N-acetylcysteine, or NAC for short, is a popular nutritional supplement for good reason. It's safe, inexpensive and widely available, and has many applications in integrative medicine. NAC offers potential benefits for various women’s health issues, making it an easy intervention to add to a comprehensive protocol. This article will explore the research behind NAC for women’s health, particularly in the context of Polycystic Ovary Syndrome (PCOS), and offer practical information on its benefits and dosage.
What is NAC?
N-acetylcysteine (NAC) is a supplement form of cysteine, a type of antioxidant and building block of protein that may help support those with polycystic ovaries. NAC (N-acetylcysteine) is a precursor to the amino acid l-cysteine. In the body, NAC is a powerful antioxidant. It helps protect cells by neutralizing free radicals, thereby decreasing oxidative stress. Additionally, NAC promotes glutathione synthesis. In addition to its antioxidant effects and promotion of glutathione synthesis, it’s also a powerful anti-inflammatory compound that can reduce inflammatory signaling in cells.
You get cysteine by eating high-protein foods such as beef, chicken, eggs, and whole grains. Your body can also make some cysteine by combining two other amino acids: serine and methionine. But if you're low on these two amino acids, then you may need to take a cysteine supplement.
NAC and Women's Health
NAC has been investigated heavily in women with PCOS undergoing fertility treatments. Women are also more likely to get autoimmune diseases because of a complex interplay between the X chromosomes and hormonal shifts. Brain health is something women think about a lot, whether experiencing “mommy brain” when pregnant or nursing or the debilitating brain fog and memory changes in perimenopause.
NAC and PCOS
Polycystic Ovary Syndrome, PCOS, is the most common endocrine disorder women face during the reproductive years, affecting 5-10% of women. Women with PCOS may experience a decline or halt to ovulation, increased testosterone levels, and insulin resistance, leading to metabolic dysfunction and cardiometabolic disease. Women with PCOS tend to have increased inflammation and fewer circulating antioxidants, making NAC a helpful supplement.
Read also: Guide to PCOS Exercise
In people with PCOS, the body can sometimes have too many harmful molecules that can cause stress inside the body, which isn’t good for your health. In PCOS, this stress can lead to lower levels of cysteine in the blood.
Cysteine is found in protein-rich foods, so incorporating chicken, pork, beef, tuna, as well as plant foods such as lentils, oats and sunflower seeds into the diet can be beneficial to ensure adequate levels. However, if you want to add to your diet to further aid symptoms of PCOS, supplementing with NAC may be for you. Research into cysteine deficiency and NAC supplementation in people with PCOS is fairly new, with most studies being short and with few participants.
NAC for PCOS Symptoms
For many people, PCOS brings multiple different symptoms, including metabolic complications, fatigue, excess hair growth, and acne-prone skin. NAC has the potential to help in such areas. Here’s how it could make a difference:
- Reduced Insulin Resistance: NAC may help the body release the right amount of insulin and help cells use insulin more effectively. This can support better blood sugar control and improved metabolism.
- Fighting Inflammation: Research shows that NAC helps the body make more of a natural antioxidant called glutathione. This helps protect the body from harmful molecules and can reduce inflammation over time.
- Hormonal Changes: When insulin and inflammation levels go down, hormones like testosterone may also drop. This can help with symptoms such as acne and unwanted hair growth. NAC may also help increase hormones like follicle-stimulating hormone (FSH) and progesterone, which support regular periods and healthy thickening of the womb lining.
- Improved Ovulation: When the body has more antioxidants and less damage from stress, the health of the egg follicles can improve, which may help increase ovulation.
Some studies suggest supplementing with NAC is a potential contender to replace metformin for those with PCOS experiencing insulin resistance. If you think this may be something you wish to try, talk to your doctor about making this swap or adding it to your medications - just to be safe!
NAC in Comparison to Metformin for PCOS
NAC vs. NAC and Metformin, both have been studied extensively for their role in managing PCOS. But how do they stack up against each other? Studies have shown that NAC, when taken at a dose of 600mg three times a day, can have similar effects to Metformin, which is typically prescribed at a dose of 500mg three times a day.
Read also: Hormonal Balance & Diet
However, it's not all a tie. Women who took NAC were found to be 87% less likely to ovulate compared to those on Metformin. On the flip side, NAC has been shown to reduce BMI significantly compared to Metformin.
NAC and Fertility
The promising role of N-Acetyl Cysteine (NAC) in enhancing fertility in women with PCOS has sparked interest in the scientific community. Studies have also linked NAC to an increase in the number of ovulatory follicles and peak endometrial thickness in women with PCOS.
NAC may improve fertility in people of all sexes. One study found that men and people assigned male at birth who had trouble with infertility improved their semen quality when they took NAC alone or with selenium. NAC may also help women and people assigned female at birth ovulate regularly, particularly if you have infertility that comes with a condition like PCOS.
