Subjects? I have a NAC for that (2023)

In the chemical soup that encompasses our bodies and our biochemistry, oxidants and antioxidants are at constant war. called a supplementN-Acetylcystein(we'll abbreviate it to NAC) has the potential to make a huge difference in the way we process toxins. Of course I had heard of NAC beforepunishment/Rescuer for people who come to the ER with an overdose of the worst things, acetaminophen (Tylenol or Paracetamol).

If you decide to have a whole bottle (or much, much less withAlcohol- even the upper limits of a normal daily dose can damage your liver when combined with alcohol), you may feel nauseous immediately, but then recover and forget about it - until a few days later, when accumulated liver cell death sets in and A rotting liver makes you very, very sick, and nothing but a liver transplant will save you. Otherwise you die a pretty horrible death. Livers are vital, we don't have backups, bypass machines, mechanical livers or liver-like dialysis machines. apparently there is56,000 emergency department visits per yearof Tylenol overdoses in the US and 100 deaths.

Ok meSomeone shows up at the ER with a Tylenol overdose, get a level four or more hours after ingestion and record the level and hours after ingestion on a handy chart. Above the dark line in the graph? Welcome to the world of N-acetylcysteine, a nasty compound that's usually given with fruit juice but still makes some people vomit. Administer a loading dose of 150 mg/kg followed by 70 mg/kg for 17 more doses. If you cannot maintain the dose, it should be repeated. During this time, the psychiatrist is usually called to the emergency room to determine if it is safe to let the person go or if there is a serious problem.SuicideTry that requires more intervention. It's surprisingly easy to accidentally overdose on Tylenol, given that acetaminophen is in a million over-the-counter medications, as well as prescription pain relievers Percocet and Vicodin, etc. 4000mg per day is the upper limit of "safe" (without alcohol) - if you are unlucky, you can get acute liver failure with as little as 7800mg.

The treatment is as simple as it is magical: possible fulminant liver failure on the one hand, and leaving the hospital without any problems on the other. And the treatment has everything to do with the master of the body.antioxidant, glutathione. It appears that a metabolite of Tylenol, NAPQI, kills liver cells like Gangbuster. Glutathione can bind to it and render it harmless, but once you run out of glutathione, the leftover NAPQI does its nasty work. That's where N-acetylcysteine ​​(NAC) comes in - it's a ready-made precursor to glutathione, so your liver can be fueled to fight NAPQI.

Well, look at the Wikipedia article. In addition to treating mucus build-up in cystic fibrosis, NAC is also used in acetaminophen overdose, possibly reducing renal contrast toxicity (although this does not appear to be the case), interstitial lung disease, and reducing noise-induced hearing loss, slowing pancreatic beta cell destruction, Curing hangovers and reducing flu symptoms. But of course none of that matters to me. As a specialist, medical convention requires me to stick to the brain and keep my little nose away from other parts of the body...but NAC has some interesting properties in the mind, too.

As usual, it's all about glutamate,the excitatory neurotransmitter of doom. In short, too much glutamate around is for your neurons like whipping your horse until it is killed. Horses and their brains need time to graze, relax and eat proper food, and sometimes a good massage and brushing. Well, NAC seems to be able to get into some tricky areas of the brain and do amazing things.Managementof glutamate. A number of fascinating studies have appeared in recent years using NAC alone or as an adjunct treatment for some difficult problems.psychiatricConditions. Some of these have been decent multi-center randomized controlled trials. The real deal.

These difficult conditions? Trichotillomania (compulsive hair pulling that is common and extraordinarily difficult to treat – decades of research has yielded results as effective as the NAC study!). Schizophrenia.Bipolar Depression(Another very difficult and disabling condition that doesn't respond well totherapyor medicine, and the condition I have seen responds best to NAC in my own practice). There is an ongoing study on thisTable of contents. Studies range from 2,000 to 4,800 mg daily of the capsules (better tolerated than the ER drink, which is a much higher dose overall), and most studies reported more adverse events and side effectsPlaceboarm than in the treatment arm.

Many of the studies lasted up to 6 months, which is a lifetime for randomized controlled clinical trials, and all studies had positive effects. That's pretty amazing considering pharmaceutical companies have undoubtedly spent millions upon millions on huntingbipolar Depression, for example without showing much (there is quetiapine,fluoxetineand olanzapine and fluoxetine with modest effect and many side effects). Another nice little study used NAC to do thisreduce cocaine cravings- again, something for which there really is no effective FDA-approved medical treatment.

Why would a master antioxidant precursor have anything to do with glutamate in the brain? The mechanism is a bit hysterically complicated, so I'll quote from the article on trichotillomania:

[NAC] is a hepatoprotective antioxidant that is converted to cysteine, a substrate for the glutamate-cysteine ​​antiporter. This antiporter allows cysteine ​​uptake, which causes reverse glutamate transport into the extracellular space, thereby stimulating inhibitory metabotropic glutamate receptors and thus reducing synaptic release of glutamate. Restoration of extracellular glutamateconcentrationin the nucleus accumbens seems to block the restitution ofcompulsive behaviors.

Scientific language translation: NAC helps prevent excess (and toxic) glutamate from being in the wrong place at the wrong time. It helps us turn that brain to pasture for rest and recovery.

What are the disadvantages of NAC? I can think of two things that might be important: First, NAC is a mucolytic that thins mucuscutdisulfide bonds. I suspect it might increase the risks - you don't want to run out of mucus. The slime is important. Paul Jaminet mentions this problem and links to a studyHere. Also, cutting disulfide bonds in the body is what triggers this bad inflammationHomocysteineit's supposed to, resulting in crusty collagen and inelastic elastin in the arteries (which would possibly first show up as high blood pressure).

Of course, no hunter-gatherer consumed 2 grams of NAC per day. It's not evolutionary psychiatry. But it appears to have the potential to replicate the natural glutamate situation in a's brain, perhaps with some downsidesLow stress lifewith many suitable minerals and micronutrients. Hey, maybe the lack of tons of carbs on top of thatInflammatory diet for rodents. or someKetosis.

We live a modern life: some brains are already going in the wrong direction. It would certainly be worth studying NAC further to have more information and giving it a try in stubborn or stubborn conditions that significantly affect performance in my opinion.

Copyright Emily Deans, MD