The REAL Reasons To Use N-Acetylcysteine (NAC)

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-acetylcysteine, which is a common supplement. It's an approved drug in the United States as well. NAC, or N-acetylcysteine, is an amino acid. It absorbs very well orally, and it is the rate Limiting or main effector of our formation of glutathione. And so a lot of clinicians will, and a lot of laypeople will use N-acetylcysteine to try and increase glutathione levels in the body, which is great. Glutathione is one of the 3 most basic and most important antioxidants. And those 3 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. So 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 3 different amino acids. There's glycine, there's glutamine, and then there's cysteine. So why is cysteine, or N-acetylcysteine as it's used mostly orally and other ways, so important? Well, it's because of the 3 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 in the body, the body cannot synthesize, mostly in the liver, the glutathione. that it requires. So when your body needs to make glutathione, it will go in and it will look for these 3 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. And so cysteine through N-acetylcysteine supplementation can increase the glutathione. That's why it's so important. These 3 base antioxidants that protect all of our cells, glutathione, vitamin C, and vitamin E, work as a triplet. They work all together. Glutathione we make in the body. Vitamin C we have to get from our diet because we don't make that as humans. And then vitamin E we generally have to get from the diet as well. And so when we're making glutathione, it's a little harder to make because the body has to go through these multiple steps. Then antioxidants are protective against free radical formation, damage to the blood vessels, damage to the brain, damage to kidneys, all, all sorts of things. That's why glutathione's 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, N-acetylcysteine, it'll actually raise their glutathione? Now, when you're looking at N-acetylcysteine, so some people say, well, are there pluses and minuses of just taking N-acetylcysteine versus glutathione? And there's a couple of layers we want to think about. Both of them can be what are called mucolytic substances, which is a little different than antioxidant. But in hospital medicine, N-acetylcysteine, which used to be a drug called Mucamist, could be used in a ventilator system, could even be intravenously given, but it could be taken orally, used in a ventilator nebulizer. And when you breathe it in, it helps to break down the mucus bonds. And so mucolytic, it helps you to breathe better. Well, imagine if you're, you know, having asthma or you're on a ventilator and your mucus secretions are very sticky. That's what NAC is very helpful with there. Well, it turns out glutathione is also helpful in that way, but NAC is the standard drug approach to that. The next thing is, is that what does absorb of the N-acetylcysteine will help you to make more glutathione. And then you have more of that triplet of antioxidant working. There's also the difference in N-acetylcysteine as a supplement is moderately or reasonably priced. Glutathione as a supplement, there's 2 oral forms that will work. One is acetyl glutathione and the other is liposomal glutathione. Those are the 2 that have research to show that they're absorbed. And so if you're using those 2, they're very good and they get into your bloodstream, but they can be more costly than N-acetylcysteine. So people will say, okay, well, why wouldn't I just take N-acetylcysteine, boost my glutathione that way? And 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 an acute problem, such as those respiratory things I was saying, sometimes what we'll do is we'll just use the N-acetylcysteine and then in maintenance we'll move to glutathione with people. And then there's this other factor, which is some people do not go through the multiple steps in their own body, in the liver mostly. To take the 3 amino acids and turn them into glutathione. So if you don't do that, why would you not do that? Well, that's because of SNPs or single nucleotide polymorphisms that affect the different enzyme steps in formation. And so people can have glutathione synthetase SNPs, and there's some other synthesis enzymes to get the 3 amino acids stuck together and turned into glutathione. So sometimes people will have a lot of NAC go in the body and very little glutathione come out the other end because their body just is not very efficient because genetically they inherited that. You can check for these single nucleotide polymorphisms through nutrigenomic testing. And especially if you're somebody who's hypersensitive, maybe you have mast cell activation syndromes or mast cell activation disorders, multiple chemical sensitivity, environmental toxins, things of that nature, it's probably good to look there. And the reason becomes important is although the NAC is good for lots of things and it's less costly than glutathione, if I have enzyme defects in making glutathione, I may need to supplement 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 3 aminos together as glutathione, your central antioxidant. So a couple of things just technically about N-acetylcysteine to consider. First is it smells, smells sort of like eggs It's got a sulfury smell. Why? It's a thiol. It's a sulfur-containing amine or amino acid. It should have some smell. It shouldn't smell like rotten eggs, but it's going to smell. The next thing is, is that you, your urine certainly will have a sulfury smell to it if you're taking any thiols like N-acetylcysteine. So just that you're not doing wrong. It's just that's the way that your urine will smell. Also, if you're sweating a lot, you may have a little more sulfury smell. That usually is a little more diffuse than the urine smell is. Now, Mostly for people who are trying to use it chronically long-term and they're an adult, they're probably prescribed something along the lines of a half a gram to gram and a half, 2 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 it in a nebulizer, maybe gram doses or a ventilator, et cetera. So it's a very wide index, but generally speaking, we try and 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, other sensitive sensitizing sort of issues. So it might be good to look at nutrigenomics about making it, and then you might need to take glutathione proper. But basically it's a way to increase your glutathione, and also it does a few other good things like the mucolytic effect, helping keep the secretions flowing, which we often use it, as I said, both in the hospital and also at home with people with colds and flu and things of that nature. All right, so that's N-acetylcysteine today.