does not decrease levels of total cholesterol, low density lipoprotein (LDL) cholesterol, or triglycerides when compared with control. Tocotrienols were shown to increase levels of high-density lipoprotein (HDL) cholesterol by a modest and clinically insignificant amount. Sub-group analyses did not find that baseline lipid levels, or dose and duration of tocotrienol supplementation, notably alter results (104430). These findings are limited because the studies included not only patients with hypercholesterolemia, but also healthy patients and patients with various conditions such as type 2 diabetes, metabolic syndrome, and kidney disease. Tocotrienols have also been studied in combination with tocopherols (28730,85107,104430) and polymethoxylated flavones (99694) without notable benefit.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. Oral tocotrienols have only been evaluated in combination with other ingredients; their effect when used alone is unclear. Details: A small study in healthy adults over 40 years of age with self-diagnosed, subjective memory decline shows that taking a specific combination supplement (BGG Japan Co.) containing tocotrienols 50mg and astaxanthin 9 mg daily for 12 weeks modestly improves composite and verbal memory when compared with placebo (105099). This study was funded by the supplement manufacturer.
• Aging. Although there is interest in using oral tocotrienols for aging, there is insufficient reliable information about the clinical effects of tocotrienols for this condition.
• Alzheimer disease. Although there is interest in using oral tocotrienols for Alzheimer disease, there is insufficient reliable information about the clinical effects of tocotrienols for this condition.
• Alopecia areata. Although there is interest in using topical tocotrienols for alopecia areata, there is insufficient reliable information about the clinical effects of tocotrienols for this condition.
• Breast cancer. It is unclear if oral tocotrienols are beneficial for improving early breast cancer outcomes or preventing recurrence. Details: Clinical research in Malaysian patients with early-stage breast cancer shows that taking tocotrienols 200 mg daily, in conjunction with tamoxifen 20 mg daily for up to 5 years, does not improve survival or reduce the rate of cancer recurrence when compared with taking tamoxifen with placebo (99697). The validity of this study is limited by the lack of randomization and insufficient power to evaluate an effect on cancer-related mortality.
• Chronic kidney disease (CKD). Although there is interest in using oral tocotrienols for CKD, there is insufficient reliable information about the clinical effects of tocotrienols for this condition.
• Diabetic nephropathy. It is unclear if oral tocotrienol-rich vitamin E is beneficial for slowing diabetic nephropathy progression. Details: A small clinical study in patients with diabetic nephropathy shows that taking a specific tocotrienol-rich vitamin E supplement (Tocovid SupraBio, Hovid Nutriworld) 200 mg twice daily for 12 weeks seems to modestly reduce serum creatinine, with a corresponding increase in estimated glomerular filtration rate (eGFR), when compared with placebo. According to a sub-group analysis, these improvements remained statistically significant in patients with low tocopherol levels (less than 42 mcmol/L) at baseline, but not in those with higher levels at baseline (103010). Another small clinical study shows that taking this same supplement regimen for 12 months reduces serum creatinine levels and improves eGFR at 8 months, but not 12 months, when compared with placebo. In a subgroup analysis of patients with stage 3 chronic kidney disease, these benefits persisted at 12 months when compared with placebo (107390).
• Familial dysautonomia. It is unclear if oral tocotrienols are beneficial for familial dysautonomia outcomes. Details: A small clinical study in patients with familial dysautonomia shows that taking tocotrienols 100 mg for 3-4 months decreases the number of hypertensive crises by at least 50% in about 80% of patients when compared to baseline (28720). However, another small clinical study shows that taking tocotrienols 50 mg or 100 mg daily for 3 months improves subjective symptom reports, but does not improve objective clinical measurements, when compared to baseline (99700). The validity of these findings is limited by small study sizes and the absence of comparator groups.
• Hypertrophic scars. It is unclear if topical tocotrienols improve hypertrophic scar appearance or vascularity. Details: A clinical study in adults with recently healed surgical scars shows that applying a cream containing 5% tocotrienols twice daily for 6 weeks does not improve scar appearance or vascularity at the end of treatment or 10 weeks after treatment completion when compared with a placebo cream (99699). It is unclear if a cream containing a greater concentration of tocotrienols might be beneficial.
• Impaired glucose tolerance (prediabetes). It is unclear whether oral tocotrienols are beneficial in patients with prediabetes. Details: A small clinical trial in adults with untreated prediabetes shows that taking delta-tocotrienol 300 mg orally daily for 12 weeks reduces fasting plasma glucose and insulin levels and improves glycated hemoglobin and the homeostatic model assessment for insulin resistance (HOMA-IR) when compared with placebo (107856).
• Metabolic syndrome. Oral tocotrienols have only been evaluated in combination with other ingredients; their effect when used alone is unclear. Details: A moderate sized clinical trial in adults with metabolic syndrome shows that taking delta-tocotrienols 500 mg and resveratrol 300 mg daily for 24 weeks improves body weight, waist circumference, blood pressure, fasting blood glucose, serum triglycerides, total cholesterol, high-density lipoprotein cholesterol, and markers of inflammation and oxidative stress compared with placebo (112144). It is unclear if these effects are due to the tocotrienols, resveratrol, or the combination.
• Nonalcoholic fatty liver disease (NAFLD). Small clinical studies suggest that oral tocotrienols may modestly improve steatosis and other outcomes in patients with NAFLD. Details: A small clinical trial in adults with NAFLD shows that taking tocotrienols 200 mg twice daily for one year might reduce steatosis, as measured by ultrasound hepatic echogenic response, when compared with placebo (99695). Another small clinical trial in overweight or obese adults with NAFLD shows that taking a specific product (American River Nutrition, Inc.) containing 90% delta-tocotrienol and 10% gamma-tocotrienol, as 300 mg twice daily for 24 weeks, modestly reduces fatty liver index (FLI), hepatic steatosis measured by ultrasound, and liver enzyme levels when compared with placebo (104428). These findings are limited because liver biopsy was not used to determine disease progression. Assessment by liver ultrasound examination has limited accuracy when used in obese patients and when testing for steatohepatitis or fibrosis.
• Postmenopausal conditions. It is unclear if oral tocotrienols are beneficial for improving symptoms in postmenopausal patients. Details: A small clinical study in postmenopausal patients shows that taking a specific product (DeltaGold70) 430 mg or 860 mg daily, containing 300 mg or 600 mg tocotrienols, respectively, for 12 weeks does not improve quality of life, body weight, or body fat percentage when compared with placebo (99690).
• Stroke. It is unclear if oral tocotrienols are beneficial for improving outcomes in patients after stroke or transient ischemic attack (TIA). Details: Observational research in patients after an ischemic stroke or TIA has found that taking tocotrienols 400 or 800 mg daily for one year is associated with reduced resistance to aspirin in patients using aspirin with clopidogrel, but not in patients using only aspirin or only clopidogrel, when compared with placebo (104429).
• Wound healing. Although there is interest in using topical tocotrienols for wound healing, there is insufficient reliable information about the clinical effects of tocotrienols for this condition. More information is needed to rate tocotrienols for these uses.

