This interesting nutrient is made from the amino acid cysteine joined to an acetyl group. Acetylcysteine (also spelled N-Acetyl-L-Cysteine) is a strong antioxidant. It donates the amino acid cysteine to help form the antioxidant glutathione. Glutathione is a powerful antioxidant normally found in the body. N-Acetyl-L-Cysteine (N-A-C) is an amino acid and antioxidant. N-Acetyl-L-Cysteine is a precursor in the body to the critical antioxidant glutathione, which is produced intracellularly, particularly by the liver. NAC is significantly more cost effective than taking glutathione.

N Acetyl Cysteine Supplement

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Side Effects of Acetylcysteine
Other than large doses causing nausea, acetylcysteine is a safe nutrient. I experienced nausea for a few minutes within an hour of taking three 600 mg pills on an empty stomach.

N Acetylcysteine and folic acid beneficial for blood vessel health
Effects of folic acid and N-acetylcysteine on plasma homocysteine levels and endothelial function in patients with coronary artery disease.
Acta Cardiol. 2007 December. Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
High blood levels of homocysteine are related with premature coronary artery disease and adverse cardiac events in patients with coronary artery disease. Sixty patients were randomized to either folic acid 5 mg or N-acetylcysteine 600 mg or placebo daily for eight weeks. Brachial artery endothelial functions were studied by using high-resolution ultrasound and assessed by measuring endothelium-dependent dilation (EDD) and endothelium-independent dilation (NEDD). Folic acid and NAC therapies decreased plasma homocysteine, and increased EDD. There was no significant difference in improving EDD between the folic acid and the NAC group. In patients with high homocysteine and CAD, folic acid and NAC lowered plasma homocysteine levels and improved endothelial function. The effects of both treatments in improvement of EDD were similar.

N Acetylcysteine Recommendations
Acetylcysteine is sold in dosages ranging from 250 to 600 mg. Acetylcysteine can help form the powerful antioxidant glutathione but the formation of glutathione synthesis is under feedback control. Administration of acetylcysteine with the resulting increase in glutathione levels may cause a feedback inhibition in glutathione synthesis. Thus, it may be best to take acetylcysteine every other day. The use of acetylcysteine certainly should be considered as an additional supplement in protecting various cells from damage in the elderly and those with Parkinson’s disease. If you are planning to use acetylcysteine along with other antioxidants, limit your daily dosage to 100 to 500 mg and don’t take it all the time. Acetylcysteine could protect the liver of those who take acetaminophen on a regular basis.

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N Acetylcysteine for hemodialisis patients
Intravenous N-acetylcysteine during haemodialysis reduces the plasma concentration of homocysteine in patients with end-stage renal disease.
Clin Drug Investig. 2006;26(4):195-202. Nephrology Hypertension Division, Department of Internal Medicine, Airlangga School of Medicine, Dr Soetomo Teaching Hospital, Surabaya, Indonesia.
The current study aimed to determine the effect of intravenous N-acetylcysteine on plasma homocysteine levels when administered during haemodialysis in patients with end-stage renal failure.  Sixty patients with end-stage renal failure were randomised to receive a 4-hour intravenous infusion of N-acetylcysteine or placebo during a 4-hour haemodialysis session. After haemodialysis in the placebo treatment group, plasma homocysteine was reduced by 23.7% from the pre-dialysis level, whereas patients treated with N-acetylcysteine exhibited an 88.3% decrease. Reduction of plasma homocysteine concentration was significantly correlated with a reduction of pulse pressure. A 10% decrease in plasma homocysteine concentration was associated with a 1.45mm Hg decrease in pulse pressure. Intravenous administration of N-acetylcysteine during hemodialysis normalises plasma homocysteine concentration, and this is associated with improved pulse pressure in patients with end-stage renal failure. Intravenous administration of N-acetylcysteine during haemodialysis may be a promising approach to help reduce cardiovascular risk in this vulnerable group of patients.

