What is N- Acetylcysteine?

N-acetylcysteine (NAC) has been widely used in the past, most notably for its role in liver health and the detoxification pathways, main clinical uses are for paracetamol overdose and Chronic Obstructive Pulmonary Disease (COPD). NAC is the acetylated precursor of both amino acid L-cysteine and reduced glutathione (GSH), NAC comes in supplemented form and is then converted in to cysteine for the body to use. NAC has shown to be directly correlated with GSH and is known to inhibit the rate-limiting substrate for glutathione resynthesise. EFSA state that NAC contributes to GSH homeostasis, NAC helps to keep the redox state in balance, supports natural defence system and supports the detoxification of the liver.

Glutathione is a powerful antioxidant that is found as enzymes in liver cells (hepatocytes), it is a key player for metabolizing heavy metals, toxins and metabolic by-products, it is directly correlated to low cysteine levels.3 Glutathione is a tripeptide, γ-L-glutamyl-L-cysteinyl glycine present in all cells and the most abundant non- protein thiol that defends against oxidative stress, recent studies have further found that it is a key determinant of redox signalling, vital in detoxification of xenobiotics, modulates cell proliferation, apoptosis, immune function and fibro genesis. There is now a wide pool of knowledge that shows treating people who suffer with Sjogren’s syndrome, influenza, hepatitis C and myoclonus epilepsy with NAC improves associated symptoms, further research has found the benefits of treatment on drug addiction and OCD disorders substantiating the overall use of NAC as natural medication.

NAC N-Acetyle Cysteine helps with CHRONIC OBSTRUCTIVE PULMONARY DISEASE -

COPD is a disease characterised by limited airflow, both the airway inflammation and oxidation/antioxidation imbalance are directly correlated to the occurrence and development of the disease. NAC has been widely used as a powerful antioxidant which has highly effective anti-inflammatory properties.

Recent studies have shown significant differences with supplementation groups, in a study by Hu, GF 5 they worked with 108 patients in a stable stage of COPD, 2 groups were divided from the inclusion criteria and one administered NAC (600mg 2x/d) the other a placebo. Results of the study found significant reductions for all markers in the NAC group, the conclusion of the study showed NAC improves the effect of oxidative stress and inflammatory response on cardiopulmonary function that inhibits the airway remodelling caused by protease activation. A similar study concluded NAC adjuvant therapy for patients with stable COPD optimizes airway inflammation, and remodelling. Therefore it is worth popularization and applying to clinical practice in the future.

Ebd El Havis, A et al. took 3 groups of 15 COPD patients consisting of, control, low dose (600mg) and high dose (1200mg), NAC was administered for 10 consecutive days. The selected patients were within the ages of 40-74 and all had history of ⩾ 2 exacerbations per year. The major findings found that treatment significantly reduced Malondialdehyde (MDA) levels in both groups compared to control. High dose showed superior measurements in Spiro-metric Pulmonary Function Tests (SPFTs), Interleukin (IL)-8 and P/F Ratio (arterial oxygen concentration).

MDA levels in the 3 groups before & after treatment

Salve and Atram combined a trial on the supplementation of NAC and physical activity in patients with COPD.8 100 patients took part in the study and divided into NAC and placebo groups, NAC group were given 600mg once daily and instructed to walk for 20 minutes daily for 10 weeks continuously. At the end of the study the results showed significantly improved quality of life statistics with NAC and exercise giving further evidence of NAC and its use in COPD patients.

NAC is great for LIVER HEALTH 

NAC has been shown to be an effective tool for detoxification pathways. The liver is a powerful organ, the main function is to filter blood coming from the digestive tract, detoxification of chemicals and drugs and the manufacturing of proteins vital for blood clotting and further functions. It has been shown that NAC aids the liver by preventing toxicity through reducing the impact of the formation and accumulation of N-acetyl-p-benzoquinone-imine (by-product of xenobiotic metabolism of the analgesic paracetamol) by acting as a glutathione substitute thus enhancing non-toxic sulfate conjugation.

Liver failure is a life-threatening disease and requires urgent care, however it is developed over many years. A more severe case of liver failure is acute liver failure, acute liver failure is rare but is a life threatening multisystemic medical emergency that can develop rapidly. It is known as the rapid development of acute liver injury with impaired synthetic function and encephalopathy in a person with previous normal liver health.

A prospective study was conducted to determine if the administration of NAC therapy would impact mortality in patients with NAI-ALF by Mumtaz et al. 47 patients with non-acetaminophen-induced acute liver failure (NAI-ALF) were registered. Patients received 140mg/kg with a further 70mg/kg every 4 h, for a total of 17 doses, within 6 hours of admission. The results found a significant difference in survival rates in the NAC group (47%) compared to placebo (23%) giving encouraging use of NAC. Sale et al. reviewed the latest evidence of NAC supplementation on NAI-ALF from human studies published in the previous 10 years prior to the review. All the studies represented improvements in NAC supplemented groups giving encouraging signs for further research and the use of NAC clinically for NAI-ALF.

NAC AND DIABETES 

Type II diabetes mellitus (T2DM) is a metabolic disorder that inhibits pancreatic insulin secretion and decreased action/resistance in certain target tissues. Overall development of diabetes can be caused by non enzymatic glycation of tissue proteins, new research has developed knowledge on the potential role of free radicals in the pathogenesis of diabetes. A study undertaken by Ozkilic, A. et al11 looked at the relationship of glutathione and antioxidant enzymes in patients with T2DM. Thirty- Two T2DM patients underwent measurements of glutathione peroxidase, catalase and GSH before and after 3 months supplementation of NAC. Glutathione peroxidase was significantly lower in the treated group indicating that NAC supplementation could gave a positive effect on non enzymatic glycation of the tissue proteins in people with T2DM.

