From The July 1997 Issue of Nutrition Science News
Doctor's Insight
NAC Increases AIDS Survival Rate
by Richard N. Podell, M.D.
AIDS patients who took high doses of NAC were twice as likely to live an additional two years--a spectacular result.
I never thought I'd be nostalgic for the days when AIDS activists conducted sit-ins at St. Patrick's Cathedral in New York. But I'm beginning to reconsider.
The proof that nutritional treatments can slow the pace of AIDS is strong, though not conclusive. Yet the people pioneering AIDS research either don't know or don't care--at least not enough to fund studies or alert people.
Last month (NSN, June 1997), this column discussed research results showing HIV infection progressed faster among people whose vitamin B12 blood levels were low. Now, Stanford Medical School researchers have shown that taking N-acetyl cysteine (NAC)--a form of the amino acid cysteine and a glutathione precursor--might double AIDS patients' chances of long-term survival. Big news? Big research budget? Not on your life.
Glutathione, a small protein, is an important antioxidant that helps the liver detoxify environmental chemicals. Blood glutathione levels decline in people infected with HIV. The lower their glutathione levels are, the more rapidly they develop AIDS symptoms and die. Both HIV and AIDS create high levels of oxidative stress--otherwise known as free radical-damage to cell structures. Such stress likely drains the body's stores of glutathione.
Doctors have known this for years, but until now, no one has tried to answer the obvious question: Would raising glutathione levels slow AIDS' destructive course?
AIDS is generally considered severe when the immune system's CD4 lymphocyte cell counts drop below 200 per microliter of blood. All of the HIV-infected patients involved in the Stanford study had CD4 counts below 200 and were given the choice of taking the glutathione precursor NAC. Participants took high doses of 3,200 mg to 8,000 mg a day. (Most commercially available NAC capsules contain 500 mg to 600 mg.) Those who took NAC were twice as likely to survive for two years as those who didn't--a spectacular result.
Does this prove that NAC slows the course of AIDS? No, not conclusively. The researchers couldn't afford a true double- blind study in which neither the scientists nor the patients knew what they were taking. All of the patients were sick, but perhaps some were less optimistic about trying a new treatment, while others had a stronger will to live. We can't be certain unless we offer a placebo pill and select at random who will get what.
Still, the results are encouraging. NAC is readily available in health food stores and costs only a fraction of what standard AIDS drugs cost. Hospital emergency room personnel have long used intravenous NAC as a standard treatment for acetaminophen poisoning. Acetaminophen overdose depletes the glutathione vital to detoxification, whereas NAC replaces it. Glutathione may also help treat oxidative stress-related diseases such as lung disease and hepatitis.
So why aren't government agencies, drug companies and HMOs more interested in the new findings? Leonard Herzenberg, Ph.D., the Stanford group's principal investigator, sums it up: "The issue is that no company seems willing to fund future trials."
Selenium, noted for its cancer-preventing effects, is a crucial cofactor for glutathione peroxidase--an enzyme involved in detoxifying many environmental pollutants. Not surprisingly, selenium levels also tend to be low in HIV-infected people. Would supplementing both selenium and glutathione be more effective than either alone? Or should other antioxidants such as vitamin C, beta-carotene and vitamin E be added?
These questions would certainly be addressed if public health was a priority for both drug companies and the government. In the real world, however, things don't work that way. Companies are driven by profit. The fact is there isn't much money to be made in nutritional research because supplements like NAC can't be patented.
Perhaps a petition that's been filed with the Food and Drug Administration will get some results. It asks that warning labels be placed on glutathione-depleting drugs, such as alcohol and acetaminophen, that are a danger to HIV-infected people.
Squeaky wheels get attention, and the federal government has the money to fund projects such as the Stanford NAC study. And that's why I'm nostalgic for the good old days--when activists stood up for what they believed was right.
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