Additional Benefits of NAC
The main benefits of NAC come from the supplement’s antioxidant and anti-inflammatory properties. Antioxidants are compounds that help fight disease in your body. Anti-inflammatories reduce swelling and irritation in your body's tissues. While researchers don’t yet understand exactly how NAC works to promote health, they do know that it helps your body make more glutathione, a potent antioxidant that helps to get rid of cell-damaging free radicals. Free radicals are also called reactive oxygen species (ROS). ROS can damage your DNA, a process known as oxidative stress. In general, reducing oxidative stress with antioxidants like NAC can help lower your risk of certain health conditions, such as heart disease, diabetes, and infertility.
Potential benefits of NAC:
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- Treatment of chronic lung diseases. NAC supplements, particularly the kind you breathe in, may lessen inflammation in your airways. This might reduce the number of future flare-ups caused by chronic obstructive pulmonary disease (COPD) and improve lung function, but not all studies have found these results. The supplement may also help make wheezing and coughing less severe in some people with ongoing bronchitis. More studies are needed to confirm these results. High-dose NAC (1,200 milligrams per day) may also help lower inflammation, break up biofilms where germs live, and lessen damage caused by oxidative stress in the lungs and airways of people with cystic fibrosis, when used alone or with other medications.
- Improving liver and kidney function. Your liver and kidneys flush drugs and other toxins out of your body. NAC supplements can speed up this breakdown process and may help your organs work better if you have liver or kidney disease. But more research is needed to know for sure.
- Viral suppression. There aren’t many studies on NAC and the immune system, but current research suggests that it and glutathione may help to improve immune function in people with HIV. Some research shows that the supplement may help to suppress HIV-1 reproduction. But more research is needed to know if NAC has a big benefit for people with HIV or AIDS. Test tube studies also show that NAC may stop the flu virus from replicating. In a six-month study, people who took 600 milligrams of NAC twice daily reported fewer flu symptoms than those who didn’t take the supplement.
- Balancing blood sugar in people with insulin resistance. Research suggests that NAC may help to improve insulin resistance - when your body doesn’t respond to insulin, the hormone that keeps your blood sugar in check. There’s some evidence the supplement may be particularly helpful for people with insulin resistance who have polycystic ovary syndrome (PCOS), a hormonal condition that interferes with periods and the ovaries. Researchers have found little evidence that NAC can help people with type 2 diabetes gain good control over their blood sugar or make them more sensitive to insulin.
- Better brain function. NAC helps to refill glutathione levels in the body. It also helps control a neurotransmitter called glutamate and can lessen inflammation and damage caused by oxidative stress. These functions may help protect cells needed for brain health, which may benefit people with neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases.
- Improving treatment for mental health conditions. Researchers have found mixed results when it comes to how well NAC works to treat psychiatric disorders. Still, there’s promising evidence that the supplement may change the brain and nervous system in a way that helps lessen symptoms of: Major depressive disorder, Schizophrenia, Bipolar disorder, Posttraumatic stress disorder (PTSD), Obsessive-compulsive disorder, Trichotillomania (hair pulling), Substance use disorders. Some studies show that the supplement may help ease symptoms of withdrawal, including a strong urge or craving to take drugs. This may lessen the chances of relapse in people who’ve stopped misusing substances such as stimulants, cannabis, tobacco, and alcohol.
- N-acetylcysteine for skin picking. NAC may improve symptoms of excoriation disorder, also called skin-picking disorder (SPD). One study found that people with SPD who took 1,200-1,300 milligrams of NAC daily for three months reported fewer SPD behaviors than those who didn’t take the supplement.
- Lowering heart disease risk. Studies on human cells show that, when combined with green tea, NAC may help lessen damage caused by LDL cholesterol. LDL is the “bad” kind of cholesterol linked to heart disease.
- NAC weight loss: Researchers have studied the effects of NAC on obesity-related health problems. One review analyzed studies done on animals and human cells, showing that NAC can lower inflammation, oxidative stress, and insulin resistance while improving fat tissue function. NAC may help control key processes in obesity, such as fat storage, energy metabolism, and hormone balance. But more research is needed.
- Other uses of N-acetylcysteine: More research is needed, but there’s a small amount of evidence that NAC may: Prevent cell damage that may turn into cancer, Lessen side effects of cancer treatment, Control inflammation and reduce asthma attacks, Dissolve blood clots, Ease symptoms of Sjögren's syndrome, an autoimmune condition that causes dryness, Help treat inflammatory conditions like lupus or rheumatoid arthritis.
NAC Dosage and Forms
There are different types of NAC supplementation, such as intravenous and inhalers; however, the most common is oral supplements. When used in medical treatment, the typical recommendation for NAC is between 600 and 1,800 milligrams. In some studies, researchers have people take up to 3,000 milligrams a day, divided into two or three doses.
Previous research suggested a dose of approximately 1.6 to 3g/day, with some demonstrating that only doses over 3g produce an effect in people with PCOS. However, recent studies have demonstrated that smaller doses such as 600mg and 1200mg can still have a significant effect in PCOS management. If you're overweight, you might find that the higher end of this dosage range is more beneficial. However, it's crucial to remember that you should never exceed a daily dosage of 7 grams.
