Some antioxidants may not be as safe as you previously thought they were as new studies come into publication. According to a Life Extension Magazine article from January, 2008, “N-Acetyl Cysteine May Curb Gambling Addiction,” researchers from the University of Minnesota gave increasing doses of N-Acetyl Cysteine (NAC) to 27 pathological gamblers for eight weeks, with a mean dose of nearly 1,500 mg/day.
Also see the news release, “New insights into treatment options for patients suffering from severe alcoholic hepatitis.” And check out the news release, “Treatment with NAC is associated with better outcomes for children with liver failure.” Also, a new retrospective study on the effects of N-acetylcysteine (NAC) on children with acute liver failure not caused by acetaminophen poisoning has found that the treatment was associated with a shorter hospital stay, higher incidence of liver recovery, and better survival after transplantation. The study is in the January 2008 issue of Liver Transplantation, a journal by John Wiley & Sons. The article is also available online via Wiley Interscience.
Acute liver failure in children is rare but can be fatal. Acetaminophen poisoning is a common cause, and is treated with NAC, which acts as an antidote, an anti-inflammatory agent and an antioxidant. One small, uncontrolled study suggested that NAC could also help children with non-acetaminophen induced acute liver failure, leading some medical centers to adopt the treatment.
Five years ago, researchers led by Christine Kortsalioudaki of King’s College Hospital in London sought to retrospectively evaluate whether NAC is beneficial for those children. Read the original study or its abstract, “Safety and efficacy of N-acetylcysteine in children with non acetaminopen induced acute liver failure.” Kortsalioudaki, Christine; Taylor, Rachel; Cheeseman, Paul; Bansal, Sanjay; Mieli-Vergani, Giorgina; Dhawan, Anil. Liver Transplantation; January 2008.
The researchers examined the medical records of 170 children who came to King’s College Hospital with non-acetaminophen induced acute liver failure between 1989 and 2004. Those treated before 1994 were not treated with NAC, while those who came after 1995 did receive NAC. All the children also received standard care to maintain normal tissue oxygenation and prevent and address complications of acute liver failure.
The children who received NAC spent fewer days in intensive care, and in the hospital overall. 43 percent survived with their native liver, compared to 22 percent of children who did not receive NAC. And death rates while awaiting transplant, after transplant, and after ten years were notably lower in children who had received NAC. Adverse effects were mentioned in just 11 percent of cases and NAC was discontinued in one.
“Our data demonstrates that NAC has minor, self-limited adverse effects and can be safely administered to children with non-acetaminophen induced acute liver failure,” the authors report, according to the news release. “Additionally this study suggests NAC may have a positive effect on the outcome of non-acetaminophen induced acute liver failure, improving the survival with native liver as well as post liver transplant survival.”
An accompanying editorial by Mike Leonis and William Balistreri of the Cincinnati Children’s Hospital Medical Center points out that the two groups compared in Kortsalioudaki’s study were markedly dissimilar in their clinical presentation which could account for some of the differences in outcomes. Also, further stratification of the NAC-treated group into middle and later years showed better outcomes in the latter group which would argue that the improvement was due to non-NAC related effects.
“This study does support the idea that intravenous NAC is a well-tolerated and safe medication for pediatric patients with acute liver failure,” Leonis and Balistreri write, according to the news release. However, it raises further question as to whether intravenous NAC is beneficial in pediatric patients with non-acetaminophen induced acute liver failure.
They point out that two current randomized-controlled prospective clinical trials are addressing this question. “Hopefully with the completion of both of these studies, convincing information will be available to guide clinicians on the true utility of NAC in non-APAP-induced ALF,” they conclude. Also check out the journal’s Editorial: “Is there a ‘NAC’ to treating acute liver failure in children.” Leonis, Mike; Balistreri, William. Liver Transplantation; January 2008.
At the end of treatment, 16 out of 27 (60%) participants reported a reduced urge to gamble. Of these 16 responders, 13 entered a placebo-controlled phase for a further six weeks. During this phase, 83% of those who received NAC responded favorably, compared with only 28.6% of the placebo group.
According to that 2008 article, NAC may help control addiction by its effect on glutamate, a brain chemical which is frequently associated with reward. Scientists were able to reduce people’s urges to gamble. This research could be encouraging for a lot of addictions. And the studies continue.
What are the reasons people use NAC?
It’s up to you, the consumer to talk with your healthcare professionals and decide what supplements may be of help, and then weigh the benefits against the risks. Keep on looking at new research reports in magazines that go both to consumers and healthcare professionals. In another study, the common antioxidant, NAC found in health food stores may not be as safe as once thought, according to a 2007 study.
Some people use NAC for body building, and others may use it to self-treat seasonal bronchial-like coughs. Check out the issue found in a study that looked at how NAC could fool the body into thinking that it has an oxygen shortage. You don’t want to create pulmonary hypertension (PAH) in the arteries that bring blood to the lungs.
N-acetylcysteine (NAC), an anti-oxidant commonly used in nutritional and body-building supplements, can form a red blood cell-derived molecule that makes blood vessels think they are not getting enough oxygen.