NAC AND TREATING ADDICTION 

NACs effectiveness is primarily attributed to its ability to stimulate glutathione (GSH) synthesis, enhance glutathione-S-transferase activity, promote liver detoxification by inhibiting xenobiotic biotransformation, and as a powerful free radical scavenger. Preclinical studies have suggested that levels of glutamate within the nucleus accumbens mediate reward-seeking behaviour. The nucleus accumbens is a collection of neurons within the forebrain. It is thought to play an important role in reward, laughter, pleasure, addiction and fear. Restoring extracellular glutamate concentration in the nucleus accumbens seems to block reinstitution of compulsive behaviours and decrease cravings. Studies examining cocaine addiction demonstrate that N-acetyl cysteine (NAC) seems to increase extracellular levels of glutamate, stimulate inhibitory glutamate receptors, and thereby reduce synaptic release of glutamate. Research from 2007 reveals further evidence that NAC influences the glutamate receptors - this was shown in an interesting study on NAC’s effects on pathological gambling.14 Results from this study reveal that NAC supplementation (1200-1500mg per day) resulted in a significant reduction in gambling cravings and that the efficacy of NAC lends support to the hypothesis that pharmacological manipulation of the glutamate system might target core symptoms of reward-seeking addictive behaviours.

NAC AND OBSESSIVE COMPULSIVE DISORDER (OCD) –

Is a common health disorder in which a person has obsessive thoughts and compulsive behaviours. Raised levels of glutamate is known to be linked with OCD, glutamate is an abundant neurotransmitter that is found in the brain. NAC could be an effective adjuvant to serotonin reuptake inhibitor in children and adolescents with OCD, Ghanizadeh, A et al. looked at 34 patients diagnosed with OCD and the effect of NAC (600mg 2x/d) in conjunction with citalopram (anti-depressant drug) as the adjuvant to serotonin. Over the course of the study, the NAC group significantly decreased symptoms of OCD which can be seen in Yale- Brown Obsessive-Compulsive Scale. This specific trial gives indication that NAC adds to the effect of citalopram in improving the resistance and control to compulsions in children and adolescents.

Changes of Yale Brown Obsessive Compulsive Scale Score in the Two Groups During

NAC FOR POLYCYSTIC OVARY SYNDROME (PCOS) –

Is a common condition which affects how a women’s ovaries function, around 5 – 15% of women are affected and is the leading cause of infertility due to chronic anovulation. Women with PCOS typically have raised levels of vascular cell adhesion molecule 1 (VCAM-1) and is positively correlated with elevated testosterone levels. Badawy, A et al.16 designed a trial looking at 573 patients of which 470 were treated with NAC (1200mg/d) for one menstrual cycle, supplementation began on day 3 of the cycle and lasted for 5 days continually. Results showed a significant change in ovulation rate after NAC 17.9% compared to 52.1%, as well as increased pregnancy rate to 11.5%. Overall the study justified the supplementation of NAC, results showed to reduce VCAM-1 levels and improved insulin sensitivity, reducing the overall PCOS aggravation and providing evidence to be an effective adjuvant in augmenting ovulation in polycystic ovary patients.

NAC FOR CYSTIC FIBROSIS (CF) –

Is a disease that is inherited which effects the secretory glands, this can cause issues to the lungs and digestive system. It is known that NAC depolymerizes mucus in vitro breaking disulphide bridges between macromolecules, this process potentially reduces sputum tenacity that enables it to be removed from the respiratory tract. A systematic review undertaken by Duijvestijn, Y and Brand P18 looked at six randomized controlled studies in clinical settings on NAC and CF, the overall conclusion is there is a potential beneficial effect in long term use of NAC for patients with cystic fibrosis. Further studies are needed to determine the true effect of NAC supplementation but the reduction in neutrophilic inflammation shows positive correlation between NAC and CF.

NAC FOR SPORTS PERFORMANCE 

At elite level the finest margins count, finding that extra edge could be key. Slattery et al.19 looked at the positive effects 1200mg (2x 600mg per/d) of NAC had on 10 triathletes over 9 days. The results showed that short term supplementation improves repeated sprint cycling performance, overall mean power in the supplemented group had a significant improvement compared to placebo thus improving overall distance achieved in each sprint test. It was discovered that NAC does not inhibit adaptive responses to exercise, it enhances oxidant/antioxidant ratio during exercise providing a favourable environment for muscles to contract and adapt in well trained triathletes undergoing intensive training.

Ingredients

One vegan capsule provides:
N-acetyl cysteine 600mg

Safety:

NAC is generally safe and well tolerated even at high doses.
Side effects including nausea, vomiting, headache, dry mouth, dizziness, or abdominal pain have been reported, but these are rare.

Contraindications:

Contraindicated in individuals with active peptic ulcer.
Pregnancy and breast-feeding: Not recommended for use during pregnancy or lactation

Drug interactions: Potential negative interactions involving Acetaminophen and Metoclopramide. Nitroglycerin – used for dilating blood vessels

Recommended use: There are studies mentioning use of NAC in children 7-14 on the effect on OCD but recommended use would be one capsule 600mg for children below 14 years of age.

Related products: NAC+ Veg Caps, Saffron and Marigold Veg Caps, Milk Thistle Veg Caps, Balanced Zinc Complex Veg Caps, Balanced Amino Acid Complex Veg Caps.