Acetylcysteine study
N-acetylcysteine enhances muscle cysteine and glutathione availability and attenuates fatigue during prolonged exercise in endurance-trained individuals.
Medved I.  Victoria University of Technology, Melbourne, Victoria, Australia.
J Appl Physiol. 2004 Jun 11
The production of reactive oxygen species in skeletal muscle is linked with muscle fatigue. This study investigated the effects of the antioxidant compound N-acetylcysteine on muscle cysteine, cystine and glutathione, and on time to fatigue during prolonged, submaximal exercise in endurance athletes. Eight males completed a double-blind, crossover study, receiving acetylcysteine or placebo before and during cycling for 45 min at 71%VO2peak, then to fatigue at 92%VO2peak. Acetylcysteine was intravenously infused at 125 mg.kg(-1).h(-1) for 15 min, then 25 mg.kg(-1).h(-1) for 20 min prior to and throughout exercise. Arterialized venous blood was analyzed for acetylcysteine, glutathione status and cysteine concentration. A vastus lateralis biopsy was taken pre-infusion, at 45 min exercise and fatigue and analysed for acetylcysteine, total glutathione (TGSH), reduced glutathione (GSH) cysteine and cystine. Time to fatigue at 92%VO2peak was reproducible in preliminary trials (CV 5.6+/-0.6%) and with acetylcysteine was enhanced by 26.3+/-9.1% (acetylcysteine 6 vs CON 5). Acetylcysteine increased muscle total and reduced NAC at both 45 min and fatigue (P<0.005). Muscle cysteine and cystine were unchanged during CON, but were elevated above pre-infusion levels with acetylcysteine. Muscle TGSH declined (P<0.05) and muscle GSH tended to decline (P=0.06) during exercise. Both were greater with acetylcysteine (P<0.05). Neither exercise nor NAC affected whole blood TGSH. Whilst blood GSH was decreased and calculated oxidised glutathione (cGSSG) increased with exercise (P<0.05), both were unaffected by NAC. In conclusion, acetylcysteine improved performance in well-trained individuals, with enhanced muscle cysteine and GSH availability a likely mechanism.

Acetylcyeteine questions
Q. The following study indicates that taking N-acetylcysteine may not be as safe as previously thought. I would really like your thoughts re this development. I have asthma and found N-acetylcysteine to help reduce symptoms. Source: University of Virginia Health System: Certain preparations taken to enhance athletic performance or stave off disease contain an anti-oxidant that could cause harm. According to new 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 issue of the Journal of Clinical Investigation. "NAC fools the body into thinking that it has an oxygen shortage," said Dr. Ben Gaston, UVa Children's Hospital pediatrician and researcher who led the study. "We found that an NAC product formed by red blood cells, know 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. We are not aware of any clinical studies in humans that show N acetylcysteine causes pulmonary arterial hypertension. Perhaps it does if used daily in high dosages for prolonged periods. Most of the time we recommend users to take this supplement every other day. We also suggest, as a general rule, for people to take a few days or a week off each month from the use of a particular supplement.
   We cannot determine from reading the study what the total amount of NAC the rodents were exposed to daily. When researchers do studies in rodents, they often use dosages several times higher (per weight ratio) than what humans would normally consume. Also, the metabolism of rodents is different than that in humans. Although a lot can be learned from studying the influence of nutrients and drugs in rodents and other animals, this does not necessarily give us the exact effect these nutrients and medicines would have in the human body.
   We will wait for human studies to learn for certain what kind of benefits and side effects N acetylcysteine has if used for prolonged periods. In the meantime, using lower dosages and taking breaks appears to be a reasonable approach.

Q. What is the difference between N-Acetyl and Acetyl-L? Does an Acetyl version of an amino acid make it more likely to be used by the brain?
   A. For practical purposes, N-acetyl and Acetyl-l are the same as far as supplements are concerned. Adding an acetyl seems to make an amino acid more active or potent, but it depends on the amino acid the acetyl group is attached to.

Q. I have recently purchased some N-Acetyl-L-Cysteine supplements, and I've read on a couple websites that it should be refrigerated after opening. The instructions on the bottle are to store the product in a 'cool dry place'. I live in a subtropical climate (southern Taiwan) and I'm wondering if I should keep opened bottles of Acetylcysteine in the refrigerator or not.
   A. It would be a good idea to keep the n-acetylcysteine supplement bottle refrigerated.

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