Certain preparations taken to enhance athletic performance or stave off disease contain an anti-oxidant that could cause harm. According to 2007 research at the University of Virginia Health System, N-acetylcysteine (NAC), an anti-oxidant commonly used in nutritional and body-building supplements, can form a red blood cell-derived molecule that makes blood vessels think they are not getting enough oxygen.
This leads to pulmonary arterial hypertension (PAH), a serious condition characterized by high blood pressure in the arteries that carry blood to the lungs. The results appear in the September 2007 issue of the Journal of Clinical Investigation. See, A type of antioxidant may not be as safe as once thought.
“NAC fools the body into thinking that it has an oxygen shortage,” said Dr. Ben Gaston, University of Virginia Children’s Hospital pediatrician and researcher who led the study, according to the September 4, 2007 news release, A type of antioxidant may not be as safe as once thought. “We found that an NAC product formed by red blood cells, known as a nitrosothiol, bypasses the normal regulation of oxygen sensing. It tells the arteries in the lung to ‘remodel’; they become narrow, increasing the blood pressure in the lungs and causing the right side of the heart to swell.”
A new understanding of the way oxygen is sensed by the body
Gaston notes that this is an entirely new understanding of the way oxygen is sensed by the body. The body responds to nitrosothiols, which are made when a decreased amount of oxygen is being carried by red blood cells; the response is not to the amount of oxygen dissolved in blood. He says that this pathway was designed much more elegantly than anyone had previously imagined. “We were really surprised”, he said.
The research team administered both NAC and nitrosothiols to mice for three weeks. The NAC was converted by red blood cells into the nitrosothiol, S-nitroso-N-acetylcysteine (SNOAC). The normal mice that received NAC and SNOAC developed PAH. Mice missing an enzyme known as endothelial nitric oxide synthase did not convert NAC to SNOAC, and were protected from the adverse effects of NAC, but not SNOAC. This suggests that NAC must be converted to SNOAC to cause PAH.
Could regular use of NAC produce the same effects in humans?
The next step is to determine a threshold past which antioxidant use becomes detrimental to heart or lung function, according to Dr. Lisa Palmer, co-researcher of the study. “The more we understand about complexities in humans, the more we need to be aware of chemical reactions in the body,” explained Palmer, in the news release.
According to Gaston and Palmer, NAC is being tested in clinical trials for patients with cystic fibrosis as well as other conditions; and clinical trials with nitrosothiols are being planned. These results, Palmer says, should motivate researchers to check their patients for PAH.
The results also open up a range of possibilities in treating PAH. Palmer added that the signaling process could be restorative and healing if they figured out how to keep NAC from fooling the body.
“From here we could devise new ways for sensing hypoxia or we could in theory modify signaling to treat PAH,” Palmer said, according to the news release. Check out research studies in the antioxidants you take to see whether they are as safe now, after new research as you thought they were in the past. Studies usually change every few years on various supplements.
New insights into treatment options for patients suffering from severe alcoholic hepatitis.
There’s also another study to peruse, published in April 2010, from the European Association for the Study of the Liver, “New insights into treatment options for patients suffering from severe alcoholic hepatitis.” Researchers looked at results from two new studies. The results can help inform future clinical practice.
Results from two French studies presented on April 16, 2010 at the International Liver CongressTM 2010 press conference may help inform clinical practice in the treatment of patients with severe or acute alcoholic hepatitis. The first study demonstrated the positive potential of performing liver transplantation for patients suffering from severe alcoholic hepatitis (SAH) earlier than the recommended 6-months rule (required minimum of recorded abstinence for an alcoholic patient to be eligible for a liver transplant).
Those patients who do not respond to treatment with steroids have a 6-month survival of around 30% and most deaths actually occur within 2-months. The results show that early liver transplantation could be proposed to non-respondents, pending a very careful evaluation of selected patients.
Acute alcoholic hepatitis (AAH) however, is an absolute contraindication for liver transplantation. It has a low survival rate, with mortality remaining at around 35% at 6 months despite corticoid treatment, the current standard of care for the condition. The second study presented in 2010 helped to inform a potential new treatment option for those patients who do not respond to standard treatment with corticoid.
Combined corticoids plus N-acetyl cysteine were used to slow the progression of liver disease in that 2010 study
Data demonstrated that treatment with combined corticoids plus N-acetyl cysteine (C+NAC) showed an increase in survival rates. There have been few, large, well-designed trials advocating the use of N-acetyl cysteine to slow progression of liver disease. This latest study adds to the growing body of evidence in the benefits of treatment with C+NAC in patients with acute liver disease.
Professor Philippe Mathurin from the Hôpital Huriez, CHRU Lille, France who presented the results commented, according to the news release: “Whilst the management of alcoholic hepatitis is steeped in controversy, as clinicians we have a responsibility to treat these patients in the most effective way possible, and as researchers we have a mandate to highlight new options.
“These latest results across large patient cohorts are the sort of clinical studies that are vital to help guide best practice in the treatment pathway for difficult-to-treat patients with a challenging medical history. Alongside education and, ideally, prevention strategies we can achieve some successful outcomes.” (Europeans use the word, ‘whilst’ to mean ‘whereas’, or sometimes the word, ‘while’ which are the equivalent of those words used in the USA.)