N-Acetyl Cysteine, also known as NAC, is a versatile antioxidant. It is commonly used to support various health functions. It may help reduce the toxicity of acetaminophen and could support muscle performance. This article will discuss NAC, its role in the body, how to test for it, and the sources of NAC.
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What is NAC?
NAC is a synthetic form of the non-essential amino acid l-cysteine. L-Cysteine is a precursor to glutathione, a significant antioxidant. NAC, when taken orally, has a low bioavailability of 4-10% due to its processing in the small intestine and liver.
What is NAC's Role in The Body?
NAC is a powerful antioxidant. Antioxidants are molecules that help neutralize free radicals, which can cause damage to cellular parts, including DNA. NAC is also a precursor to glutathione, one of the most powerful antioxidants. Through its antioxidant capability and the increased production of glutathione, NAC may assist in detoxification pathways in the liver and support the health of endothelial cells (cells that line the heart, lymph, and blood vessels). NAC is also known for its ability to support the neutralization of certain chemicals. It may help improve insulin sensitivity, support a healthy inflammatory response, and has a mucolytic (breaking down mucus secretions) function.
Because of these actions, NAC has been shown to be helpful in a variety of conditions, the most common and well-researched being the following:
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a common condition that can affect fertility. PCOS can come with symptoms such as hirsutism (facial hair, dark hairs on the body), cycle irregularities, ovarian cysts, and blood sugar dysregulation. Clomid is a first-line drug therapy for women with PCOS, as it can help to induce ovulation. However, some women may not respond to Clomid. Studies suggest that Clomid with concurrent NAC supplementation may support increased ovulation and pregnancy rates in women with PCOS who are resistant to Clomid.
Preterm Delivery
Bacterial vaginosis infections can increase risk factors for preterm delivery. Inflammatory responses during these infections can increase the complexity of the infection. NAC may help support a healthy inflammatory response during infections. Additionally, studies show that in women with previous preterm birth and bacterial vaginosis infection, NAC taken with progesterone, a hormone essential for pregnancy, after the 16th week of pregnancy may support a reduced risk of preterm births and improve pregnancy outcomes.
Recurrent Pregnancy Loss
Recurrent pregnancy loss (RPL) is defined as the loss of 3 or more consecutive pregnancies within the first two trimesters (20 weeks). Compared to folic acid, a B vitamin essential for the development of the fetus, administration of both folic acid and NAC may support an increased live birth rate.
Acetaminophen Toxicity
Acetaminophen is a pain and fever-reducing over-the-counter drug. Acetaminophen is the most commonly overdosed drug in pregnancy, and it is one of the most common causes of drug-induced liver toxicity in children and adults. The metabolite of acetaminophen can cause liver damage. NAC is used to help manage acetaminophen-induced liver toxicity by supporting the reduction of the harmful metabolite of acetaminophen, increasing glutathione levels, and utilizing its antioxidant capabilities to support liver cell health. NAC may reduce the harm done by acetaminophen-induced liver toxicity if given within a specific timeframe after overdose.
Ulcerative Colitis
Ulcerative colitis (UC) is a type of chronic inflammatory bowel disease (IBD) characterized by inflammation and ulceration in the inner lining of the large intestine. UC patients can have frequent bloody and mucus-filled loose stools, with rectal pain and weight loss, among other symptoms. NAC may help protect the cells of the colon from inflammation while supporting a healthy inflammatory response. NAC was also shown to support the recovery rate of the colonic cells and colonic lining.
Muscle Performance
NAC has been shown to support muscle performance. A study showed that NAC increased the forced output of muscle by 15% after 3 minutes of repetitive contractions.
How to Test NAC Levels
Since NAC is converted into l-cysteine, there is no test to check NAC levels directly. NAC can be indirectly assessed through testing cysteine and glutathione levels.
Cysteine
Checking cysteine levels can indirectly assess the need for NAC, as cysteine levels can be increased from NAC. Cysteine can be tested through amino acid profiles such as the Plasma Amino Acids by Doctor's Data (cystine, the extracellular form of cysteine, is found on this test) and Urine Amino Acids - FMV by Doctor's Data.
Glutathione
Since NAC can increase glutathione levels, low glutathione may suggest the potential benefit of NAC. Glutathione can be tested in the blood as a single marker, such as the glutathione test by Doctor's Data. Like cysteine, it can also be found on the Spectracell Laboratories micronutrient test discussed above.
Sources of NAC
Foods
While no dietary sources of NAC exist, cysteine is found in foods such as chicken, turkey, eggs, yogurt, and garlic.
Supplements
Per WebMD: "Although many dietary supplement products contain NAC, the US FDA has stated that it's illegal for dietary supplements to contain NAC since it's technically an approved drug. But as of August 2022, the FDA is considering changing this stance. It may allow for NAC in dietary supplements as long as no safety issues come up. A final decision is pending. Prescription NAC products are available under the guidance of a healthcare provider."
Drugs
NAC is used as a drug that can be taken in the form of inhalation, intravenous (IV) solutions, and oral medications. Oral doses are in the range of 600 -1200 milligrams daily.
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Summary
NAC is a powerful antioxidant on its own, but its ability to convert into another one of the most powerful antioxidants, glutathione, makes it even more credible. While there is no way to test for NAC, cysteine and glutathione levels may be utilized to assess if NAC may be helpful.
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