NAC comes in the following forms:
- Solution to inhale
- Intravenous injection
- Dissolvable tablets
- Pills
- Powder
- Liquid
When and How to Take NAC
How much you take and how often you take it depend on why you’re taking NAC in the first place. Your doctor will let you know what’s safe and effective for your health condition.
Side Effects and Safety Precautions
N-acetylcysteine can provide health benefits. But, like all medications and dietary supplements, NAC may come with risks. NAC is generally well-tolerated by the body. However, like any supplement, it can cause some side effects. The most common ones are related to the digestive system. You might experience nausea, abdominal pain, or even vomiting. Remember, everyone's body responds differently to supplements. So, while these side effects are common, they don't occur in everyone. And if they do occur, they're usually mild and temporary.
The most common side effects of NAC include:
- Upset stomach
- Nausea or throwing up
- Diarrhea
- Fatigue
- Eye irritation
- Itching or rash
- Skin swelling
- Wheezing
Less commonly, NAC may cause:
- Low blood pressure
- Increased asthma symptoms
- Chest tightness or numbness around your mouth (if you inhale it)
- Headache
- Life-threatening allergic reaction (anaphylactic shock)
Other Considerations
NAC may also:
- Slow blood clotting. NAC can make it harder for your blood cells to stick together. This may help break up blood clots or cause you to bleed more easily.
- Interact with medications. Talk to your doctor before you take NAC supplements. They may not be safe with the following medications: Immunosuppressants like azathioprine or cyclophosphamide, and prednisone, Medicine for chest pain (angina), including isosorbide and nitroglycerin, Antifungal drugs like oxiconazole. NAC may not work as well when paired with certain antibiotics (oxytetracycline, tetracycline, and trypsin) or activated charcoal. But if you do need to take two drugs together, your doctor can let you know if you need to adjust the dose of your supplement.
Who Should Not Take NAC?
Ask your doctor which supplements are right for you, but NAC may not be safe for people who:
- Bleed easily. NAC may raise your odds of bleeding problems if you have a bleeding disorder such as hemophilia or you take blood-thinning drugs.
- Have cystinuria. This disorder causes you to pee out a lot of cystine, which is related to cysteine. People with cystinuria are naturally more likely to form cystine kidney stones. These are hard deposits made of minerals and salts that build up.
- Take nitroglycerin. NAC can widen your blood vessels. This may further lower your blood pressure and cause serious headaches if you take nitroglycerin regularly.
- Firstly, if you're pregnant or breastfeeding, it's crucial to consult your healthcare provider before starting any new supplement, including NAC.
- Secondly, those with asthma should be cautious.
- Thirdly, if you're scheduled for surgery, it's recommended to stop taking NAC at least two weeks before the procedure.
- Lastly, always start with a low dose to see how your body reacts, and never exceed the recommended dosage.
Additional Supplements for PCOS
While N-Acetyl Cysteine (NAC) has shown promising results in improving fertility among women with PCOS, it's not the only supplement that can help. There are other supplements that can potentially aid in managing PCOS symptoms and enhancing fertility.
Inositol
Inositol and in particular myo-inositol, is often hailed as a wonder supplement for women with PCOS due to its insulin-sensitising properties. By improving the body's use of insulin, Inositol can help to regulate menstrual cycles, improve ovulation, and even reduce the levels of male hormones in the body.
Vitamin D
Vitamin D is another supplement that's been making waves in the PCOS and fertility scene. It's not just about bone health anymore. This sunshine vitamin, as it's often called, also plays a key role in the production of sex hormones. But here's the kicker, a large number of women with PCOS have been found to be deficient in Vitamin D.
Omega-3 Fatty Acids
Omega-3 fatty acids are another supplement that's worth considering if you're dealing with PCOS and fertility issues. Omega-3s are also important for hormone regulation, which is crucial for women with PCOS. Furthermore, there's some evidence to suggest that omega-3s can support fertility.
Importance of Lifestyle Changes
Living with Polycystic Ovary Syndrome (PCOS) can be challenging, but making certain lifestyle changes can significantly improve your symptoms and fertility. From dietary changes to exercise and stress management, these lifestyle adjustments can play a crucial role in regulating your hormones, managing your symptoms, and improving your overall well-being.
Dietary Changes
When it comes to managing PCOS and boosting fertility, dietary changes can play a significant role. Limiting processed foods and sugars is also crucial. Remember, it's not about a quick fix, but a long-term commitment to a healthier lifestyle. Lastly, don't forget to stay hydrated.
Exercise
Exercise can play a pivotal role in managing PCOS and improving fertility. Regular physical activity helps in regulating hormones, particularly insulin, which is often out of balance in women with PCOS. A mix of both cardio and strength training exercises is recommended. It's important to remember that exercise doesn't have to be strenuous to be effective.
Stress Management
Living with PCOS can be stressful, and this stress can further exacerbate the symptoms of the condition. It's a vicious cycle, but there are ways to break it. This doesn't mean you have to become a zen master overnight. Small, consistent steps can make a big difference. Start by identifying the sources of stress in your life. It's not about eliminating stress entirely - that's impossible.