Transcription
Without cysteine in the body, the body cannot synthesize, mostly in the liver, the glutathione that it requires. Welcome to my YouTube channel! I'm Dr. A, so let's get into today's topic, which is NAC, also known as N-acetyl cysteine, a common supplement. It's an approved drug in the United States. NAC, or N-acetylcysteine, is an amino acid that absorbs very well orally and is the rate-limiting or main effector of our formation of glutathione.
A lot of clinicians and laypeople will use N-acetylcysteine to try and increase glutathione levels in the body, which is great. Glutathione is one of the three most basic and important antioxidants, and those three keep each other recycled. Meaning, when they're in their reduced state, they're ready to be an antioxidant; when they're in their oxidized state, they have to be reduced again. Vitamin C, glutathione, and vitamin E all do this together and keep each other as ready and active antioxidants.
Now, when we get to N-acetylcysteine, people say, "Well, why is it more important?" Because glutathione is made up of three different amino acids: glycine, glutamine, and cysteine. So why is cysteine, or N-acetylcysteine, as it's used mostly orally and in other ways, so important? It's because, of the three amino acids that make glutathione, N-acetylcysteine is the rate-limiting amino acid to make glutathione. What that means is that your body can have glutathione production through some glycine and glutamine in the body or in the diet, but without cysteine, the body cannot synthesize, mostly in the liver, the glutathione that it requires.
When your body needs to make glutathione, it will look for these three amino acids and assemble them through a multi-step process. The multi-step process can have all the glycine and all the glutamine that it wants, but if it doesn't have enough cysteine, it will slow down and basically stop. So, cysteine, through N-acetylcysteine supplementation, can increase glutathione. That's why it's so important. These three base antioxidants that protect all of our cells—glutathione, vitamin C, and vitamin E—work as a triplet; they work all together. Glutathione is made in the body, vitamin C has to be obtained from our diet because we don't make that as humans, and then vitamin E generally has to be obtained from the diet as well.
When we're making glutathione, it's a little harder to make because the body has to go through these multiple steps. Antioxidants are protective against free radical formation, damage to the blood vessels, damage to the brain, damage to the kidneys, and all sorts of things. That's why glutathione is so important and usually why N-acetylcysteine becomes very important, especially when we're trying to raise levels of glutathione.
Now, people will often say, "Well, is there any research that shows, number one, it's the rate-limiting step, and number two, that if you give somebody cysteine or N-acetylcysteine, it'll actually raise their glutathione?" When you're looking at N-acetylcysteine, some people ask, "Are there pluses and minuses of just taking N-acetylcysteine versus glutathione?" There are a couple of layers to consider. Both can be what are called mucolytic substances, which is a little different than antioxidants. In hospital medicine, N-acetylcysteine, which used to be a drug called Mucomyst, could be used in a ventilator system and could even be given intravenously. It could be taken orally or used in a nebulizer, and when you breathe it in, it helps to break down the mucus bonds, making it mucolytic and helping you to breathe better.
Imagine if you're having asthma or you're on a ventilator and your mucus secretions are very sticky; that's what NAC is very helpful with. It turns out glutathione is also helpful in that way, but NAC is the standard drug approach to that. The next thing is that the absorption of N-acetylcysteine will help you to make more glutathione, and then you have more of that triplet of antioxidants working.
There's also a difference in N-acetylcysteine as a supplement; it is moderately or reasonably priced. Glutathione as a supplement has two oral forms that will work: one is acetyl glutathione, and the other is liposomal glutathione. Those are the two that have research to show that they're absorbed, so if you're using those two, they're very good and they get into your bloodstream, but they can be more costly than N-acetylcysteine.
People will say, "Okay, well, why wouldn't I just take N-acetylcysteine to boost my glutathione that way?" The answer is, well, you certainly can. One of the issues that can come up, though, is if you're using N-acetylcysteine more for acute problems, such as those respiratory issues I mentioned, sometimes what we'll do is just use N-acetylcysteine and then, for maintenance, we'll move to glutathione with people.
There's also this other factor: some people do not go through the multiple steps in their own body, mostly in the liver, to take the three amino acids and turn them into glutathione. If you don't do that, why wouldn't you? That's because of SNPs, or single nucleotide polymorphisms, that affect the different enzyme steps in formation. Some people can have glutathione synthetase SNPs, and there are some other synthesis enzymes to get the three amino acids stuck together and turned into glutathione. Sometimes, people will have a lot of NAC go into the body and very little glutathione come out the other end because their body just is not very efficient due to genetic inheritance.
You can check for these single nucleotide polymorphisms through nutrigenomic testing, especially if you're someone who's hypersensitive, maybe you have mast cell activation syndromes or mast cell activation disorders, multiple chemical sensitivity, environmental toxins, or things of that nature. It's probably good to look there. The reason that becomes important is that although NAC is good for lots of things and is less costly than glutathione, if I have enzyme defects in making glutathione, I may need to supplement with glutathione proper and maybe use NAC just to back it up or for other purposes.
So, your genetics can get in the way of putting those three amino acids together as glutathione, your central antioxidant. A couple of things just technically about N-acetylcysteine to consider: first, it smells sort of like eggs; it has a sulfury smell. Why? It's a thiol; it's a sulfur-containing amine or amino acid, so it should have some smell. It shouldn't smell like rotten eggs, but it's going to smell. The next thing is that your urine will certainly have a sulfury smell to it if you're taking N-acetylcysteine, so just know there's nothing wrong; that's just the way your urine will smell. Also, if you're sweating a lot, you may have a little more sulfury smell, which is usually a little more diffuse than the urine smell.
Now, mostly for people who are trying to use it chronically long-term, and they're adults, they're probably prescribed something along the lines of a half a gram to a gram and a half, or two grams a day, and then maybe back off to a maintenance level. If somebody's having a lot of respiratory disorders and problems and using a nebulizer, maybe gram doses or a ventilator, etc., so it's a very wide index. Generally speaking, we try to dose it a little higher in the beginning and then taper that down for maintenance over the long run.
So, when we're thinking of it, we need to remember that N-acetylcysteine is the more economical way to get cysteine in the body and produce glutathione. We might have troubles with our genetics, especially if we have mast cell issues or multiple chemical sensitivity, environmental toxicities, or other sensitizing issues. So, it might be good to look at nutrigenomics regarding making it, and then you might need to take glutathione proper. But basically, it's a way to increase your glutathione, and it also does a few other good things, like being mucolytic, which we often use in the hospital and also at home with people with colds, flu, and things of that nature.
All right, so that's N-acetylcysteine today!