Being Alive; June 1997
Brian A. Smith, D.C.

Many people use NAC without understanding why to take, how much to take or when to take it. First, what is it? Cysteine is an amino acid found throughout the body and is used for a variety of reasons. It has been found to be consistently depressed in people who are hiv+. It is one of the three amino acids making up glutathione, a molecule important in immune function and also found to be severely deficient in people with hiv. Cysteine is required for the transport of other amino acids into cells so that chemicals such as interferons and antibodies can be made.

NAC stimulated interest as a possible treatment over 8 years ago. It is known that supplementation with NAC will cause glutathione levels to increase and that glutathione levels are decreased by an average of 30% in the blood and 60% in lung tissue in hiv+ persons. In early 1991, Dr. Alton Meister of Cornell University Medical College reported the spread of hiv to be reduced up to 90% using NAC. Since that time numerous studies have been conducted and the results are promising for NAC. When used in combination with Interleukin-2 (IL-2), it resulted in markedly enhanced immune cell proliferation and function. One study demonstrated a significant T4 cell increase using NAC. Another demonstrated that hiv replicates more easily when glutathione levels are low and that NAC replenishes glutathione levels. Low cysteine levels also appear to correlate with elevated TNF (tumor necrosis factor) and b-2-m (beta-2-microglobulin) levels, both of which signify an increase in viral activity.

There are multiple reasons why glutathione levels are lower in hiv+ people. First, inflammatory cytokines are chemicals produced in response to hiv infection. These chemicals deplete glutathione by reacting with it. Second, alcohol will lower glutathione levels. Third, many drugs, most commonly acetaminophen (Tylenol), deplete glutathione. Fourth, hiv itself may lower glutathione levels by a complicated mechanism involving producing a chemical, called TAT, that interferes with two enzymes necessary for glutathione function.

Cysteine is available in two forms: L-cysteine and N-acetyl-cysteine. In my practice I have utilized both forms. In patients that are not on any antiviral, I use NAC. L-cysteine is beneficial in cases of sinusitis, lung congestion and other upper respiratory infections or inflammations. NAC has the same effect on mucus, but is more costly. To date, no research has been done evaluating the immune effects of L-cysteine. Knowing that the beneficial immune effects of NAC are due to the increased cysteine levels, there appears no reason why L-cysteine could not be used in place of NAC.

The doses used in most studies of people with hiv were 1800 to 2000 mg per day in 3 doses of 600 mg or 4 doses of 500 mg. However, the most recent study used doses ranging from 3200 to 8000 mg per day, though the authors of that study do not give a reason for the use of these higher doses. As an amino acid, it is much better to take it on an empty stomach with either water or fruit juice (the sugar in the juice enhances absorption). One commonly read hiv treatment book says to take it with food but that is completely wrong! Other foods, mainly other proteins, will compete with the uptake of cysteine and you will be wasting your money. The culprits in the food are two other amino acids, taurine and methionine, which will decrease the absorption of cysteine. (This is one good example why you must be sure to have a knowledgeable person in charge of your nutrition.)

To summarize: 1800-2000 mg of cysteine (either form) on an empty stomach per day will benefit your immune system and suppress viral activity. Occasionally a person will complain of mild stomach distress from taking this supplement without food. In this case, I recommend the person eat something light that has little or no protein, such as a bowl of cereal or oatmeal, pasta, or some fruit.

Dr. Brian A. Smith is a chiropractic doctor who has specialized in the treatment of immune-suppressed individuals for more than ten years and maintains a private practice in West Hollywood. He can be reached at 213.656.2652.

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