(Read more about TOCOTRIENOLS)

LIKELY SAFE ...when used in amounts found in foods. Astaxanthin has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when taken orally and appropriately. Astaxanthin 4-18 mg daily has been used with apparent safety for up to 12 weeks. Doses of 40 mg daily have been used with apparent safety for up to 4 weeks (19165,19167,19197,32621,96884,105100).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in amounts greater than those typically found in foods.

(Read more about ASTAXANTHIN)

POSSIBLY SAFE ...when used orally and appropriately. Tocotrienols have been used with apparent safety at doses of up to 600 mg daily for up to 18 months (99690,99695,99696,104427,104428,112286). Tocotrienols have also been used with apparent safety at a dose of 200 mg daily for up to 5 years (99697). There is insufficient reliable information available about the safety of tocotrienols when applied topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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CYTOCHROME P450 2B6 (CYP2B6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, astaxanthin may decrease levels of drugs metabolized by CYP2B6.  Details In vitro research shows that astaxanthin induces cytochrome CYP2B6 enzyme activity in human hepatocytes (32613). This effect has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, astaxanthin may decrease levels of drugs metabolized by CYP3A4.  Details In vitro research shows that astaxanthin induces CYP3A4 enzyme activity in human hepatocytes (32613). This effect has not been reported in humans.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = B Concomitant use of tocotrienols with anticoagulant or antiplatelet agents might increase the risk of bleeding. However, this has not been reported in humans.  Details Taking tocotrienols orally inhibits experimentally-induced platelet aggregation in humans (3237,104429). Theoretically tocotrienols might increase the risk of bleeding if taken with antiplatelet or anticoagulant drugs. However, tocotrienols 400-800 mg daily have been used with aspirin and/or clopidogrel for 1 year with no clear cumulative antiplatelet effects and no reports of bleeding (104429).

(Read more about TOCOTRIENOLS)

General ...Orally, astaxanthin seems to be well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, diarrhea, red fecal color.

Gastrointestinal ...Orally, astaxanthin 6 mg daily has caused two cases of increased bowel movements and two cases of red fecal color (91736). A higher dose of astaxanthin (AstaCarox, AstaReal AB) 40 mg daily has caused severe stomach/abdominal pain in two patients (19165).

Ocular/Otic ...Canthaxanthin, another carotenoid substance that is chemically related to astaxanthin, has caused crystals in the retina and loss of visual acuity in one patient (8455). This effect has not been observed with astaxanthin, but patients who have visual changes while taking astaxanthin should stop taking it immediately.

(Read more about ASTAXANTHIN)

General ...Orally, tocotrienols appear to be well-tolerated. No adverse effects have been reported in clinical trials.
Most Common Adverse Effects:
Topically: Mild itching.

Dermatologic ...Topically, a cream containing 5% tocotrienols has been reported to cause mild itching in 7% of patients in one clinical study (99699). Contact dermatitis has been reported in 33% of patients using a cream containing vitamin E as a mixture of tocopherols and tocotrienols (4721). However, it is unclear if this effect resulted from tocopherols, tocotrienols, or the combination.

(Read more about TOCOTRIENOLS)