What Is NAC

N-acetyl cysteine, or more commonly referred to as NAC, is a supplemental form of the conditionally essential amino acid cysteine that converts into glutathione, a vital antioxidant. Recently there has been an elevated interest in the uses and benefits in NAC primarily due to its role in antioxidant production. Studies have shown that NAC can improve cognitive health, liver disease, and has been studied under several other clinical conditions. We’re going to explore what NAC is, what it does, and if this supplement can enhance your health and wellness.

Believe it or not, NAC or N-acetyl cysteine, is an FDA approved treatment for acetaminophen (Tylenol) toxicity and certain respiratory conditions, including chronic obstructive pulmonary disease (COPD) [R].
Since NAC is an FDA approved drug, it is technically not permitted to be used as a dietary supplement. However in August of 2022, due to several consumer requests, the FDA announced its consideration to allow and permit the use of NAC as a dietary supplement [R].
NAC is a supplemental form of cysteine, a conditionally essential amino acid. NAC is considered conditionally essential, because your body naturally produces it from other amino acids, yet in certain conditions, may require additional cysteine from food or dietary supplements.

The primary role of NAC is to act as a precursor in the production of glutathione. Glutathione, is an important and vital antioxidant. Think of antioxidants as an invisible coat of armor. Free radicals, also referred to as reactive oxygen species (ROS), can cause cellular damage over time, and have been associated with chronic disease states. Free radicals, cause what’s called oxidative stress, and can occur due to several environmental and physiological factors.
NAC increases the intracellular concentration of glutathione (GSH), which is the most crucial biothiol responsible for cellular redox imbalance [R].

NAC has shown therapeutic potential in several investigational studies, due to its anti-inflammatory properties and mechanisms on tumor necrosis factor-alpha (TNF-α) and interleukins (IL-6 and IL-1β) by suppressing the activity of nuclear factor kappa B (NF-κB). Thus, NAC has been investigated for several clinical conditions, such as

gastrointestinal diseases
lung diseases (Cystic Fibrosis, chronic obstructive pulmonary disease (COPD))
male infertility
liver disorders
ulcerative colitis
sickle cell disease
cardiovascular disease
neurodegenerative disease
Polycystic ovary syndrome (PCOS)

The progression of chronic respiratory disease has a direct relation to inflammation and increased oxidative stress. Research has shown that NAC is potential powerful therapeutic agent for obstructive diseases including chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), and idiopathic pulmonary fibrosis (IPF), due to its mucolytic properties [R]. 
The clinical efficacy of NAC on patients with COPD has been well investigated and documented. COPD is characterized by chronic symptoms related to airflow obstruction determined by the inhalation of toxic agents, being frequent in smoking patients.
The BRONCHUS study followed 523 COPD patients for 3 years. This phase III double blind, randomized, controlled trial, treated patients with 600mg per day of oral NAC vs placebo. The study demonstrated a significant improvement in airway and a reduction or exacerbation of the disease.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine-glands related diseases and causes of anovulatory infertility. PCOS is also associated with recurrent pregnancy loss (RPL). The first interventional treatment of PCOs is clomiphene citrate (CC). However, a systematic review showed that treatment with CC showed a pregnancy rate and a miscarriage rate of 36 and 20.4% up to 40% of PCOS patients have CC resistance. NAC is a mucolytic drug with insulin-sensitizing properties that has been used successfully as a supporting therapy in subjects with CC-resistant PCOS [R]. Recent studies have shown that NAC and CC combination therapy increased both ovulation and pregnancy rates in women with CC-resistant PCOS [R].

NAC is also used as a sports supplement for its ability to modulate exercise induced damage through its anti-inflammatory and antioxidant properties.
A systematic review identified 16 studies that showed NAC does in fact have a positive effect and benefit on exercise performance, antioxidant capacity, and glutathione homeostasis.
Research has shown that NAC reduces exercise-induced inflammation and fatigue through its thiol content, promoting the up-regulation of anti-inflammatory cytokines and minimizing skeletal muscle damage after exhaustion of contractile activity [R].

Interventional dosages vary with the most common dosage between 600-1800mg per day. However, NAC does have low bioavailability as an oral supplement. NAC is also available and can be administered intravenously, as an aerosol spray, or in liquid or powder form.

Pharmacokinetic and tolerability studies have shown that NAC is safe and well tolerated even at higher doses.

NAC has been shown to have several benefits on human health. Most notably NAC is converted into glutathione a powerful antioxidant and that can reduce oxidative stress and free radical damage. Free radicals can damage cell membranes and DNA and have been correlated to several chronic disease states.
Many acute and chronic health conditions are associated with low glutathione levels, including age related disease like diabetes and heart disease.

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